immune therapies Flashcards
why do we want to manipulate the immune response?
promote protective immune responses -vaccination -fight tumours -treat immunocompromised px suppress unwanted immune response -chronic inflammation -autoimmunity -allergy
why do we 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
what vaccines are available in the uk?
pertussis diphtheria tetanus polio hib hep b menB and menC rotavirus PCV MMR seasonal flu HPV
how do vaccines work?
stimulate adaptive immunity and generate long-term immunological memory
IgG aim of vaccination
how is vaccine immunity achieved?
bind to and neutralise pathogen
IgG highly effective at neutralising and clearing
response never 0 once primed
IgG aim of vaccination
what is the primary response of natural infection
low specificity IgG produced first
high specificity IgG takes longer
-required T cell help
what is the secondary response to natural infection
more rapid
more effective
high specificity IgG produced by long-lived plasma cells
what are the types of vaccines?
live attenuated inactivated subunit (purified antigens) -recombinant -toxiod -polysaccharide -conjugate viral vector
describe live attenuated
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
describe inactivated
killed through chemical or physical process cannot replicate or cause disease weak immunity several doses required eg polio, pertussis
describe subunit
no live components
recombinant- produced by genetic engineering
eg hep b HPV
fragments/proteins
conjugate- polysaccharide antigens linked to proteins to produce response
what are adjuvants?
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
what are the routes of vaccine administration?
intramuscular subcutaneous intradermal intranasal oral
how could a dental caries vaccine work?
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
what has caused the reduction in infectious disease?
widespread implementation of vaccines
cleaner drinking water
better nutrition
better living standards
what non-communicable diseases have increased as a result of less infectious disease?
cardiovascular disease cancer metabolic disorders CKDs autoimmune disease neurodegenerative disorders
what are the conventional immunosuppressive drugs?
corticosteriods
NSAIDS
methotrexate (DMARDs)
biological therapies
what are corticosteriods?
synthetic cortisol eg prednisolone
NSAID function
treat wide range of inflammatory/allergic conditions
systemic/topical application
what are side effects of corticosteriods?
weight gain risk of infection risk of diabetes risk of diabetes risk of hypertension
what is cortisol?
stress hormone released during fight/flight
dampens immune response
target many dif pathways
describe NSAIDs
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
describe methotrexate
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
what are biological therapies?
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
what are anti-TNF therapies
work in dif ways
-infliximab bins soluble TNF-a
-etanercept binds and blocks TBF receptor
often combined with methotrexate
