immuno Flashcards
1
Q
secondary lymphoid organ with many afferents, one or more efferents
A
lymph node
2
Q
lymph node features
A
encapsulated with trabeculae
3
Q
LN functions
A
nonspecific filtration by macrophages, storage and activation of B and T cells, antibody production
4
Q
follicle
A
located in outer cortex
B cell localization and proliferation
5
Q
primary follicle
A
dense and dormant
6
Q
secondary follicle
A
pale germinal centers - ACTIVE
7
Q
medulla is made up of
A
medullary cords and medullary sinuses
8
Q
medullary cords
A
closely packed lymphocytes and PLASMA cells
9
Q
medullary sinuses
A
communicate with efferent lymphatics
contain reticular cells and MACROPHAGES
10
Q
paracortex
A
houses T cells
between cortex and medulla
high endothelial (post capillary) venules - T + B cells enter
digeorges - poorly develped
11
Q
extreme cellular immune response
A
paracortex greatly enlarges EX: viral
12
Q
where do UL and lateral breast drain
A
axillary LN
13
Q
where does stomach drain
A
celiac LN
14
Q
where do duodeneum and jejunum drain
A
superior mesenteric LN
15
Q
where does sigmoid colon drain
A
colic –> inf mesenteric LN
16
Q
where does rectum drain (above pectinate line)
A
internal iliac LN
17
Q
where does anal canal drain (below pectinate line)
A
superficial inguinal LN
18
Q
where do tests drain
A
superficial and deep plexuses –> para-aortic LN
19
Q
where does scrotum drain
A
superficial inguinal LN
20
Q
where does superficial thigh drain
A
superficial inguinal LN
21
Q
where does lateral side of dorsum of foot drain
A
popliteal LN
22
Q
right lymphatic duct
A
right arm, right chest, right half of head
23
Q
thoracic duct
A
everything else
24
Q
sinusoides of spleen
A
long vasc channel in red pulp
fenestrated barrel hoop basement membrane
25
where are T cells found in the spleen
white pulp - periarterial lymphatic sheath (PALS)
26
where are the B cells found in the spleen
white pulp - follicles
27
spleen function
macrophages remove encapsulated bacteria
28
splenic dysfunction
less IgM --> less complement activatoin --> less C3b opsonization --> increase susceptibility to encap organsisms
29
encap organisms
SHINe SKiS
| step pneumo, h flu type B, n meningitis, salmonella, klebsiella, group B strep
30
what is seen postsplenectomy
nuclear remnants = howell-jolly bodies
target cells
thrombocytosis
31
spleen germinal center
B cells
32
spleen PALS
T cells
33
spleen marginal zone
APCs
34
Spleen red pulp
RBC
35
site of T cell differentiation and maturation
thymus
36
thymus
3rd branchial pouch - epithelium
| lymphocytes - mesenchymal origin
37
thymic cortex
dense - immature T cells
38
thymuc medulla
pale - mature T cells + epithelial reticular cells with Hassall's corpuscles
39
where does positive selection occur
cortex - MHC restriction
40
where does negative selection occur
medulla - nonreactive to self
41
germinline coded, fast and nonspecific response, no memory
innate immunity - neutrophils, macrophages, denderitic cells, NK cells and complement
42
VDJ recombination, slow on first exposure with faster in memory response
adaptive immunity - B and T cells and circulating antibody
43
MHC
encoded by HLA genes
| present antigen fragments to T cells and bind TCR
44
HLA-A, HLA-B, HLA-C
MHC I
45
MHC 1
binds TCR + CD8
46
mediates viral immunity
MHC1
47
binds with B2 microglobulin to transport to cell surface
MHC 1
48
HLA-DR, HLA-DP, HLA-DQ
MHC 2
49
MHC 2
binds TCR + CD4
50
where are MHC class 1 expressed
all nucleated cells (not rbc)
51
where are MHC class 2 expressed
only on APC
52
where is MHC class 1 antigen loaded
in RER with intracellular peptides
53
where is MHC class 2 antigen loaded
following release of invariant chain in an acidified endosome
54
HLA A3
hemochromatosis
55
HLA B27
PAIR - psoriasis, ankylosing spondylitis, IBD, reiters syndrome
56
HLA DQ2/DQ8
celiacs
57
HLA DR2
MS, hay fever, SLE, goodpastures
| SHaGgy M
58
HLA DR3
DM1, graves
59
HLA DR4
RA, DM1
60
HLA DR5
PA --> B12 deficient, hashimotos
61
only lymphocyte member of innate immune system
NK cells
62
NK cells
use perforin and granzymes to induce apoptosis of virally infection cells and tumor cells
63
what enhances NK activity
IL-2, IL-12, IFN-alpha, IFN-beta
64
when are NK cells induced to kill
exposed to nonspecific activation signal on target cell/ absence of class I MHC on target cell surface
65
B cell function
make antibody - opsonize bacteria
66
which B cells neutralize viruses
IgG
67
which B cells activate complement
IgG and IgM
68
which B cells sensitize mast cells
IgE
69
Cell seen in allergies
B cell = IgE - HS I
70
Cell seen in cytotoxic rxn
B cell = IgG - HS II
71
Cell seen in IC rxn
B cell = IgG - HS III
72
hyperacute and humorally mediated acute and chronic organ rejection
B cells
73
CD4 T cell function
help make B cell antibody + produce cytokines to active other cells
74
CD8 T cell function
kill virus-infected cells directly
75
which cell is seen in delayed cell-mediated HS (IV)
T cells
76
which tell is seen in acute and chronic cellular organ rejection
T cells
77
what selection happens in thymic medulla
negative selection - T cells expressing TCRs with HIGH AFFINITY for self antigens --> apoptososis
78
what selection happens in thymic cortex
positive selection - T cells expressing TCRs capable of binding surface self MHC molecules survive
79
what do cytotoxic T cells do in thymus
CD8+ kill virus-infected cells, neoplastic cells and donor graft cells
80
what stimulates CD4 --> Th1
IL-12
81
what stimulates CD4--> Th2
IL-4
82
where do Th1 and Th2 develop
LN
83
only APC that can activate naiive T cell
dendritic cell
84
APC's
DMB
| denderitic cells, mo, B cells
85
two signals for naiive T cell activation
dendritic cell phagocytosis
1. ag. presented on MHC II/I + recognized by TCR on Th/Tc
2. costim signal = CD28 (naiive T cell) + B7 (dendritic cell)
86
B cell activation
```
B cell R-medated endocytosis
1. ag. presented on MHC II - Th
2. costim signal = CD40 (B cell) + CD40 L (Th)
B cella ctivates --> class switching, affinity maturation, ab. production
```
87
B cell class switching
Th --> cytokines --> Ig class switching of B cell
88
what do Th1 cells secrete
IFN-y
89
what do Th2 cells secrete
IL-4,5,10,13
90
Th1 cell function
activate macrophages
91
Th2 cell function
recruit eosinophils for parasite defense + promote IgE production by B cells
92
what inhibits Th1
IL-4 and IL-10 (from Th2)
93
what inhibits Th2
IFN-y (from Th1)
94
macrophage-lymphocyte interaction
active lymphocytes (release IFN-y) and mo (release IL1, TNF-alpha) stimulate one another
95
cytotoxic t cell MOA
induce apoptosis --> kill virus-infected cells, neoplastic cells + donor graft cells
release cytotoxic granules containing preformed proteins (perforin, granzyme, and granulysin)
96
perforin
deliver content of granules into target cell
97
granzyme
serine protease, activates apoptosis inside target cell
98
granulysin
antimicrobial, induces apoptosis
99
cytotoxic T cell general
have CD8 --> bind MHC 1 on virus-infected cells
100
regulatory T cells
suppress CD4 + CD* T cell effector function --> help maintain specific immune tolerance
101
what do regulatory T cells
CD 3, 4, 25 surface markers
102
CD 25
alpha chain of IL-2 receptor
103
what do activated regulatory T cells produce
anti-inflammatory cytokines (IL-10 and TGF-B)
| Tay lives in apt 10B and is antisocial
104
antibody: variable part L and H chain
recogznie antigens
105
antibody: Fc portion IgM and IgG
fixes complement
106
antibody: heavy chain
contributes to Fc and Fab fractions
107
antibody: light chain
contributes only to Fab fraction
108
Fab
antigen binding fragment
| determines idiotype - only 1 antigenic specificity expressed per B cell (unique antigen-binding pocket)
109
Fc
constant, carboxy terminal, complement binding at Ch2 (IgG and IgM), carbohydrate side chaind
determines isotype - IgM, IgD, etc.
110
ab diversity
random recomb of VJ (light chain) or V(D)J (heavy chain genes, random comb heavy chains w/ light chains, somatic hypermutation (following ag stimulation), addition of nucleotides to DNA during recomb by terminal deoxynucleotidyl transferase
111
Fc Ch2
complement binding
112
Fc Ch3
macrophage binding
113
Fab contains
VJD, Ch1, Cl
114
opsonization
anitbody promotes phagocytosis
115
neutralization
antibody prevents bacterial adherence
116
complement activation
MAC - C3b
| antibody activates complement, enhancing opsonization and lysis
117
immunoglobulin isotype
mature B lymphocytes express IgM and IgD --> class switching (cytokines + CD40 mediate gene rearrangement) -->plasma cells - secrete IgA, IgE, IgG
118
IgG
secondary delayed response to ag
| fixes complement, crosses placenta, opsonize bact, neutralize bact toxins + viruses
119
IgA
prevents bact/virus attachment to MUCOUS MEMBRANES; doesnt fix complement
circulation - monomer
secreted - dimer
crosses epithelial cells via trancytosis
picks up secretory componenet from epithelial cells before secretion
120
IgM
primary immediate response to antigen; fixes complement
ag R = surface of B cells (monomer)
pentamer - trap free ag out of tissue while humoral response evolves
121
IgD
B cells and serum
122
IgE
binds mast cells and basophils
exposed to allergen --> cross-links --> mediates type I HS via release of inflam mediators (histamine)
activates eosinophils --> mediates immunity to worms
123
most abundant immunoglobulin isotype
IgG
124
which mmunoglobulin isotype provides infants with passive immunity
IgG
125
which immunoglobulin isotype is found in secretions and colostrum
IgA
secretions = tears, saliva, mucus
colostrum = early breast milk
126
which immunoglobulin isotype has lowest concentration in the serum
IgE
127
thymus-independent antigens
stimulate release of antibodies (no memory)
128
thymus-dependent antigens
```
contain protein component (dipth vaccine)
direct contact of B cells with Th cells (CD40-40L) --> class switching + immunologic memory
```
129
what type of immunity does complement play a role in?
innate immunity (and inflammation)
130
what does MAC in complement do?
help fight against gram negative bacteria
131
classic complement activation
IgM and IgG
| classic GM cars
132
alternative complement activation
microbe surface molecules
133
lectin complement activation
mannose/sugars on microbe
134
complement that binds bacteria
C3b
135
complement responsible for anaphylaxis
C3a + C5a
136
neutrophil chemotaxis complement
C5a
137
cytolysis by MAC complement
C5b-9
138
primary opsonins in bact defense
C3b and IgG
139
helps clear immune complexes
C3b
140
what prevents complement activation on self cells (RBC)
DAF (GPI anchored enzyme) and C1 esterase inhibitor
141
which complement pathway is innate and does not require antibody
alternative pathway
142
C1 esterase inhibitor deficiency
hereditary angioedema
143
whats CI in C1 esterase inhibitor deficiency
ACE inhibitors
144
C3 deficiency
severe recurrent pyogenic sinus + RT infections
| increase susceptibility to type 3 HS rxns
145
C5-9 deficiency
neisseria
146
DAF deficiency
complement-mediated lysis of RBC + PNH
147
cytokines secreted by macrophages
IL-1, 6, 8, 12,
| TNF-alpha
148
cytokines secreted by all T cells
IL-2 and IL-3
149
cytokines secretes from Th1 cells
IFNy
150
cytokines secreted from Th2 cells
IL-4, 5, 10, 13
151
IL-1
fever (hot)
activates endothelium --> express adhesion molecules
chemokine secretion --> recruit leukocytes
endogenous pyrogen --> fever, acute inflammation
ACE
152
IL-2
stimulates T cells (helper, cyto + reg)
153
IL-3
stimulates bone marrow SC (functions like GM-CSF)
154
IL-4
stimulates IgE production
differentiation into Th2 cells
growth of B cells
class switching --> IgE and IgG
155
IL-5
stimulate IgA production
differentiation of B cells
eosinophils!
156
IL-6
endogenous pyrogen
also secreted by Th2 cells
fever + acute-phase proteins
157
IL-8
major chemotactic factor neutrophils
| clean up aisle 8 - neutrophilcs recruited by IL-8 to clear infections
158
IL-10
moadulates inflamm response
also secreted by reg T cells
inhibits T cells and Th1
159
IL-12
T cells --> Th1
actives NK cells
also secreted by B cells
160
TNF-alpha
SEPTIC SHOCK
activates endothelium
leukocyte recruitment and vascular leak
161
IFN-gamma
activates macrophages and Th1 cells
suppreses Th2 cells
antiviral and antitumor properties
162
TGF beta
similar to IL-10 - inhibits inflammation
163
interferons
interFERES with viruses
proteins that place uninfected cells in an antiviral state
induce production of ribonuclease --> degrades VIRAL (not host) mRNA --> inhibits viral protein synthesis
164
interferon alpha and beta
inhibit viral protein synthesis
165
interferon gamma
increase MHC I and II expression and antigen presentation in all cells
166
activates NK cells to kill virus-infected cells
interferons
167
all cells have MHC I except
RBC
168
TCR
binds antigen-MHC complex
169
CD3
TCR signal transduction
170
CD28
on naiive T cells binds B7 on APC
171
helper T cells
CD4, CD40L
172
cytotoxic T cells
CD8
173
Ig
B cell that binds antigen
174
B cells
CD 19, 20, 21, 40
MHC II
B7
175
receptors for EBV
CD 21
176
macrophages
CD 14, 40
| MHC II, B7
177
enhanced phagocytosis of macrophages
Fc and C3b receptors
178
NK cells
CD 16 - binds Fc of IgG
| Cd 56 - unique NK marker
179
anergy
self-reactive T cell become nonreactive without costim molecule
less complete tolerance in B cells
180
superantigens
```
strep pyogenes + staph aureus
cross link Beta region of TCR to MHC class II on APCs --> can activate any T cell --> massive release of cytokines
```
181
endotoxins/LPS
gram negative: bind to endotoxin receptor CD14 --> directly stimulate mo (Th cells not involved)
182
antigen variation mechanisms
DNA rearrangement and RNA segment reassortment (flu major shift)
183
antigen variation examples bact
salmonella - 2 flagellar variants
boreelia - relapsing fever
n. gonorrhea - pilus protein
184
antigen variation examples virus
flu (major = shift; minor = drift)
185
antigen variation examples parasites
trypanosomes - programmed rearrangement
186
passive immunity means of acquisition
recieve preformed antibodies
187
active immunity means of acquisition
exposure to foreign antigens
188
passive immunity onset
rapid
189
active immunity onset
slow
190
passive immunity duration
short span of antibodies (t 1/2 = 3 weeks)
191
active immunity duration
long-lasting protection (memory)
192
passive immunity EX
IgA in breast milk, antitoxin, humanized monoclonal antibody
193
active immunity EX
natural inffection, vaccines, toxoid
194
when can combined passive and active immunizations be given
hep B or rabies exposure
195
when are patients given preformed antibodies and what kind of immunity is this
passive immunity
to be healed rapidly
tetanus toxin, botulinum toxin, HBV, rabies virus
196
Type 1 HS
atopic + anaphylatic - fast and first
| cross-links IgE on mast cells and basophils --> release of histamine *rapid after ag exposure due to preformed antibody
197
Type 2 HS
cytotoxic
IgG and IgM --> ag on enemy cell --> cellular destruction
antibody + complement --> MAC
dz specific to tissue ag found
198
Type 3 HS
immune complex mediated - antigen-antibody (IgG)-complement --> neutrophils --> lysosomal enzymes
199
Type 4 HS
delayed HS - t cell mediated
sens T lymphocytes + ag --> release lymphokids --> mo activation
4 Ts = T lymphocytes, transplant rejection, TB skin tests, touching (contact dermatitis)
200
antibody mediated HS reactions
HS I, II, III
201
Type 1 HS test
skin test - specific IgE
202
Type 2 HS mechanisms
opsonization - phagocytosis/complement activation
complemented mediated lysis
ADCC - NK cells
203
Type 2 HS test
coombs (direct and indirect)
204
serum sickness
type III HS
ab to foreign produced within 5 days --> IC form + deposited in membranes --> fix complement --> tissue damage
most now caused by drugs actin as haptens
sx - fever, urticaria, arthralgias, proteinuria, lymphademopathy 5-10 d post-ag exposure
FLAP U
205
arthrus reaction
Type III HS
local subacute
intradermal injection of ag --> antibodies --> ag-antibody complexes
CANE - complement activation, necrosis, edema
cause = antigen-antibody complexes
206
type III HS test
immunofluorescent staining
207
type IV HS test
patch test, PPD
208
type 3 examples
apples - arthrus rxn, polyarteritis nodosa, poststrep glomerulonephritis, sle, serum sickness
vasculitis + systemic manifestation
209
type 4 examples
can you C GGraMP - contact dermatitis, GBS, GVHD, MS, PPD
210
blood transfusion rxn: allergic
HS I vs plasma proteins in transfused blood --> urticaria, prurius, wheezing, fever
211
blood transfusion rxn: anaphylactic
severeeee *IgA-deficient pts must recieve blood that lacks IgA --> dyspnea, bronchospasm, hypotension, resp arrest, shock
212
febrile nonhemolytic transfusion reaction
HS II *host ab. vs donor HLA ag + leukocytes --> fever, headaches, chills, flushing
213
acute hemolytic transfusion reaction
HS II *intravasc hemolysis (ABO) or extravasc hemolysis (host ab. vs foreign ag or donor RBC) --> fever, hypotension, tachypena, tachycardia, flank pain, hemoglobinemia (intravasc), jaundice (extravasc)
214
allergic blood transfusion rxn tx
antihistamines
215
antinuclear antibodies
SLE nonspecific
216
anti-dsDNA
SLE
217
anti-Smith
SLE
218
antihistone
drug-induced lupus
219
rheumatoid factor
RA
220
anti-CCP
RA
221
anticentromere
scleroderma - CREST syndromes
222
anti-Scl-70
scleroderma diffuse
| anti-DNA topoisomerase I
223
antimitochondrial
primary biliary cirrhosis
224
IgA antiendomysial
celiac
225
IgA anti-tissue transglutaminase
celiac
226
anti-basement membrane
goodpasture
227
anti-desmoglein
pemphigus vulgaris
228
antimicrosomal
hashimotos thyroiditis
229
antithyroglobulin
hashimotos
230
anti-jo-1
polymyositis, dermatomyositis
231
anti-SRP
polymyositis, dermatomyositis
232
anti-Mi-2
polymyositis, dermatomyositis
233
anti-SSA
sjogrens syndrome
| anti-Ro
234
anti-SSB
sjogrens syndrome
| anti-La
235
anti-U1 RNP
mixed CT disease
| ribonucleotide protein
236
anti-smooth muscle
autoimmune hepatitits
237
anti-glutamamte decarboxylase
type 1 DM
238
c-ANCA
granulomatosis w/ polyangiitis (wegeners)
239
p-ANCA
microscopic polyangitis, churg-strauss
240
bacterial infections in pt w/ no T cells
sepsis
241
bacterial infections in pt w/ no B cells
encapsules - SHiN SKis
| strep pneumo, h flu type b, n meningitis, salmonella, klebsiella, group b strep
242
bacterial infections in pt w/ no granulocyte
staph, burkholderia cepacia, serratia, nocardia
243
bacterial infections in pt w/ no complement
neisseria (no MAC)
244
viral infection in pt w/ no T cells
CMV, EBV, VZV, chronic infection w/ resp/GI viruses
245
viral infections in pt w/ no B cells
enteroviral encephalitis, polio virus
| CI = live vaccine
246
fungi/parasitic infection in pt w/ no T cells
candida, PCP
247
fungi/parasitic infection in pt w/ no B cells
GI giardiasis (no IgA)
248
fungi/parasitic infection in pt w/ no granulocyte
candidia, aspergillus
249
B cell deficiencies tend to produce
recurrent bacteiral infections
250
T cell deficiencies tend to produce
fungal and viral infections
251
X linked agammaglobulinemia AKA
Brutons
252
X linked agammaglobulinemia defect
X-linked recessive - increase in boys
| defect in BTK (tyrosine kinase gene) --> no B cell maturations
253
X linked agammaglobulinemia sx
opsonization defect --> recurr bact infections after 6 months (low maternal IgG)
254
X linked agammaglobulinemia dx
decrease maturation, number of B cells, immunoglobulins
255
most common primary immunodeficiency
Selective IgA deficiency
256
Selective IgA deficiency sx
asx
sinopulmonary infections, GI infections, autoimmune disease
Anaphylaxis to IgA-containing blood products
257
Selective IgA deficiency dx
IgA < 7 mg/dL
| heterophile antibody --> false-positive beta-HCG
258
CVID
common variable immunodeficiency
259
CVID defect
defect in B cell maturation - many cuases
260
CVID sx
20-30s; increase risk autoimmune dz, lymphoma, sinopulmonary infections
261
CVID dx
normal number B cells but DECREASED PLASMA CELLS AND IMMUNOGLOBULINS
262
Thymic aplasia
digeorges syndrome
263
digeorges syndrome defect
22q11 deletion
| failure to develop 3/4th pharyngeal pouches
264
digeorges syndrome sx
hypocalcemia --> tetany
T cell deficinecy --> recurrent virla/fungal infections
congenital heart and great vessel defects
265
digeorges syndrome dx
thymus and parathyroid cells fail to develop --> decrease T cells, PTH, Ca2+
266
absent thymic shadow on CXR
digeorges syndrome
267
IL-12 R deficiency defect
decrease Th1 response
REMEMBER: Th --> IL-12 --> Th1
Th --> IL-4 --> Th2
268
IL-12 R deficiency sx
disseminated mycobacterial infections
269
IL-12 R deficiency dx
low IFN-gamma (from Th1)
270
hyper IgE syndrome AKA
jobs syndrome
271
jobs syndrome defect
Th1 cells fail to produce IFN-y --> neutrophils cant respond to chemotactic stimuli
272
jobs syndrome sx
FATED
| course facies, cold (noninflamted) staph abscesses, retains primary teeth, high IgE, dermatologic problems (eczema)
273
jobs syndrome dx
high IgE
274
chronic mucocutaneous candidiasis defect
T cell dysfunction
275
chronic mucocutaneous candidiasis sx
candidiana albicans infection of skin and mucous membranes
276
SCID defect
most common x-linked = defective IL-2
| adenosine deaminase deficiency
277
SCID sx
failure to thrive, chronic diarrhea, thrush
| reccurent infections
278
SCID dx
```
decreased t-cell recombinant excision circles
absent thymic shadow
LN biopsy - germinal centers
peripheral blood smears - B cells
flow cytometry - T cells
```
279
ataxia-telangiectasia defect
defect in ATM gene - codes for DNA repair enzymes
280
ataxia-telangiectasia sx
TRIAD: cerebellar defects (ataxia), spider angiomas (telangiectasia), IgA deficiency
281
ataxia-telangiectasia dx
increase AFP
282
hyper IgM syndrome defect
defective CD40L on Th = unable to class switch
283
hyper IgM syndrome sx
severe pyogenic infections early in life
284
hyper IgM syndrome dx
high IgM
| LOWWWW IgG, IgA, IgE
285
wiskott-aldrich syndrome defect
x-linked
| WASP gene on X chromosome --> T cells unable to reorganize actin cytoskeleton
286
wiskott-aldrich syndrome sx
TRIAD TIE = thrombocytopenia purpura, infections, eczema
287
wiskott-aldrich syndrome dx
high IgE, IgA
low IgM
thrombocytopenia
288
leukocyte adhesion deficiency (type 1) defect
LFA-1 integrin (CD18) protein on phagocytes
289
leukocyte adhesion deficiency (type 1) sx
recurrent bacterial infections, absent pus formation, delayed separation of umbilical cord
290
leukocyte adhesion deficiency (type 1) dx
neutrophilia
291
chediak-higashi syndrome defect
AR defect in LYST
| microtubule dysfunction in phagosome-lysosome fusion
292
chediak-higashi syndrome sx
recurrent pyogenic infections by staph + strep
| partial albinism, peripheral neuropathy
293
chediak-higashi syndrome dx
giant granules in neutrophils
294
chronic granulomatous disease defect
lack NADPH oxidase --> decrease ROS (superoxide) + absent resp burst in neutrophils
295
chronic granulomatous disease sx
increase susceptibility to catalase positive organisms (stapg, e coli, aspergillus)
296
chronic granulomatous disease dx
abnormal dihydrorhodamine (DHR) flow cymotry test
297
autograft
from self
298
syngeneic graft
from identical twin or clone
299
allograft
from nonidentical individual of same species
300
xenograft
from different species
301
hyperacute rejection onset
minutes
302
hyperacute rejection pathogenesis
```
ab mediates (type 2)
preformed anti-donor ab in transplant recipient
```
303
hyperacute rejection features
occludes graft vessels -->ischemia and necrosis
304
acute rejection onset
weeks
305
acute rejection pathogenesis
cell mediated
CTLs reacting vs foreign MHCs
reversible w/ immmunosuppresants (cyclopsporine, muromonab-DC3)
306
acute rejection features
vasculitis of graft vessels w/ dense interstitial lymphocytic infiltrate
307
chronic rejection onset
months-years
308
chronic rejection pathogenesis
class I-MHC non self percieved by CTLs as class I-MHCself presenting on non-self antigen
309
chronic rejection features
irreversible
t cell and ab.-mediated vascular damage (obliterative vascular fibrosis)
fibrosis of graft tissue and blood vessels
310
GVHD pathogenesis
grafted immunocompetent T cells in IC disease host --> reject cells with foreign proteins --> severe organ dysfunction
311
GVHD features
maculopapular rash, jaundice, hepatosplenomegaly, diarrhea
| BM + Liver transplant (rich in lymphocytes)
312
potentially beneficial in BM transplant
GVHD --> to kill cancer cells!
313
cyclosporins mechanism
binds cyclophilins --> inhibits calcineurin --> prevents IL-2 and R production --> inhibits differentiation/activation of T cells
314
cyclosporins clinical use
suppresses organ rejection post-transplant; some autoimmune dz
315
cyclosporins toxicity
nephrotoxicity, HTN, hyperlipidemia, hyperglycemia, tremor, gingival hyperplasia, hirsuitism
HHHunTiNG
316
tacrolimus (FK-506) mechanism
binds FK-bidning protein --> inhibits calcineurin + IL-2 secretion
317
tacrolimus clinical use
potent immunosuppresive used in organ transplant recipients
318
tacrolimus toxicity
nephrotoxicity, HTN, hyperlipidemia, hyperglycemia, tremor
| HHunTiN
319
azathioprine mechanism
6-mercaptopurine antimetabolite precursor interfers w/ nucleic acid metabolism/synthesis --> toxic to proliferating lymphocytes
320
azathioprine clincial use
kdiney transplant,a utoimmune dz (glomerulonephritis + hemolytic anemia)
321
azathioprine toxicity
BM suppression
| active metabolite metabolized by xanthine oxidase --> increased allopurinol = toxic effects
322
muromonab-CD3 (OKT3) mechanism
monoclonal antibody binds CD3 (epsilon chain) on T cell surface --> block cell interaction w/ CD3 protein responsible for T-cell signal transduction
323
muromonab-CD3 (OKT3) clinical use
immunosuppresion post-kidney transplant
324
muromonab-CD3 (OKT3) toxicity
cytokine release syndrome, HS ran
325
sirolimus (rapamycin) mechanism
inhibits mTOR --> inhibits T cell prolif in response to IL-2
326
sirolimus (rapamycin) clinical use
immunosuppresion post-kidney transplant w/ cyclopsporine + corticostoeroids; also used w/ drug-eluting stents
327
sirolimus (rapamycin) toxicity
hyperlipidemia, thrombocytopenia, leukopenia
328
aldesleukin used for
renal cell carcinoma, metastiac melanoma
329
epoetin alfa used for
anemias (renal fialure)
330
filgastrim used for
recover BM
331
sargramostim used for
recover BM
332
alpha-interferon used for
hep B + C, kaposis sarcoma, leukemias, malignant melanoma
333
beta-interferon used for
MS
334
gamma-interferon used for
CGD
335
oprelvekin used for
thrombocytopenia
336
thrombopoietin used for
thrombocytopenia
337
muromonab-CD3
CD3 --> prevents acute transplant rejection
338
Digoxin Immune Fab
digoxin --> antidote for digoxin intoxication
339
infliximab
TNF-alpha --> CD, RA< psoriatic arthritis, akylosing spondylitis
340
adalimumab
TNF-alpha --> CD, RA, psoriatic arthritis
341
abciximab
glcyoprotein IIb/IIIa --> prevent cardiac ischemia in unstable angina + pts treated w/ PCI
342
trastuzumab
HER2 --> HER-2 overexpressing breast cance
343
rituximab
CD20 --> B-cell non-hodgkins lymphoma
344
omalizumab
IgE --> additional line of tx for severe asthma
