immune therapies

Question 1

why do we want to manipulate the immune response?

Answer 1

promote protective immune responses
-vaccination
-fight tumours
-treat immunocompromised px
suppress unwanted immune response
-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 vaccines are available in the uk?

Answer 3

pertussis
diphtheria
tetanus
polio
hib
hep b
menB and menC rotavirus
PCV
MMR
seasonal flu
HPV

Question 4

how do vaccines work?

Answer 4

stimulate adaptive immunity and generate long-term immunological memory
IgG aim of vaccination

Question 5

how is vaccine immunity achieved?

Answer 5

bind to and neutralise pathogen
IgG highly effective at neutralising and clearing
response never 0 once primed
IgG aim of vaccination

Question 6

what is the primary response of natural infection

Answer 6

low specificity IgG produced first
high specificity IgG takes longer
-required T cell help

Question 7

what is the secondary response to natural infection

Answer 7

more rapid
more effective
high specificity IgG produced by long-lived plasma cells

Question 8

what are the types of vaccines?

Answer 8

live attenuated
inactivated
subunit (purified antigens)
-recombinant
-toxiod
-polysaccharide
-conjugate
viral vector

Question 9

describe live attenuated

Answer 9

live but weakened via genetic manipulations
capable of replication w/i host cells
excellent life-long immunity
potentially pathogenic in immune- compromised
eg MMR, BCG, rotavirus

Question 10

describe inactivated

Answer 10

killed through chemical or physical process
cannot replicate or cause disease
weak immunity
several doses required
eg polio, pertussis

Question 11

describe subunit

Answer 11

no live components
recombinant- produced by genetic engineering
eg hep b HPV
fragments/proteins
conjugate- polysaccharide antigens linked to proteins to produce response

Question 12

what are adjuvants?

Answer 12

enhance immune responses to vaccine antigens
inactivated/subunit vaccines
aluminium/ca salts
-maintain and prolong antigen stability
-enhance and prolong antigen presentation
-granuloma formation
intramuscular delivery

Question 13

what are the routes of vaccine administration?

Answer 13

intramuscular
subcutaneous
intradermal
intranasal
oral

Question 14

how could a dental caries vaccine work?

Answer 14

bacterial aetiology
cariogenic bacteria produce acids that demineralise tooth surfaces
mutans strep
-extremely efficient at accumulating and producing carious surfaces, tolerant to low pH
vaccine used to block colonisation

Question 15

what has caused the reduction in infectious disease?

Answer 15

widespread implementation of vaccines
cleaner drinking water
better nutrition
better living standards

Question 16

what non-communicable diseases have increased as a result of less infectious disease?

Answer 16

cardiovascular disease
cancer
metabolic disorders
CKDs
autoimmune disease
neurodegenerative disorders

Question 17

what are the conventional immunosuppressive drugs?

Answer 17

corticosteriods
NSAIDS
methotrexate (DMARDs)
biological therapies

Question 18

what are corticosteriods?

Answer 18

synthetic cortisol eg prednisolone
NSAID function
treat wide range of inflammatory/allergic conditions
systemic/topical application

Question 19

what are side effects of corticosteriods?

Answer 19

weight gain
risk of infection
risk of diabetes
risk of diabetes
risk of hypertension

Question 20

what is cortisol?

Answer 20

stress hormone released during fight/flight
dampens immune response
target many dif pathways

Question 21

describe NSAIDs

Answer 21

ibuprofen, aspirin
reduce pain, inflammation & fever
constant use can lead to gastro-intestinal bleeding, liver and kidney problems
interacts with other medications, warfarin, diuretics, methotrexate

Question 22

describe methotrexate

Answer 22

high dose as chemotherapy agent
low dose inflammatory arthritis
multi-faceted anti-inflammatory effects
flows progression of arthritis
can be combined with biological therapies
non-specific action

Question 23

what are biological therapies?

Answer 23

genetically engineered antibodies made from human genes
directly target specific components of immune system to inhibit activity
-B-cell inhibitor
-cytokine blockers
moderate to severe RA px to slow disease progression
may be combined with DMARDs

Question 24

what are anti-TNF therapies

Answer 24

work in dif ways
-infliximab bins soluble TNF-a
-etanercept binds and blocks TBF receptor
often combined with methotrexate

Question 25

what is TNF?

Answer 25

in arthritic coordinates pathological immune reaction in joint, leading to destruction of bone and surrounding tissues