Immune Therapies

Question 1

Why manipulate the immune response?

Answer 1

Promote protective immune responses
Vaccination
Fight tumours
Treat immunocompromised patients

Suppress unwanted immune responses
Chronic inflammation
Autoimmunity
Allergy.

Question 2

Why do we vaccinate?

Answer 2

Most effective strategy to prevent infectious disease

Promote human health

Primary aim to induce immunity in individuals

Successful programmes protect entire communities and populations

Question 3

What is included in the 6 in 1 vaccine?

Answer 3

Pertussis (whooping cough)
Diphtheria
Tetanus
Polio
Hib
Hepatitis B.

Question 4

How do vaccines work?

Answer 4

Replicate immunity from natural infection without illness. Primary aim of vaccination is to stimulate adaptive immunity and generate long-term immunological memory. Vaccination involves exposing our immune system to disease-causing microbial antigens but without causing disease.

Question 5

Primary response- IgM to secondary (immunological memory- IgG). 1st then 2nd response to antigen. “Class switching”- happens when T cell talks to B cell.

Answer 5

Primary response
Low specificity IgM produced first
High specificity IgG takes longer
Requires T cell help

Secondary response
More rapid
More effective
High specificity IgG produced by long-lived plasma cells.

Question 6

What is the most important goal of vaccination?

Answer 6

To create a high affinity IgG.

Question 7

What are the three types of vaccines?

Answer 7

live attenuated
inactivated
subunit (purified antigens).

Question 8

What is a live attenuated vaccine?

Answer 8

It is live but weakened via genetic manipulations. It has excellent life-long immunity and capable for replication within host cells. Potentially pathogenic in immune compromised individuals. Examples are MMR, BCG and rotavirus. CANT BURST OUT OF CELL TO INFECT OTHER CELLS.

Question 9

What is an inactivated vaccine?

Answer 9

Killed through a chemical physical process. Structurally intact but dead. Cannot replicate of cause disease and provides weak immunity- takes a few vaccines to develop sufficient response. Example- polio and pertussis.

Question 10

What is subunit vaccine?

Answer 10

No live components
Recombinant – produced by genetic engineering
Hep B
HPV
Toxoid – inactivated bacterial toxins
Diphtheria
Tetanus
Polysaccharide on outside of cell membrane– encapsulated bacteria –evade from host- T cell-independent
Conjugate – polysaccharide antigens linked to proteins
PCV/Hib/Men-C.

Question 11

T cells only activatd in response to peptides not polysaccharides.

Answer 11

.

Question 12

What is an adjuvant?

Answer 12

Enhance immune responses to vaccine antigens
Inactivated/subunit vaccines
Aluminium/calcium salts
Maintain and prolong antigen stability
Enhance and prolong antigen presentation
Induce granuloma formation (caused by aluminium and calcium salts- makes antigen stay at site and stays in immune system for longer)
Intramuscular delivery.

Question 13

diff routes of vaccine administration and examples?

Answer 13

BCG- intradermal
Measles and yellow fever- subcut
IM- hep b, Hib
Oral- rotavirus.

Question 14

Why was there a reduction in infectious diseases?

Answer 14

Reduction in infectious diseases 
Widespread implementation of vaccination strategies
Cleaner drinking water
Better nutrition
Better living standards.

Question 15

Naturally occurring NCD increased from 2007-2017 eg. cancer, metabolic disorders, autoimmune diseases etc.
CD decreased from 2007-2017.

Answer 15

.

Question 16

What are the effects of corticosteroids?

Answer 16

Side effects
Weight gain
Risk of infection
Risk of diabetes
Risk of hypertension.

Question 17

Aarachidonic acid

Answer 17

.

Question 18

Methotrexate?

Answer 18

Used at high doses as chemotherapy agent
Used at low doses to treat inflammatory arthritis

Multi-faceted anti-inflammatory effects
Slows progression of arthritis
Can be combined with biological therapies. Only works for a period of time until body stops responding.

Question 19

What are biological therapies?

Answer 19

Genetically engineered antibodies made from human genes

Directly target specific components of immune system to inhibit activity
B-cell inhibitor (Rituximab)
Cytokine blockers (IL-1, IL-6, IL-17, TNFa)

Moderate to severe RA patients to slow disease progression

May be combined with DMARDs.

Question 20

ANTI TNF- therapies?

Answer 20

Five anti-TNF drugs licensed for RA in the UK

All work in different ways
Infliximab binds soluble TNFa- binds to cytokine and stop it acting with its receptor
Etanercept binds and blocks TNF receptor

Patients can expect at least 20% clinical improvement
Often combined with methotrexate.

Question 21

Do anti-cytokine therapies have a role in the treatment of periodontitis?

Answer 21

CYTOKINES DRIVE BONE DESTRUCTION IN PERIDONTAL TISSUES.

Question 22

What are the barriers to the dental caries vaccine?

Answer 22

Biological- strep mutans dominate environments frequency exposure to dietary carbohydrates. IT IS NOT THE ONLY CARIOGENIC BACTERIA IN THE ORAL BIOFILM. Other cariogenic species likely to fill niche.

Ethical- non-life threatening conditions. Expensive. Other initiatives are ore cost effective eg. child smile, water fluoridation and dietary advice.