Most effective strategy to prevent infectious disease Promote human health Primary aim to induce immunity in individuals Successful programmes protect entire communities and populations

Immune Therapies Flashcards by abby emily leanne

why manipulate the immune response

• Promote protective immune responses
○ Vaccination
○ Fight tumours
○ Treat immunocompromised patients

• Suppress unwanted immune responses
○ Chronic inflammation
○ Autoimmunity
○ Allergy

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why vaccinate?

Most effective strategy to prevent infectious disease
Promote human health
Primary aim to induce immunity in individuals
Successful programmes protect entire communities and populations

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what is included in the UK vaccination programme

Pertussis (whooping cough)
Diphtheria
Tetanus
Polio
Hib
Hepatitis B
MenB and MenC
Rotavirus
Pneumococcal conjugate vaccine (PCV)
Measles, mumps, rubella (MMR)
Seasonal flu
Human papilloma virus (HPV)
○ Now offered to both boys and girls

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what is included in the 6 in 1 vaccine

Pertussis (whooping cough)
Diphtheria
Tetanus
Polio
Hib
Hepatitis B

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name the stages in the evolution of immunisation programme

stage 1 = pre-vaccine
eg corona virus
stage 2 = increasing coverage
stage 3 = loss of confidence
eg MMR
stage 4 = resumption of confidence
stage 5 = eradication
Eg smallpox

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name a case when there was loss of the public trust in vaccines

paper published showing incorrect relationship between MMR vaccine and autism

caused an increase in the incidences of measles, mumps and rubella

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how do vaccines work

replication immunity from natural infection without the illness / disease

exposing our immune system to disease causing microbial antigens without causing disease

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what is the primary aim of vaccination

stimulate adaptive immunity

generate long term immunological memory

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what is the most important goal of vaccination

production of high affinity IgG

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what is the primary response to natural infection

○ Low specificity IgM produced first

○ High specificity IgG takes longer
Requires T cell help

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what is the secondary response to natural infection

○ More rapid

○ More effective

§ Highly specificity IgG produced by long-lived plasma cells

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what are virulence factors

disease causing factors expressed by microbes

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how does the microbial challenge affect the host response

antigens and virulence factors act on the host

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how does the host response affect the microbial challenge

innate and adaptive immune response attacks

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what are the different types of vaccines

• Live attenuated 
• Inactivated 
• Subunit (purified antigens)
	○ Recombinant 
	○ Toxoid 
	○ Polysaccharide
	○ Conjugate

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what are live attenuated vaccines

• Live pathogen but weakened via genetic manipulations

• Capable of replication within host cells
○ The pathogen can replicate in your tissues

Excellent life long immunity
Potentially pathogenic in immune-compromised
Examples:
MMR
BCG
Rotavirus

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how do live attenuated vaccines work

attachment
influenza virus becomes attached to target epithelial cell
penetration
the cell engulfs the virus by endocytosis
uncoating
viral contents are released
biosynthesis
viral RNA enters the nucleus, where it is replicated by the viral RNA polymerase
assembly
new phage particles are assembled
release
new viral particles are made and released into the ECF
the cell which is not killed in the process continues to make new virus

[actually have no clue what any of this means it is in a diagram but dunno if it is actually associated with how this vaccine works lol]

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what are inactivated vaccines

• Killed through chemical or physical processes
○ Take the live organism and kill it but it will remain structurally intact

• Cannot replicate or cause disease
○ Safer vaccine

• Weak immunity
• Several doses required
○ Needs booster doses to generate the protective immunity

• Examples:
○ Polio
○ Pertussis

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what are subunit ((purified antigens)) vaccines

No live components
Takes 2/3 doses to get the long lived memory response you want

• Recombinant - produced by genetic engineering
○ Hep B
○ HPV

• Toxoid - inactivated bacterial toxins
○ Diphtheria
○ Tetanus

• Polysaccharide - encapsulated bacteria - T cell independent

• Conjugate - polysaccharide antigens linked to proteins
○ PCV
○ Hib
○MenC

what are adjuvants

Enhance immune responses to vaccine antigens

Inactivated / subunit vaccines

what do aluminium / calcium salts do

Maintain and prolong antigen stability
Enhance and prolong antigen presentation
Granuloma formation

why is granuloma formation useful in vaccines

§ Makes sure the antigen stays at the intended site to be presented to your immune system for longer
If you didn’t have this granuloma then it might be washed away

what are the different routes of administration

• Intramuscular
hepatitis B

• Subcutaneous
eg measles

• Intradermal
eg BCG

• Intranasal

• Oral
eg rotavirus

is there rationale for a dental caries vaccine?

Bacterial aetiology

Cariogenic bacteria produce acids the demineralise tooth surfaces

what do mutans streptococci do

Extremely efficient at accumulating and producing carious surfaces Extremely tolerant of low pH Colonisation coincides with tooth eruption Colonisation stimulates specific IgA and IgG

what are the biological considerations to dental caries vaccination

Mutans streptococci dominate environments frequently exposed to dietary carbohydrates Mutans streptococci are not the only cariogenic bacteria in the oral biofilm Other cariogenic species likely to fill niche

what are the ethical considerations to dental caries vaccination

``` ○ Non-life threatening condition ○ Expensive ○ Other initiatives more cost effective ○ Child smile ○ Water fluoridation ○ Dietary advice ```

what has caused a reduction in infectious diseases

○ Widespread implementation of vaccination strategies ○ Cleaner drinking water ○ Better nutrition ○ Better living standards

what has successful vaccination programmes contributed to

Decreasing burden of infectious diseases Increasing burden of NCDs associated with aging

name non-communicable diseases

``` ○ Cardiovascular disease ○ Cancer ○ Metabolic disorders ○ Chronic kidney diseases ○ Autoimmune diseases ○ Neurodegenerative disorders ```

what is inflammation

the body's defence to all types of challenges regardless of infectious, physical, environmental or psychological

name conventional immunosuppressive drugs

* Corticosteroids * Non-steroidal anti-inflammatories (NSAIDS) * Methotrexate (DMARDs) * Biological therapies

what are corticosteroids

Synthetic versions of cortisol eg prednisolone

what do corticosteroids do

• Non specific anti-inflammatory function • Treat wide range of inflammatory / allergic conditions Systemic or topical application

what are the side effects of corticosteroids

Weight gain Risk of infection Risk of diabetes Risk of hypertension

what are the physiological effects of corticosteroid therapy

- decreased inflammation caused by cytokines - decrease NO - decrease prostaglandins and leukotrienes - reduced emigration of leukocytes from vessels - induction of apoptosis in lymphocytes and eosinophils

what are NSAIDS

Non-Steroidal Anti-Inflammatory Drugs = ibuprofen = aspirin

what do NSAIDs do

• Reduce pain, inflammation and fever • Constant use can lead to gastro-intestinal bleeding, liver and kidney problems Interact with other medications (warfarin, diuretics, methotrexate)

what does DMARD stand for

Disease-modifying anti-rheumatic drug eg methotrexate

what do DMARDs do

* Used at high doses at chemotherapy agent * Used at low doses to treat inflammatory arthritis * Multi-faceted anti-inflammatory effects * Slow progression of arthritis * Can be combined with biological therapies

what are biological therapies

• 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

what are anti-TNF therapies

• Five anti-TNF drugs licensed for RA in the UK • All work in different ways ○ Infliximab binds soluble TNFa ○ Etanercept binds and blocks TNF receptor • Patients can expect at least 20% clinical improvement Often combined with methotrexate

how do TNF-therapies work in general

attacking immune cells release TNF which stimulates destruction of bone and cartilage and increases inflammation a TNF blocker prevents TNF from binding to its receptor, limiting its destructive inflammatory effects

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

Elevated levels of cytokines in gingival tissues | Regulate immune-mediated bone destruction

what do targeted biological therapies do

harness the specificity of antibodies to target and block pathological inflammatory pathways