Immune system Flashcards
What is the innate immune system?
The immune system we are born with. Includes:
- phagocytes and other immune cells
- inflammatory response
- external barriers
- chemical barriers
What is the adaptive immune system?
The innate immune cells will show the adaptive immune cells the invading pathogen, and the innate cell will help up-regulate or down-regulate over-all immune response.
What is effective immunity dependant on?
- barrier tissue integrity
- presence of secretions
- probiotic bacteria
- MALT/GALT
- Inflammation
- ## effective adaptive and innate immunity
what is lactoferrin?
A protein that binds to iron stopping infectious cells obtaining the iron wall
what is the function of Th1
Defence against intracellular pathogens
what is the function of Th2
Defence against external threats
what are CD4 cells
naive T-helper cells
which IL promotes differentiation of the naive Th into Th1
IL-12
which IL promotes differentiation of the naive Th into Th2
IL-2, IL-4 and IL-5
What does the production of Th1 cells trigger?
cytotoxic T cells, macrophages, IFN-y and TNF-a/b
What does the production of Th2 cells trigger?
IL-4, -5, -10 and -13, increase B-cell antibody production (especially IgE), and induces eosinophils.
What is the function of Th17
defence against extracellular pathogens
What is the function of T-reg cells
modulate and deactivate immune response.
which IL promotes differentiation of the naive Th into Th17
IL-1, IL-6, and TGF-b.
What does the production of Th17 cells trigger?
Pro-inflammatory cytokines such as IL-17, -6, -22 and TNF-a.
Which cytokines to T-reg cells activate?
IL-10 and TGF-b
Where are T-reg cells produced?
GALT
What does Th1 dominance drive?
Chronic inflammation and autoimmunity.
What does Th2 drive?
Allergies (asthma and atopic triad)
Which test results can show low immunity
- low WBC
- low secretory IgA (stool and salivary)
- positive antibody or pathogen
- pathogens in stool
what are some signs someone has low immunity?
- frequent infections
- prolonged illness
- fatigue
- loss of appetite
- aches and pains
- large lymph nodes
What signs in case taking can you look out for that can cause low immunity?
- early lack of exposure
- c-section
- breastfed
- antibiotic use
- poor nutrition
- immunosuppressants
Name some causes of lowered immunity
- impaired barrier defence
- emotional
- chemical
- physical stress
- poor sleep
- heavy metal toxicity
- leaky gut
- no tonsils/appendix
- bloody glucose regulation
How can we support the immune system?
- reduce super, starchy carbs, sugar, caffeine
- regular exercise (not over exercising)
- good sleep
- reduce stress
- reduce toxic exposure
- digestion/GI health
How does bloody glucose regulation cause low immunity?
high glucose activates Protein Kinase C (PKC) which inhibits phagocytosis and superoxide production which significantly alters innate immune response. low glucose can cause release in cortisol which inhibits inflammation.
How does vitamin A support immunity, and what does deficiency look like? Recommended dose?
- supports lymphatic tissue and immune cells
- maintains lung barrier function
D: severe respiratory infections
RD: 2500-5000 iu/day
How does vitamin C support immunity, and what does deficiency look like? Recommended dose?
- supports innate and adaptive immune system
- supports epithelial barrier, vital for collagen synthesis
- supports energy levels
- major antioxidant
D: more susceptible to infection
RD: 1-2g / day
How does zinc support immunity? Recommended dose?
- boosts WBC activity
- boosts immunity in children
- supports barrier integrity
RD: 10-15mg / day
How do probiotics support immunity? Recommended dose?
- Increase IgA
- reduce frequency and severity of infection in children
RD: 1-3 billion / day
How does vitamin D support immunity, and what does deficiency look like? Recommended dose?
- increase innate immune system
- increases T-reg cells
- ‘immune balancer’
- reduces flu risk in children
D: higher susceptibility, complications and mortality.
RD: 1000-2000 IU/day
5000-20000 IU/day for 3 months when low levels
How do betaglucens support immunity? Recommended dose?
- these polysaccharides are seen as ‘foreign’ to the immune system, and it up-regulates immune activity.
RD: 900mg/day
Which medicinal mushrooms support immunity?
- reshi
- shittake
- chaga
- miatake
If someone was unwell or deficient in vitamin A, what is the dose you would suggest?
5000 IU/day
If someone was unwell or deficient in vitamin C, what is the dose you would suggest?
2g/day or 1g an hour for several hours (5/6)
If someone was unwell or deficient zinc , what is the dose you would suggest?
30mg/day
If someone was unwell or deficient in vitamin D, what is the dose you would suggest?
5000 IU/day
Which herbs can be used for immunity during infection?
- elderberry
- betaglucans
- echinacea
- Lysine
What is a cytokine storm?
an excess of pro-inflammatory cytokines which cause lung tissue damage, resp damage, pneumonia and even death
Which nutritional deficiencies make a person more susceptible to Covid-19
vitamin D, vitamin C, B6, Selenium, Zinc, DHA and EPA
List some naturopathic ways we can support someone with COVID-19
Reducing stress, improving sleep, reducing oxidative stress, lowering blood glucose, weight management, pro-biotics, microbiome support.
How does Quercitin help with COVID-19? RD?
Impairs spike binding to ACE-2 and inhibits viral replication
RD: 500-1000mg x2 daily
How does reservatrol help with COVID-19? RD?
Inhibits SARS Cov-2 in vitro, and antioxidant.
How does turmeric help with COVID-19? RD?
- cytoprotective effects on type II alveolar cells
- decreases inflammatory macrophages
- ACE-2 blocking
RD: 1.5g daily
How does berberine help with COVID-19? RD?
- interferes with viral replication
- helps with insulin sensitivity
RD: 400mg x2 daily
what happens internally when inflammation occurs?
- vasodilation
- increased tissue permeability
- blood clotting
- accumulation of cells
- recruitment of immune cells
what are the external signs of inflammation?
redness, heat, pain, swelling, loss of function
what are some clinical presentations of chronic inflammation?
- typical inflammatory signs and symptoms
- inflammatory diagnosis (endo, IBD)
- high stress, overtraining
- steroid and analgesic use
what GP tests would be done for chronic inflammation
- CRP
- vitamin D
- WBC
- fibrinogen
- ESR
- MRI, ultrasound
what functional tests would be done for chronic inflammation
- hsCRP
- omega 6:3 ratio
- low omega 3
name some genetic SNPs that might make someone predisposed to chronic inflammation
- IL-6
-FADS1/2 - IL-13
- TNF-a
- HLA
-VDR
If TH1 is high in a test, what does this suggest?
chronic inflammation
which cytokines up-regulate inflammation?
- TNF-a
- IL-1
- IL-6
How does histamine upregulate chronic inflammation?
promotes vasodilation and vascular permeability
How does NF-kB up-regulate the inflammatory process?
activates gene transcription (translates the genetic codes into real actions)
What activates NF-kB?
- high homocysteine
- cytokines
- LPS
- heavy metals
What are Ecosanoids?
locally-acting, hormone like messengers made from the oxidation of omega-3 and 6 fat cells in the membranes. Depending on the precursor used (3 or 6), they can exert different degrees of inflammation.
What doe prostaglandin-E2 (PGE-2) do?
- ## increases vasodilation, platelet aggrigation, histamine and kinins.
How is PGE-2 activated?
certain cytokines such as TNF and IL-1 activate COX which then converts arachidonic acid to PGE-2. NF-kB facilitates this.
what is inflammation resolution?
we produce receptor antagonist that block the receptors, stopping the inflammatory components exerting their effect, blocking their actions.
how do T-reg cells help with inflammation resolution?
produce inhibitory cytokines like IL-10 and TGFb which inhibit pro-inflammatory cytokines such as Th1
name some ‘less inflammatory’ cytokines
- lipoxins
- PGE-1
- PGE-3
- protectins
- resolvins
how does the western diet cause chronic inflammation?
- high refined sugar increases free radicals and AGE
- High omega-6 and low omega-3 increases PGE-2
how can chronic high cortisol lead to chronic inflammation?
it can lead to glucocorticoid receptor resistance, which leads to failing to down-regulate inflammatory response
list some causes or risk factors for chronic inflammation
- sex hormone imbalance
- metabolic endotoxaemia
-excess exercise - poor quality sleep
- excessive exercise
explain the mode of action of NSAIDs, and side effects
inhibits COX-1 and COX-2, down-regulating prostaglandin synthesis.
SE: no COX-1 causes low mucosal secretions in the stomach, potentially leading to ulceration
explain the mode of action of corticosteroids, and side effects
inhibits inflammatory proteins blocking NF-Kb, induces expression of anti-inflammatory proteins, inhibits 5-LOX and COX-2.
SE: weight gain, diabetes, hypertension, blurred vision, osteoporosis
name some naturopathic approaches to chronic inflammation
- blood glucose regulation
- gut health
- oxidative stress
- stress, sleep, recovery support
- immune function
- methylation
How can turmeric help with chronic inflammation, and what’s the RD?
blocks NF-Kb activation and inhibits pro-inflammatory cytokines IL-1 and IL-6. antioxidant.
RD: 500-2000 mg/day
How can curcumin help with chronic inflammation, and what’s the RD?
Reduces PGE-2 and LOX-5. Regulates cytokines such as IL-1, -6, -12, TNFa. Reduces joint inflammation and arthritic pain. Antioxidant.
RD: 200-400mg /day
How can ginger help with chronic inflammation, and what’s the RD?
Inhibits TNFa and PGE-2 through COX-2. Reduces inflammatory joint pain
RD: 500-1000mg/day
How can Boswellia help with chronic inflammation, and what’s the RD?
Reduces 5-LOX activity
RD: 250-500mg/day
How can EFA’s especially EPA (purified fish oil) help with chronic inflammation, and what’s the RD?
Inhibits PGE-2 pathway. Inhibits NF-Kb, TNF and IL-6.
RD: 1g /day
How can vitamin D help with chronic inflammation, and what’s the RD?
Inhibits eosinophils. Improves T-cell function
RD: 2000-10000 IU/day
How can Rheshi help with chronic inflammation, and what’s the RD?
Reduces activity of NF-Kb
RD: 3-9g /day
Explain ‘central tolerance’
Self reactive lymphocytes are deleted in the thymus, and mature self reactive T cells are deleted in peripheral tissues, all via apoptosis.
Which Th cells are more likely to cause autoimmunity?
Th-1 and Th-17
What does the Major Histocompatability Complex (MHC) do?
encodes cell surface proteins acting as an identifier. helps the body differentiate between self and non-self antigens. dysfunction is associated with AI.
Which genetic SNP is closely linked to AI?
HLA
List some potential triggers for AI
- emotional trauma / infection (80% of AI)
- gluten
- environmental toxins
- vitamin D deficiency
Which AI diseases is low vitamin D linked to, and why?
- T1DM due to attacking pancreatic beta cells
- MS due to attacking oligodendrocytes
What % of AI sufferers are female?
78%
List 1 possible reason women are more likely to suffer from AI disease
high oestrogen from xenoestrogen consumption, contraception and HRT.
What are the clinical presentations of AI
- diagnosis
- history of pathogen exposure, gut issues, family history or stress
- Predisposing SNPs to inflammation
What blood markers would you look for in AI disease
- inflammatory markers
- specific antibodies such as RA (rheumatoid factor)
- low VD
What is the naturopathic approach to autoimmunity?
- blood glucose balancing/low GL
- gut/food sensitivity
- gut permeability
- eliminate gluten and other allogenic foods
- support methylation
- vitamin D support
- stress support
what foods are eliminated in the auto immune protocol?
alcohol, dairy, grains, refined sugar, oils, eggs, nuts, seeds, sweeteners.
How does vitamin D help with autoimmunity? RD?
- interacts with VDR which modulates gene expression
- inhibits CD4 T1 cells and their production of cytokines
- Increases T-reg activity and suppresses Th-17
RD: 2000-10000 IU/day
How do EFA’s help with autoimmunity? RD?
-high potency omega-3 fish oil can reduce inflammation by inhibiting the PGE-2 pathway
RD: 1g of EPA
How does vitamin D help with autoimmunity? RD?
which 2 gut bacteria has been linked to lowering IBD symtpoms?
L. salivarius and L-rhamnosus GG
What are some symptoms of SLE?
- fatigue
- joint inflammation
- seizures
- renal damage
- photosensitivity
- butterfly rash
what are some causes or risk factors for SLE?
- female
- genetics
- sex hormone imbalance
- viral trigger
- high toxic load
- stress
- low vitamin D
- non-breastfed/bottle fed
What is the key mechanism in an allergic response?
High Th2 response
What happens when Th2 cells initiate an allergic response?
Th2 secretes IL-4, -5, -6, -13 to regulate IgE antibody producing B cells, mast cells and eosinophils.
What is IgE’s main function?
Immunity to parasites
How does IgE activate it’s actions?
binds to mast cells triggering degranulation and histamine release
What is mast cell activation syndrome? (MCAS)
mast cells inappropriately and excessively release chemical mediators resulting in a range of chronic symptoms, and sometime anaphlaxys.
What does histamine do?
- induces IL-31
- upregulates inflammation
- increases oxidative stress
- triggers pruritus
How can histamine be exasperated?
- poor detoxification
- high histamine loading
- SNP: DAO, HNMT, MAO-B, ADH and NAT-2
How does quercetin help with allergies?
- Inhibits LOX
- stabilises mast cells
- downregulates NF-Kb and IL-4
How does nettle leaf help with allergies?
- reduces effect of histamine
- Inhibits COX-1 and COX-2
How to help histamine loading?
- reduce foods such as fermented foods like cheese, alcohol, dried fruits, spinach, aubergine, avocado.
- support detoxification oh histamine via methylation with floate and B12. Also copper, B6 and vitamin C via DAO enzyme which breaks down histamine in the gut
