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Path Immunology > Immune Therapies > Flashcards

Immune Therapies Flashcards

1
Q

What are the 7 classes of Immune therapies?

A 
Anti- T cell monoclonal antibodies
Anti Proliferative Agents
Inhibitors of cell Signalling
Corticosteroids
Plasmapharesis
Anti TNFalpha Monoclonal Antibodies
Anti IL-12/23 Monoclonal Antibody
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2
Q

4 Examples of Anti T cell Monoclonal Antibodies

A

1) Muromonab-CD3
2) Basiliximab
3) Tocilizumab
4) Abatacept

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3
Q

What is the Method of action of Muromonab-CD3?

A

Blocks CD3 on T cells

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4
Q

What is Muromonab-CD3 used for?

A

For active rejection

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5
Q

What are the side effects of Muromonab-CD3?

A

Fever

Leucopenia

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6
Q

What is the method of action of Basiliximab?

A

Blocks CD25 (alpha chain of IL-2 Receptor)

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7
Q

What is Basiliximab used for?

A

Prevents rejection in Transplantation

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8
Q

What are the side effects of Basiliximab?

A

GI disturbances

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9
Q

What is the method of action of Tocilizumab?

A

Blocks IL-6 receptor

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10
Q

What is Tocilizumab used for?

A

Rheumatoid arthritis if Anti-TNF drugs have failed

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11
Q

What are the side effects of Tocilizumab?

A

Infections

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12
Q

What is the method of action of Abatacept?

A

Anti C TLA-4 Ig, Blocks Co stimulation of T cells

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13
Q

What is Abatacept used for?

A

Rheumatoid arthritis if Anti-TNF drugs have failed

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14
Q

What are the side effects of Abatacept?

A

Inections and cough

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15
Q

3 examples of Anti proliferative Agents?

A

1) Cyclophosphamide
2) Mycophenolate
3) Azathioprine

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16
Q

What is the method of action of Cyclophosphamide?

A

Alkylates guanine base of DNA. Affects B>T cells

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17
Q

What is Cyclophosphamide used for?

A

Muti-system connective tissue diseases (e.g. SLE) and Cancer

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18
Q

What are the side effects of Cyclophosphamide?

A

Hair Loss, Bone marrow suppression, Sterility, Haemorrhagic cystitis

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19
Q

What is the method of action of Mycophenolate?

A

Blocks de novo nucleotide synthesis. Affects T>B cells

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20
Q

What is Mycophenolate used for?

A

Autoimmune Disease, Vasculitis, Transplantation

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21
Q

What are the side effects of Mycophenolate?

A

Bone Marrow Suppression, Herpes

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22
Q

What is the method of action of Azathioprine?

A

Metabolised to 6-Mercaptopurine in the liver. Blocks de novo purine synthesis

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23
Q

What is Azathioprine used for?

A

Inflammatory and Autoimmune disease, Transplantation

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24
Q

What are the side effects of Azathioprine?

A

Bone Marrow Suppression (measure TPMT), Hepatotoxicity

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25
Q

Give 3 examples of immune Therapies that are ‘inhibitors of cell signalling’

A

1) Tacrolimus
2) Ciclosporin
3) Sirolimus

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26
Q

What is the method of action of Tacrolimus?

A

Inhibits Calcineurin which normally activated the transcription of IL-2 therefore decreased IL-2

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27
Q

What is Tacrolimus used for?

A

Mainly rejection prophylaxis in transplantation

28
Q

What are the side effects of Tacrolimus?

A

Diabetes

29
Q

What is the method of action of Ciclosporin?

A

Inhibits Calcineurin which normally activated the transcription of IL-2 therefore decreased IL-2

30
Q

What is Ciclosporin used for?

A

Mainly rejection prophylaxis in transplantation

31
Q

What are the side effects of Ciclosporin?

A

Gingival hypertrophy

32
Q

What is the method of action of Sirolimus?

A

Blocks Clonal Proliferation

33
Q

What is Sirolimus used for?

A

Mainly rejection prophylaxis in transplantation

34
Q

What are the side effects of Sirolimus?

A

N/A

35
Q

What is an example of a Corticosteroid?

A

Prednisolone

36
Q

What is the method of action of Prednisolone?

A

Inhibits Phospholipase A2 causing a

  • decrease in Platelet activating factors
  • decreased Arachidonic Acid
  • Decreased trafficking of phagocytes (hence transient increase in phagocyte count)
  • Lymphopenia,
  • Apoptosis of T+B cells
  • Decreased Abs
37
Q

What is Prednisolone used for?

A

used as anti-inflammatory and in autoimmune diseases

38
Q

What are the side effects of Prednisolone?

A

Diabetes, Central obesity, Adrenal suppression, cataracts, glaucoma, Pancreatitis, osteoporosis, moon face, acne, hirtuism, neutrophilia.

39
Q

What is Plasmapharesis?

A

Each time 50% of the patients plasma is replaces with a donors

40
Q

What is Plasmapharesis used to treat?

A

Goodpastures, Myasthenia

Antibody mediated rejection

41
Q

What are the side effects of Plasmapharesis?

A

Rebound antibody procution limits efficacy

42
Q

What is an example of an Anti TNF alpha Monoclonal Antibody used for Immune Therapies?

A

Infliximab

43
Q

What is an example of an Anti IL-12/23 Monoclonal Antibody used for Immune Therapies?

A

Ustekinumab

44
Q

What is the method of action of Infliximab?

A

Binds to TNF alpha

45
Q

What is the method of action of Ustekinumab?

A

Binds to p40 subunit of IL-12 and IL-23

46
Q

What is Infliximab used to treat?

A

Psoraisis, Crohn’s, Rheumatoid Arthritis

47
Q

What is Ustekinumab used to treat?

A

Psoriasis

48
Q

What are the side effects of Infliximab?

A

TB, Lymphoma, Autoimmune phenomenon

49
Q

What are the side effects of Ustekinumab?

A

Infections and cough

50
Q

How does Rituximab work as a Immune Therapy?

A

Anti-CD20 and therefore decreased B cells (not plasma cells)

51
Q

What is Rituximab used to treat?

A

Lymphoma and autoimmune diseases

52
Q

How does Methotrexate work as an Immune Therapy?

A

Inhibits dihydrofolate reductase (DHFR) therefore decreases DNA synthesis

53
Q

What is Methotrexate used to treat?

A

Autoimmune disorders e.g. RA, Psoriasis, Crohn’s

Chemotherapy and as an abortifacient

54
Q

What are the side effects of Methotrexate?

A

Teratogenicity and hepatotoxicity

55
Q

How does Alemtuzumab (campath) work as an Immune Therapy?

A

Monocolonal antibody that binds to CD52 found on lymphocytes resulting in depletion

56
Q

What is Alemtuxumab used to treat?

A

CLL, MS

57
Q

What are the side effects of Alemtuxumab?

A

Increased susceptibility to CMV infection

58
Q

How does Natalizumab work as an Immune Therapy?

A

Anti alpha4 integrin

59
Q

What is Natalizumab used to treat?

A

MS and Crohn’s

60
Q

What is the Method for choosing an Immunosuppressive Regime to Suppress T-cells

A

Include on drug from each group

  • Inhibitors of T cell signalling : Ciclosporin, Tacrolimus
  • Anti Proliferative Agent : Azathioprine, Mycophenolate Mofetil, Methotrexate, Cyclophosphamide
  • Blocker of Cytokine Production : Prednisolone
61
Q

4 Methods to boost the immune system

A

vaccinations
Human Normal Immunoglobulin
Specific Immunoglobulin (passive vaccination)
Recombinant Cytokines

62
Q

Human Normal Immunoglobulin as an Immune system Booster

A

From over 1000 donors (all screened for HIV and Hep b/c)
Contains preformed IgG vs full range of organisms
Given every 3-4 weeks, half life is 18days
Used for primary antibody deficiences (CVID, Brutons), secondary deficiencies (CLL and Multiple myeloma, BMT) and passive vaccination

63
Q

What is Passive Vaccination (Specific Immunoglobulins) used for?

A

Rabies, Varicella Zoster, Hep B, Tetanus

64
Q

Recombinant Cytokines as Immune system boosters, types and what they are used for.

A 
Boosts immune response to cancer and some pathogens
Interferon alpha 
      - Hep B/C, Kaposi's Sacrcoma
      - Hairy cell leukaemia, chronic myelogenous leukaemia, malignant myeloma
Interferon beta
       - Relapsing MS
       - Mechanism of action unknown
Interferon gamma
       - Chronic granulomatous disease
65
Q

Allergen Desensitization - how is it done?

A

Supervised administration of the allergen
Reduces clinical symptoms of mono allergic disorders
Good for - bee and wasp venom, grass pollen, house dust mites, NOT for food or latex

Given weekly, and then maintenance dose given monthly for 3-5 years
Costly, laborious and risk of seer adverse reaction
Only treatment that alters the natural course of the disease

Path Immunology (8 decks)

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