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Hypersensitivity and Autoimmune disease Flashcards

1
Q

What are the types of hypersensitivity reactions?

A

Immediate (Type I)
Antibody-mediated (Type II)
Immune complex-mediated (Type III)
Delayed-type hypersensitivity (Type IV)

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2
Q

What are the immune mechanisms involved in a type I reaction?

A

Activation of Th2 cells resulting in the production of IgE which in turn binds to FceR on mast cells, basophils and eosinophils

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3
Q

What are the mechanisms of tissue injury behind a type I reaction?

A

Immediate reaction:
Degranulation and release of vasoactive amines (ie. histamine) and proteases

Late-phase reaction:

  1. Synthesis and secretion of prostaglandins and leukotrienes
  2. Cytokine-induced inflammation and leukocyte recruitment
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4
Q

What are the immune mechanisms involved in a type II reactions?

A

IgM and IgG against surface (cell surface or extracellular matrix)

Antibodies on top of tissue

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5
Q

What are mechanisms of tissue injury behind a type II reaction?

A

Complement mediated (cytotoxic):

  1. Opsonization and enhances phagocytosis
  2. Recruitment and activation of inflammatory cells

Non-cytotoxic:
Change in physiologic behavior of a cell

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6
Q

What are the immune mechanisms involved in a type III reaction?

A

Deposition of immune complexes comprised of IgM or IgG and soluble antigen

Complex inside tissue

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7
Q

What are the mechanisms of tissue injury behind a type III reaction?

A

Complement mediated recruitment and activation of inflammatory cells resulting in some combination of arthritis, vasculitis, and/or nephritis

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8
Q

What are the immune mechanisms involved in a type IV reaction?

A

Inflammatory cytokines, IFN-gamma and IL-17, produced by CD4+ Th1 and Th17 cells, respectively

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9
Q

What are the mechanisms of tissue injury behind a type IV reaction?

A

Only reaction due to T cells

Cytokine-mediated tissue damage:

  1. IFN-gamma activation of macrophage
  2. IL-17 recruitment and activation

Direct killing:
CTL-mediated cellular death

CD8+ CTLs (T-cell-mediated cytolysis):
Direct target killing, cytokine-mediated inflammation

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10
Q

What are some examples of Type I hypersensitivity?

A 
Allergic rhinitis
Systemic anaphylaxis
Food allergies
Wheal and flare
Asthma
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11
Q

What are the allergens that cause allergic rhinitis?

A

Trees, grasses, dust, cats, dogs, mites

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12
Q

What are the clinical findings of allergic rhinitis?

A

Edema, irritation, mucus in nasal mucosa

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13
Q

What are the allergens that cause systemic anaphylaxis?

A

Insect stings, drug reactions

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14
Q

What are the clinical findings of systemic anaphylaxis?

A

Bronchial and tracheal constriction, complete vasodilation and death

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15
Q

What are the allergens that cause food allergies

A

Milk, eggs, fish, cereals, grains

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16
Q

What are the clinical findings of food allergies?

A

Hives and gastrointestinal problems

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17
Q

What is the wheal and flare?

A

In vivo skin testing for allergies

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18
Q

What are the clinical findings of the wheal and flare

A

Local skin edema, reddening, vasodilation of vessels

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19
Q

What are the allergens that cause asthma?

A

Inhaled materials

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20
Q

What are the clinical findings of asthma?

A

Bronchial and tracheal constriction, edema, mucus production, massive inflammation

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21
Q

What are examples of Type II hypersensitivity?

A 
Autoimmune hemolytic anemia (HDNB)
Acute rheumatic fever
Goodpasture syndrome
Transfusion reaction
Autoimmune thrombocytopenia purpura
Myasthenia gravis
Graves disease
Type II (insulin resistant) diabetes
Pernicious anemia
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22
Q

What are the examples of Type III hypersensitivity?

A 
Systemic lupus erythematosus
Poststreptococcal glomerulonephritis
Arthus reaction
Serum sickness
Polyarteritis nodosa
Diffuse systemic sclerosis
Limited scleroderma
Sjorgren syndrome
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23
Q

What is the antigen involved in systemic lupus erythematosus?

A

dsDNA
Sm
Other nuceloproteins

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24
Q

What are the clinical manifestations of systemic lupus erythematosus?

A

Nephritis
Arthritis
Vasculitis
Butterfly facial rash

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25
Q

What is the antigen involved in poststreptococcal glomerulonephritis?

A

Steptococcal cell wall Ags (may be “planted” in glomerular basement membrane)

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26
Q

What are the clinical manifestations of poststreptococcal glomerulonephritis?

A

Nephritis

“lumpy-bumpy” deposits

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27
Q

What are the clinical manifestations of poststreptococcal glomerulonephritis?

A

Nephritis

“lumpy-bumpy” deposits

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28
Q

What is the antigen involved in Arthus reaction?

A

Any injected protein

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29
Q

What are the clinical manifestations of Arthus reaction?

A

Local pain and edema

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30
Q

What is the antigen involved in serum sickness?

A

Various proteins

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31
Q

What are the clinical manifestations involved in serum sickness?

A

Arthritis
Vasculitis
Nephritis

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32
Q

What is the antigen involved in polyarteritis nodosa?

A

Hepatitis B virus Ag

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33
Q

What is the clinical manifestation of polyarteritis nodosa?

A

Systemic vasculitis

34
Q

What is the antigen involved in Diffuse systemic sclerosis?

A

Antibodies to DNA topoisomerase 1

35
Q

What is the antigen involved in Limited scleroderma (CREST)?

A

Antibodies to centrometric proteins

36
Q

What is the antigen involved in Sjorgren syndrome?

A

Antibodies to ribonucloproteins

37
Q

What is the target antigen of autoimmune hemolytic anemia (HDNB)?

A

RBC membrane proteins (Rh, I Ags)

38
Q

What is the mechanism of pathogenesis of autoimmune hemolytic anemia (HDNB)?

A

Opsonization
Phagocytosis
complement-mediated destruction of RBCs

39
Q

What are the clinical manifestations of autoimmune hemolytic anemia (HDNB)?

A

Hemolysis and anemia

40
Q

What is the target antigen for acute rheumatic fever?

A

Streptococcal cell-wall Ag; Ab cross-reacts with myocardial Ag

41
Q

What is the mechanism of pathogenesis of acute rheumatic fever?

A

Inflammation and macrophage activation

42
Q

What are the clinical manifestations acute rheumatic fever?

A

Myocarditis and arthritis

43
Q

What is the target antigen for goodpasture syndrome?

A

Type IV collagen in basement membranes of kidney glomeruli and lung alveoli

44
Q

What is the mechanism of pathogenesis of goodpasture syndrome?

A

Complement and Fc-receptor mediated inflammation

45
Q

What are the clinical manifestations of goodpasture syndrome?

A

Nephritis
Lung hemorrhage
Linear Ab deposits

46
Q

What is the target antigen for transfusion reaction?

A

ABO blood glycoproteins

47
Q

What is the mechanism of pathogenesis of transfusion reaction?

A

AgM isohemagglutinins formed naturally in response to normal bacterial flora cause opsonization + complement activation

48
Q

What are the clinical manifestations of transfusion reaction?

49
Q

What is the target antigen for autoimmune thrombocytopenia purpura?

A

Platelet membrane proteins

50
Q

What is the mechanism of pathogenesis of autoimmune thrombocytopenia purpura?

A

Ab-mediated platelet destruction through opsonization and complement activation

51
Q

What are the clinical manifestations of autoimmune thrombocytopenia purpura?

52
Q

What is the target antigen for myasthenia gravis?

A

Acetylcholine receptors

53
Q

What is the mechanism of pathogenesis of myasthenia gravis?

A

Ab inhibits acetylcholine binding, downmodulates receptors

54
Q

What are the clinical manifestations of myasthenia gravis?

A

Muscle weakness and paralysis

55
Q

What is the target antigen for graves disease?

A

TSH receptor

56
Q

What is the mechanism of pathogenesis of graves disease?

A

Ab-mediated stimulation of TSH receptors

57
Q

What are the clinical manifestations of graves disease?

A

Hyperthyroidism followed by hypothyroidism

58
Q

What is the target antigen of type II diabetes?

A

Insulin receptors due to type II diabetes being insulin resistant

59
Q

What is the mechanism of pathogenesis of type II diabetes?

A

Ab-inhibits binding of insulin

60
Q

What are the clinical manifestations of type II diabetes?

A

Hyperglycemia

61
Q

What is the target antigen for pernicious anemia?

A

Intrinsic factor of gastric parietal cells

62
Q

What is the mechanism of of pathogenesis of pernicious anemia?

A

Neutralization of intrinsic factor, decreased absorption of vitamin B12

63
Q

What are the clinical manifestations of pernicious anemia?

A

Abnormal erythropoiesis anemia

64
Q

What are the examples of Type IV hypersensitivity?

A 
Tuberculin test
Contact dermatitis 
Hashimoto thyroiditis
Multiple sclerosis 
Reheumatoid arthritis
Insulin-dependent diabetes mellitus (type I)
Guillain-Barre syndrome
Celiac disease
Crohns disease
65
Q

What is the specificity of pathogenic T cells in tuberculin test?

A

PPD (tuberculin and mycolic acid)

66
Q

What are the clinical manifestations of the tuberculin test?

A

Indurated skin lesion (granuloma)

67
Q

What is the specificity of pathogenic T cells in contact dermatitis?

A

Nickel
Poison ivy/oak catechols
Hapten/carrier

68
Q

What are the clinical manifestations of contact dermatitis?

A

Vesicular skin lesion
Pruritus
Rash

69
Q

What is the specificity of pathogenic T cells in hashimoto thyroiditis?

A

Unknown Ag in thyroid

70
Q

What are the clinical manifestations of hashimoto throiditis?

A

Hypothyroidism

71
Q

What is the specificity of pathogenic T cells in multiple sclerosis?

A

Myelin basic protein

72
Q

What are the clinical manifestations of multiple sclerosis?

A

Progressive demyelination
Blurred vision
Paralysis

73
Q

What is the specificity of pathogenic T cells in rheumatoid arthritis?

A

Unknown Ag in joint synovium (type III collagen?)

74
Q

What are the clinical manifestations of rheumatoid arthritis?

A

Rheumatoid factor (IgM against Fc region of IgG)
Alpha-cyclic citrullinated (alpha-CCP)
Chronic arthritis
Inflammation
Destruction of articular cartilage and bone

75
Q

What is the specificity of pathogenic T cells in type I diabetes?

A

Islet-cell antigens
Insulin
Glutamic acid decarboxylase
Others

76
Q

What are the clinical manifestations of type I diabetes?

A 
Chronic inflammation and destruction of beta cells
Polydipsia
Polyuria
Polyphagia
Ketoacidosis
77
Q

What is the specificity of pathogenic T cells of Guillain-Barre syndrome?

A

Peripheral nerve myelin or gangliosides

78
Q

What are the clinical manifestations of Guillain-Barre syndrome?

A

Ascending paralysis and peripheral nerve demyelination

79
Q

What is the specificity of pathogenic T cells of celiac disease?

A

CD4+ cells- gliadin
CD8+ cells
HLA class I-like molecule expressed during stress

80
Q

What are the clinical manifestations of celiac disease?

A

Gluten-sensitive enteropathy

81
Q

What is the specificity of pathogenic T cells of crohn disease?

A

Unknown Ag, commensal bacteria?

82
Q

What are the clinical manifestations of crohn disease?

A

Chronic intestinal inflammation due to Th1 and Th17 cells and obstruction

Immunology (Mine) (7 decks)

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