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BDS2 - BAMS > Immune Therapies > Flashcards

Immune Therapies Flashcards

1
Q

why manipulate the immune response

A

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

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

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2
Q

why vaccinate?

A
  • 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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3
Q

what is included in the UK vaccination programme

A
  • 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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4
Q

what is included in the 6 in 1 vaccine

A
  • Pertussis (whooping cough)
  • Diphtheria
  • Tetanus
  • Polio
  • Hib
  • Hepatitis B
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5
Q

name the stages in the evolution of immunisation programme

A
  • 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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6
Q

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

A

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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7
Q

how do vaccines work

A

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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8
Q

what is the primary aim of vaccination

A

stimulate adaptive immunity

generate long term immunological memory

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9
Q

what is the most important goal of vaccination

A

production of high affinity IgG

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10
Q

what is the primary response to natural infection

A

○ Low specificity IgM produced first

○ High specificity IgG takes longer
Requires T cell help

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11
Q

what is the secondary response to natural infection

A

○ More rapid

○ More effective

§ Highly specificity IgG produced by long-lived plasma cells

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12
Q

what are virulence factors

A

disease causing factors expressed by microbes

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13
Q

how does the microbial challenge affect the host response

A

antigens and virulence factors act on the host

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14
Q

how does the host response affect the microbial challenge

A

innate and adaptive immune response attacks

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15
Q

what are the different types of vaccines

A 
• Live attenuated 
• Inactivated 
• Subunit (purified antigens)
	○ Recombinant 
	○ Toxoid 
	○ Polysaccharide
	○ Conjugate
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16
Q

what are live attenuated vaccines

A

• 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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17
Q

how do live attenuated vaccines work

A
  1. attachment
    influenza virus becomes attached to target epithelial cell
  2. penetration
    the cell engulfs the virus by endocytosis
  3. uncoating
    viral contents are released
  4. biosynthesis
    viral RNA enters the nucleus, where it is replicated by the viral RNA polymerase
  5. assembly
    new phage particles are assembled
  6. 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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18
Q

what are inactivated vaccines

A

• 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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19
Q

what are subunit ((purified antigens)) vaccines

A
  • 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

20
Q

what are adjuvants

A

Enhance immune responses to vaccine antigens

Inactivated / subunit vaccines

21
Q

what do aluminium / calcium salts do

A

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

22
Q

why is granuloma formation useful in vaccines

A

§ 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

23
Q

what are the different routes of administration

A

• Intramuscular
hepatitis B

• Subcutaneous
eg measles

• Intradermal
eg BCG

• Intranasal

• Oral
eg rotavirus

24
Q

is there rationale for a dental caries vaccine?

A

Bacterial aetiology

Cariogenic bacteria produce acids the demineralise tooth surfaces

25
Q

what do mutans streptococci do

A

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

26
Q

what are the biological considerations to dental caries vaccination

A

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

27
Q

what are the ethical considerations to dental caries vaccination

A 
○ Non-life threatening condition
○ Expensive
○ Other initiatives more cost effective
	○ Child smile
	○ Water fluoridation
	○ Dietary advice
28
Q

what has caused a reduction in infectious diseases

A

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

29
Q

what has successful vaccination programmes contributed to

A

Decreasing burden of infectious diseases

Increasing burden of NCDs associated with aging

30
Q

name non-communicable diseases

A 
○ Cardiovascular disease
○ Cancer
○ Metabolic disorders
○ Chronic kidney diseases
○ Autoimmune diseases
○ Neurodegenerative disorders
31
Q

what is inflammation

A

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

32
Q

name conventional immunosuppressive drugs

A
  • Corticosteroids
  • Non-steroidal anti-inflammatories (NSAIDS)
  • Methotrexate (DMARDs)
  • Biological therapies
33
Q

what are corticosteroids

A

Synthetic versions of cortisol eg prednisolone

34
Q

what do corticosteroids do

A

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

35
Q

what are the side effects of corticosteroids

A

Weight gain
Risk of infection
Risk of diabetes
Risk of hypertension

36
Q

what are the physiological effects of corticosteroid therapy

A
  • decreased inflammation caused by cytokines
  • decrease NO
  • decrease prostaglandins and leukotrienes
  • reduced emigration of leukocytes from vessels
  • induction of apoptosis in lymphocytes and eosinophils
37
Q

what are NSAIDS

A

Non-Steroidal Anti-Inflammatory Drugs

= ibuprofen
= aspirin

38
Q

what do NSAIDs do

A

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

39
Q

what does DMARD stand for

A

Disease-modifying anti-rheumatic drug

eg methotrexate

40
Q

what do DMARDs do

A
  • 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
41
Q

what are biological therapies

A

• 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

42
Q

what are anti-TNF therapies

A

• 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

43
Q

how do TNF-therapies work in general

A

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

44
Q

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

A

Elevated levels of cytokines in gingival tissues

Regulate immune-mediated bone destruction

45
Q

what do targeted biological therapies do

A

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

BDS2 - BAMS (18 decks)

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