Immune Modulation

Question 1

What is an immune adjuvant?

Answer 1

Increases the immune response to a select vaccine antigen without altering specificity

Question 2

Which adjuvant is most commonly used in humans?

Answer 2

ALUM

Question 3

List 2 indications for a haematopoeitic stem cell transplant.

Answer 3

SCID

Haematological Malignancy

Question 4

List 3 indications for IVIG replacement

Answer 4

Bruton’s X-linked agammaglobulinaemia
Hyper IgM Syndrome
Kawasaki Disease

Question 5

List 2 indications for specific antibody replacement

Answer 5

Hepatitis B

VZV in exposed, non-immune pregnant women

Question 6

List 2 indications for T-Cell replacement

Answer 6

Transplant patients with chronic CMV/EBV infection

Question 7

List 3 indications for IFN-alpha therapy

Answer 7

Hepatitis B
Hepatitis C
CML (Rarely used)

Question 8

List an indication for IFN-beta therapy

Answer 8

Behcet’s Disease

Question 9

List an indication for IFN-gamma therapy

Answer 9

Chronic Granulomatous Disease

Question 10

In which disease are immune checkpoint blockade agents commonly used?

Answer 10

Advanced Melanoma

Question 11

What is the MOA of Ipilimumab?

Answer 11

CTLA4 blockade

Immune checkpoint blockade -> increased APC & T-Cell activity

Question 12

Name two examples of immune checkpoint modulators

Answer 12

Ipililumab

Nivolumab

Question 13

What is the MOA of nivolumab?

Answer 13

PD-1 Blockade

Increased T Cell activation

Question 14

Give an example of a steroid used for immunosuppression

Answer 14

Prednisolone

Question 15

What is the MOA of prednisolone?

Answer 15

Phospholipase A2 inhibitor

Question 16

List two immunosuppressive agents which are anti-proliferative

Answer 16

Azathioprine

Methotrexate

Question 17

What is the MOA of Azathioprine?

Answer 17

Anti-metabolite, blocking purine synthesis

Preferentially affects T>B Cells

Question 18

List one key contraindication for Azathioprine

Answer 18

TPMT polymorphisms due to inability to metabolise and excrete

Question 19

What is the MOA of methotrexate?

Answer 19

Anti-Folate = anti-DNA synthesis

Question 20

What is the MOA of cyclosporin?

Answer 20

Calcineurin inhibitor, Blocks the IL-2 signalling pathway which limits T-Cell proliferation

Question 21

List one key side effect of syclosporin

Answer 21

Gingival Hypertrophy

Question 22

What is the MOA of rituximab?

Answer 22

Anti-CD20 = anti mature B cells, but not plasma cells

Question 23

What is the MOA of Infliximab/Etanercept?

Answer 23

Anti-TNF alpha

Question 24

What is the MOA of cyclophosphamide?

Answer 24

Alkylates guanine = no dna synthesis

B>T

Question 25

List one key side effect of cyclophosphamide use

Answer 25

Haemorrhagic Cystitis

Question 26

What is the MOA of Mycophenolate Mofetil?

Answer 26

Anti-Metabolite | T>B

Question 27

List one key side effect of mycophenolate motefil

Answer 27

Progressive multifocal leukoencepalopathy

Question 28

Which virus may cause Progressive multifocal leukoencepalopathy in patients on long term immunosuppression?

Answer 28

John Cunningham Virus