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Immu > Immu 3: Immune Modulation Therapies 1 > Flashcards

Immu 3: Immune Modulation Therapies 1 Flashcards

1
Q

Describe Clonal expansion in T cells?

A

If an antigen is presented to a T cell receptor which has high specificity for it, the T cell proliferates and differentiates into T helper, Cytotoxic and memory cells

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2
Q

List 3 vaccines given to the elderly aged over 65?

A

Pneumococcal vaccine (Pneum PPV)
Flu vaccine
Shingles

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3
Q

Describe clonal expansion in B cells ?

A

If the B cell receptor has high specificity for the antigen presented, the B cell will become activated and undergo proliferation and differentiation into IgM secreting plasma cells and B memory cells

Then undergo

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4
Q

list 3 types of APC

A

dendritic cells
macrophages
B lymphoctes

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5
Q

3 aims of vaccines

A
  • MEMORY: generate protective, long-lasting immune response
  • No adverse reactions
  • Practical considerations e.g. one vaccine, easy storage, inexpensive
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6
Q

Immunological memory is mediated by

A

B and T lymphocytes

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7
Q

Where do B cells undergo Isotype switching ?

A

Germinal centres

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8
Q

Where do plasma cells reside ?

A

Bone marrow

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9
Q

which bacteria is in the BCG vaccine ?

What does this vaccine protect against?

A

Bovine tuberculosis

Progression to active tuberculosis

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10
Q

Give 5 examples of live attenuated vaccines ?

Does pt get Sx?

A
  • MMR
  • BCG
  • Yellow fever
  • Typhoid (oral)
  • Polio (oral)

Pt gets mild Sx

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11
Q

6 examples of inactivated vaccines

A
  • Influenza
  • Cholera
  • Bubonic plague
  • Polio (Salk)
  • Hepatitis A
  • Pertussis, Rabies
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12
Q

Give 2 examples of Toxoid vaccines (Inactive toxins) ?

A

Diphtheria
Tetanus

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13
Q

Give 3 examples of subunit vaccines ?

Which sort of infections is this usually for?

A
  • Hep B (HBsAG)
  • HPV (capsid)
  • Influenza (HA)

Usually for vaccines (vaccine contains a component/subunit of the vaccine)

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14
Q

Give 3 advantages of a live vaccine compared to a component/inactivated vaccine ?

A
  • Longer lasting immunity (life long)
  • Immunity is broader (protects against more strains)
  • activate ALL phases of the immune system: T cells, B cells, with local IgA, humoral IgG
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15
Q

Give 3 advantages of a component/inactivated vaccine compared to a live vaccine ?

A
  • Can be given to immunocompromised patients
  • Storage easier
  • Lower cost
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16
Q

Why might conjugate vaccines be better than inactivated/component vaccines?

A
  • To help avoid the problems of inactivated/ component vaccines, you can put on a protein carrier with a polysaccharide
  • So conjugate vaccine has a protein carrier on top of a polysaccharide (NB inactivated ONLY has polysaccharide), which promotes T cell immunity which enhances the B cell/ antibody response
  • Polysaccharide ALONE induces a transient T cell independent B cell response (particularly in children) and does NOT stimulate a good T cell response (this is in inactivated/component vaccines)
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17
Q

Give 3 examples of conjugate vaccines ?

A

HiB (haemophilus influenza B)
Meningococcus
Pneumococcus

18
Q

List 2 indications for Haematopoeitic stem cell transplantation ?

A

SCID
Haematological malignancy

19
Q

List 3 primary immunodeficiency diseases in which Antibody replacement (pool of antibodies to variety of organisms) is indicated ?

A

Bruton’s X-linked agammaglobulinaemia
X-linked hyper IgM syndrome
Common variable immunodeficiency

20
Q

In which 2 Haematological malignancies is Antibody replacement indicated ?

A

CLL
Multiple myeloma

21
Q

List 3 diseases in which IgG immunoglobulin therapy can be used ?

What is MoA?

A

Shingles infection (varicella zoster)
Rabies (post exposure)
Hepatitis B

MoA: post-exposure prophylaxis (passive immunisation)

22
Q

Give one example of an infection in which adoptive cell transfer (ACT) can be used to infuse a donor’s T cells ?

A

EBV infection in immunocompromised patients.

T cells from a donor are isolated and exposed to EBV antigen to stimulate Clonal expansion of specific T cells. These T cells are infused into the immunocompromised recipient to treat EBV infection.

23
Q

what is TCR and CAR T cell therapy

  • T cell receptor T cells (TCR-T cell therapy)
  • Chimeric antigen receptor T cells (CAR-T cell therapy)
A

TCR (T cell receptor T cells therapy)

  • T cells taken from patient
  • viral/non-viral vectors are used to insert fragments of genes into these T cells
  • these gene fragments encode receptors
  • for TCR therapy - insert a gene that encodes a specific TCR against a tumour cell antigen

CAR-T therapy (Chimeric antigen receptor T cells)

  • for CAR therapy, stead of putting a vector with a TCR in, a chimeric antigen receptor (which is a mix of an antibody and T cell receptor) is inserted

used in ALL and NHL

24
Q

In CAR-T therapy, against CD is it effective against?

A
  • most common use of this method is for a TCR expressing CD19 variable antibody fragment (so the antibody recognises CD19) which is put onto the end of CD28 and CD3z (which is the signalling domain)
25
Q

Which conditions are CAR-T therapy useful against? (2)

A
  • Used for Acute Lymphoblastic Leukaemia in kids
  • Used for some form of non-Hodgkin lymphoma
26
Q

Ipilimumab targets which 2 immune checkpoints?

A
  • CTLA4 (INHIBITORY signal)
  • CD28 (STIMULATORY signal)
27
Q

How does Ipilimumab work in treatment of advanced melanoma ?

A

Ipilimumab blocks CTLA4 which is an inhibitory receptor on T cells
This causes increased T cell activation and boosts the immune response

T cells have CD28 (activator receptor) and CTLA4 (inhibitory receptor).
CD80 and CD86 on APCs can bind to either to activate/inhibit T cells

28
Q

Pembrolizumab and Nivolumab are used for which 2 conditions?

A
  • Advanced melanoma
  • Metastatic renal cell cancer
29
Q

How does Pembrolizumab and nivolumab work in the treatment of advanced melanoma ?

A

They inhibit PD-1 receptors on T cells.
This causes increased T cell activation because PD-1 is an inhibitory pathway.

PD-1 receptors on T cells cause an inhibition of T cells when activated by PD-ligand 1 or 2 on APC or tumour cells

30
Q

What side effects are more common in patients receiving monoclonal antibodies for advanced melanoma (Pembrolizumab and Nivolumab)?

A

Auto-immune diseases (arthritis, thyroid disease, Diabetes)

Because the T cell response is over stimulated

31
Q

what happens when B cells with appropriate specificity get selected

A

proliferate
differentiate into T cell independent IgM plasma cells
undergo germinal centre reaction and differentiate into T cell dependent IgG producing memory and plasma cells

32
Q

features of memory B and T cells

A

memory T - different pattern of expression of cell surface proteins involved in chemotaxis and cell adhesion, allowing rapid access to non-lymphoid tissues
memory B - circulating pre-formed high-affinity IgG antibodies present

33
Q

name the membrane fusion glycoprotein of influenza virus

A

haemagglutinin (HA)
target for antibodies

34
Q

what is tumour infiltration T cell therapy

A
  • remove tumour
  • stimulate T cells within the tumour with cytokines in the presence of the tumour so they develop resistance to it
  • select and expand tumour infiltrating lymphocytes and reinfuse into the patient
35
Q

how can we block immune checkpoints (2)

A
  • Iplimumab - antibody specific to CTLA4 - advanced melanoma
  • Pembrolizumab and Nivolumab - antibodies specific to PD1 - activates T cells - advanced melanoma
36
Q

Which IL is CD8 T cell response dependent on?

A

IL-2

37
Q

What is a common adjuvant that can be added to vaccines to increase immune response without altering its specificity?

A

Aluminium salts

38
Q

Use of IFN alpha cytokine therapy (4)

A
  • Hairy cell leukaemia
  • CML
  • Multiple myeloma
  • Used as an adjunct for: HBV, HCV, Kaposi sarcoma
39
Q

Use of IFN beta cytokine therapy (2)

A
  • Behcet’s
  • relapsing MS
40
Q

Use of IFN gamma cytokine therapy (1)

A

Stimulates phagocytes in patients with Chronic granulomatous disease

Immu (9 decks)

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