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T's Immunology Y5 > Immune modulating therapies > Flashcards

Immune modulating therapies Flashcards

1
Q

what are the pros and cons of live attenuated vaccines

A

Pros = lifelong immunity (no boosters), activates all phases of the immune response, protects vs cross-reactive strains

Cons = danger to immunocomp + immunocomp contacts, revision to virulence, cold storage

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2
Q

MMR, Polio (sabin), influenza and varicella virus

A

live attenuated vaccines

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3
Q

Pertussis, Polio (salk), cholera vaccine

A

Inactivated vacc

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4
Q

tetanus, dipheria vaccine

A

toxoid inactivated vacc

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5
Q

Hep B, HPV vacc

A

subunit inactivated vacc

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6
Q

pros and cons of inactivated vacc

A

Pros = no reversion risk, safe for immunocomp, low cost, easy storage

Cons = low longevity, needs boosters, may req conjugation/adjuvants

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7
Q

what vaccine is used for encapsulated organisms (NHS bac)

A

conjugate - tetanus toxin + Ag form encapsulated org
req boosters

= poorly immunogenic polysaccharide (Ag) + immunogenic protein carrier (adjuvant)

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8
Q

most common adjuvant used in vaccines and their function

A

Aluminium hydroxide

-> increase immune response without decreasing specificity (prolong release of Ag)

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9
Q

what vacc type is provenge

A

dendritic cell vaccine - Ex-vivo dendritic cells pulsed with tumour Ag

Provenge = personal immunotherapy for prostate cancer

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10
Q

harvest sites for HCST

A

bone marrow, periph blood, umbilical cord

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11
Q

what HCST is used for MM and lymphoma

A

Auto

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12
Q

what HCST is used for leukemia

A

Allo

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13
Q

indications for IVIG

A

CVID, Hyper IgM, MM, CLL, post HCST

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14
Q

how is IVIG produced

A

large donor pool that is screened then filtered+ treated for microorg

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15
Q

how is specific Ig produced

A

prod by single donor with high titres of IgG to specific pathogens

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16
Q

indications for specific Ig

A

post-exposure prophylaxis for Hep B, rabies, VZV in preg/immunosuppression, tetanus

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17
Q

indications for viral specific T cell therapy

A

for severe, persistent viral inf in immunocomp

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18
Q

indications for tumour infiltrating T cell therapy

A

immunotherapy for metastatic cancer

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19
Q

what are the indications for CAR-T cell therapy

A

ALL and NHL

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20
Q

how does CART-T cell therapy work

A

leukapherisis -> T cells engineered to express chimeric Rs that bind to CD19 on B cells -> binding triggeres cytotoxic killling of B cells

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21
Q

what does CTLA4-CD80 binding stimulate and where are these Rs expressed

A

inhib T cell activation
CTLA4 = T cell
CD80 = APCs

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22
Q

what does PD1-PD1L binding stimulate and where are these Rs expressed

A

Inhib T cell activation
PD1 = T cells
PD1L = APCs

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23
Q

what does CD28-CD80 binding stimulate and where are these Rs expressed

A

stimulate T cell activation
CD28 = T cells
CD80 = APCs

24
Q

what ligands can Tumour cells express to evade T cells activation

A

CD80 and PD1

25
function and use of ipilimumab
= CDLA4 inhib used vs advanced melanoma complication = autoimmunity
26
function and use of pembrolizumab/nivolimumab
PD1 inhibitor | vs advanced melanoma / metastatic renalCC
27
function and use of IL2
stim T cell response | used vs RCC
28
function and use of IFNa
= antiviral | vs HepB/C, hairy cell leukemia, kaposi sarcoma, MM, CML
29
function and use of IFNb
immunomodulator | used vs Behcet's lymphoma, relapsing MS
30
function and use of IFNg
enhances macrophage function | used vs CGD
31
what are antiproliferative agents used to treat
used vs cells with high turnover rates (vs canceers and for immunosupp)
32
what is azathioprine converted to and what is it used to treat
conv to 6mp in liver -> inhib de novo purine synth used to prev graft rejection
33
what is mycophenolate converted to and what is it used to treat
conv to mycophenolic acid -> inhib de novo guanine synht used to preg graft rejection
34
function and use of cyclophosphamide
alkylates guanine base -> inhib DNA synth
35
function and use of mehtotrexate
dihydrofolate reductase inhibitor -> inhib DNA synth
36
adverse effects of Azathioprine
BM suppression, infection, malig | TPMT polymorph -> toxic accum -> hepatotox
37
adverse effects of mycophenolate
BM suppression, infection, malig | -> progressive multifocal leukoencephalopathy + HSV reactivation
38
adverse effects of cyclophosphamide
BM suppression, infection, malig | haemorrhagic cystitis + non-melanoma skin cancer
39
adverse effects of methotrexate
BM suppression, infection, malig | pulmonary fibrosis, pneumonitis, folate def
40
class and method of action of tacrolimus and cyclosporine
calcineurin inhib - block c stim IL2 expression
41
adverse effects of calcineurin inhib
gingival hyperplasia
42
class and method of action of sacrolimus
mTOR inhib - Block IL2 expression -> clonal expression of T cells
43
class and method of action of tofacitinib
JAK inhibitor - inhib JAK-STAT signalling -> dec pro inflam gene transcription
44
method of action of PDE4 inhibitors
dec cAMP -> dec cytokine prod
45
function and use of Rabbit ATG
= cell surface antigen inhib -> dec lymphocytes, dec T cell activation used vs acute allograft rej
46
function and use or basiliximab
= cell surface antigen inhib blocks IL2 used vs acute allograft rej
47
function and use of abatacept
= cell surface antigen inhib stim CTLA4-Ig -> dec T cell activ used vs rheumatoid arth
48
function and use of rituximab
= cell surface antigen inhib anti-CD20 - targets mature b cells used vs B cell lymphoma
49
function and use of natalizumab
= cell surface antigen inhib anti a4 integrin -> dec T cell migration used vs MS
50
function and use of vadolizumab
= cell surface antigen inhib anti a4b7 integrin -> dec cell migration to gut used vs IBD
51
function and use iflixumab
anti TNFa abs (cytokine inhib) | used vs rheumatoid arth, psoriasis, ank spond, IBD
52
function and use anti IL12/23 cytokine inhib
inhib differentiation to Th1 and Th17 -> dec IL12%IL23 | used vs psoriasis
53
function and use denusomab
anti RANKL | dec bone resorbtion - used vs osteoporosis
54
side efect of denusomab use
avascular necrosis of jaw
55
function and use of anti IL-6R
dec neutrophil/macrophage/T/B cell activation | used vs rheumatoid arth
56
difference between plasmapheresis and plasma exchange
blood passed through cell seperator plasmapheresis - plasma Tx to remove Ig and reinfused plasma exchange - plasma discarded and replaced with coloid (albumin)
57
indications for plasmapheresis
goodpastures, myaesthenic crisis, graft rejection

T's Immunology Y5 (10 decks)

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