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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
Q

function and use of ipilimumab

A

= CDLA4 inhib
used vs advanced melanoma

complication = autoimmunity

26
Q

function and use of pembrolizumab/nivolimumab

A

PD1 inhibitor

vs advanced melanoma / metastatic renalCC

27
Q

function and use of IL2

A

stim T cell response

used vs RCC

28
Q

function and use of IFNa

A

= antiviral

vs HepB/C, hairy cell leukemia, kaposi sarcoma, MM, CML

29
Q

function and use of IFNb

A

immunomodulator

used vs Behcet’s lymphoma, relapsing MS

30
Q

function and use of IFNg

A

enhances macrophage function

used vs CGD

31
Q

what are antiproliferative agents used to treat

A

used vs cells with high turnover rates (vs canceers and for immunosupp)

32
Q

what is azathioprine converted to and what is it used to treat

A

conv to 6mp in liver -> inhib de novo purine synth

used to prev graft rejection

33
Q

what is mycophenolate converted to and what is it used to treat

A

conv to mycophenolic acid -> inhib de novo guanine synht

used to preg graft rejection

34
Q

function and use of cyclophosphamide

A

alkylates guanine base -> inhib DNA synth

35
Q

function and use of mehtotrexate

A

dihydrofolate reductase inhibitor -> inhib DNA synth

36
Q

adverse effects of Azathioprine

A

BM suppression, infection, malig

TPMT polymorph -> toxic accum -> hepatotox

37
Q

adverse effects of mycophenolate

A

BM suppression, infection, malig

-> progressive multifocal leukoencephalopathy + HSV reactivation

38
Q

adverse effects of cyclophosphamide

A

BM suppression, infection, malig

haemorrhagic cystitis + non-melanoma skin cancer

39
Q

adverse effects of methotrexate

A

BM suppression, infection, malig

pulmonary fibrosis, pneumonitis, folate def

40
Q

class and method of action of tacrolimus and cyclosporine

A

calcineurin inhib - block c stim IL2 expression

41
Q

adverse effects of calcineurin inhib

A

gingival hyperplasia

42
Q

class and method of action of sacrolimus

A

mTOR inhib - Block IL2 expression -> clonal expression of T cells

43
Q

class and method of action of tofacitinib

A

JAK inhibitor - inhib JAK-STAT signalling -> dec pro inflam gene transcription

44
Q

method of action of PDE4 inhibitors

A

dec cAMP -> dec cytokine prod

45
Q

function and use of Rabbit ATG

A

= cell surface antigen inhib
-> dec lymphocytes, dec T cell activation
used vs acute allograft rej

46
Q

function and use or basiliximab

A

= cell surface antigen inhib
blocks IL2
used vs acute allograft rej

47
Q

function and use of abatacept

A

= cell surface antigen inhib
stim CTLA4-Ig -> dec T cell activ
used vs rheumatoid arth

48
Q

function and use of rituximab

A

= cell surface antigen inhib
anti-CD20 - targets mature b cells
used vs B cell lymphoma

49
Q

function and use of natalizumab

A

= cell surface antigen inhib
anti a4 integrin -> dec T cell migration
used vs MS

50
Q

function and use of vadolizumab

A

= cell surface antigen inhib
anti a4b7 integrin -> dec cell migration to gut
used vs IBD

51
Q

function and use iflixumab

A

anti TNFa abs (cytokine inhib)

used vs rheumatoid arth, psoriasis, ank spond, IBD

52
Q

function and use anti IL12/23 cytokine inhib

A

inhib differentiation to Th1 and Th17 -> dec IL12%IL23

used vs psoriasis

53
Q

function and use denusomab

A

anti RANKL

dec bone resorbtion - used vs osteoporosis

54
Q

side efect of denusomab use

A

avascular necrosis of jaw

55
Q

function and use of anti IL-6R

A

dec neutrophil/macrophage/T/B cell activation

used vs rheumatoid arth

56
Q

difference between plasmapheresis and plasma exchange

A

blood passed through cell seperator

plasmapheresis - plasma Tx to remove Ig and reinfused
plasma exchange - plasma discarded and replaced with coloid (albumin)

57
Q

indications for plasmapheresis

A

goodpastures, myaesthenic crisis, graft rejection

T's Immunology Y5 (10 decks)

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