Immune surveilance Flashcards

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1
Q

How does the immune system play a role in cancer?

A
  • immunodeficiency lead to tumour formation eg. kaposi sarcoma
  • inflammatory conditions lead to cancers too eg. ulcerative colitis and colon cancer
  • tumours infiltrated with lymphocytes have a better prognosis
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2
Q

Can the body defend against cancer?

A
  • anti-tumour immune response eg. CD8+ CTLs
  • production of immune memory
  • specificity of individual tumours = tumour antigens
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3
Q

What are the 3 ways the immune system prevents tumours?

A
  • speedy resolution of inflammation
  • elimination of viral infections
  • early elimination of tumour cells before they can do harm
    = IMMUNE SURVEILANCE
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4
Q

What is tumour immunosurveilance?

A
  • process where the immune system continually recognises cancerous and pre-cancerous cells leading to their elimination before they can cause damage
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5
Q

What are the 3Es of immunoediting?

A
  • elimination
  • equilibrium
  • escape
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6
Q

Define tumourigenesis

A
  • normal cells undergoing change
  • develop abnormal tumour antigens
  • danger signals such as extra-cellular matrix products
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7
Q

Describe elimination

A
  • similar to old concept of immunosurveilance
  • NKs, NKTs, Macs and DCs
  • INFgamma and chemokines lead to tumour death
  • tumour specific DCs activate adaptive immunity in draining lymph nodes
  • tumour specific CD4+ and CD8+ cells join
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8
Q

Describe Equilibrium

A
  • elimination phase is incomplete
  • tumour cells lie dormant and may modulate tumour antigen expression and stress signals
  • the immune system eliminates susceptible tumour clones when possible sufficient to prevent tumour expansion
  • tumour heterogeneity = darwinian selection
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9
Q

What are tumour stem cells?

A
  • can evade host immune surveillance
  • tumour ‘seeds’
  • lose MHC class I and have no NK activating ligands and silence TAA.
  • can produce immunosuppressive cytokines eg. IL-4, IL-10
  • selectively recruit ‘regulatory’ cells
  • resistance to innate and adaptive immune response
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10
Q

Describe escape

A
  • immune system is unable to control the tumour growth leading to tumour progression
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11
Q

Describe antigen processing and presentation

A
  • some tumour cells express MHC class I/peptide complexes
  • ligands to CD8+ T cells resulting in their activation and subsequent destruction of the tumour cell in vitro and in vivo
  • to activate CD4+ T cells, APCs take up cell debris from tumour cells = pinocytosis, receptor mediated endocytosis
  • material is processed within lysosomes and selectively bound to MHC class II molecules
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12
Q

What do CD4+ T cells do?

A
  • cause lymphotoxin secretion which results in direct tumour cell death
  • secrete cytokines activating other cells such as NK, macrophages, CD8+ t cells
  • rarely tumours themselves can act as APCs by presenting antigens on MHC class II molecules
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13
Q

What are tumour antigens?

A
  • produced by tumour cells can trigger immune response
  • important in tumour identification and targeting in immunotherapy
  • broadly classified as - tumour specific antigens = produced only be tumour cells
  • tumour associates antigens - produced by tumour cells but also produced by normal cells
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14
Q

What are some tumour specific antigens (TSA)?

A
  • proteins of genes not directly involved in forming the tumour
    eg. unique TSAs of human melanomas, MAGE-C2 peptides expressed on HLA-A2 in tumour, not expressed in germ-line cells recognised by CTLs
  • proteins of altered genes involved in transformation oncogenes= Ras
  • tumour suppressor genes = p53
  • chromosome translocations - BCR/ABL in CML
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15
Q

What are tumour associated antigens (TAA)?

A
  • products overexpressed genes
  • Her2/neu member of EGFR family; prostate specific Ag
  • cancer/testes Ags: on only normal testes
  • altered membrane glycolipid and glycoprotein, Ags higher levels in tumours = altered post-transcriptional modifications
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16
Q

What are the products of oncogenic virus tumour antigens?

A
  • viral peptides are foreign = tumours immunogenic
  • EBV - burkitts lymphoma - associated with nasopharyngeal cancer
  • HPV16, 18 - associated with cervical cancer
  • Hep B, C = associated with liver cancer
17
Q

What are oncofoetal antigens?

A
  • inc in normal foetus
  • de-repression on malignant transformation, released into serum
  • markers for diagnosis and following therapy
  • carcinoembryonic Ag (CEA)
  • highly glycosylated, Ig superfamily member, inc. in colorectal cancer
18
Q

What is the result of down regulation and defects in antigen presentation?

A
  • most healthy cells express MHC class I/peptide complexes
  • in vitro studies show that tumour cells expressing tumour antigens by this mechanism get killed by CD8+ T cells
  • tumours that have been selected not to express class I = survival advantage
19
Q

How is MHC class I lost from the surfaces?

A
  • loss of functional beta-2 micro globulin expression
  • loss of MHC class I alleles
  • down-modulation of molecules involved in antigen-processing and presentation = TAP1/2, LMP2/7
20
Q

What is the result of loss of co-stimulation?

A
  • melanoma cells are immunogenic but do not evolve anti-tumour immunity
  • lack of CD80/86 expression on cell surface which is required for co-stimulation of T cell alongside binding
  • results in T cell anergy and block IL-2 gene transcription
21
Q

What are some immunosuppressive factors?

A
  • factors are either expressed/secreted by malignant cells by surrounding cells in stroma
  • TGF-b = powerful, affecting nearly all cell of the innate and adaptive immune system
  • VEGF - prevents maturation of DCs
  • prostaglandins
  • IL-10 protects tumours from tumour specific CTLs and down regulates MHC class I expression
22
Q

What are T-regulatory cells?

A
  • CD4+ T cells with high expression of CD25
  • 2 types =
  • nTregs (Tregs developing in the thymus to ensure tolerance to self-antigens)
  • adaptable Tregs (naive CD4+ T cells induced in the periphery
23
Q

How are Tregs identified?

A
  • FOXP3 = winged helical transcription factor
  • FOXP3 is vital for the development and function of these cells as mutations lead to severe auto-immune condition = IPEX
24
Q

Why are Tregs important?

A
  • Tregs found in far greater concentrations in peripheral blood in patients with a variety of cancers
  • also found in far greater quantities within tumour milieu, ascites, draining lymph nodes in patients with cancer
25
Q

What is the function of Tregs?

A
  • mediate suppression on tumour specific CD4+ and CD8+ T cells via TCR
  • TGF-b and IL-10 thought to be secreted in vivo and membrane bound TGFb is also highly potent
26
Q

How are Tregs targeted?

A
  • anti CTLA 4
  • ipilimumab
  • tremelimumab
  • targeting CD35 - LMB-2 fusion protein
  • ontak
  • conventional chemotherapy drugs like cyclophosphamide in smaller more frequent doses = deplete Tregs, enhance effector T cell function
  • targeting GITR
27
Q

What are some other immunoregulatory cells?

A
  • myeloid derived suppressor cells: ROS and NO suppress T cell activity
  • NKT cells: produce IL-10, IL-4
  • chemokines: tumour produce CCLS