Immuno 9: Immune Modulation Therapies 1

Question 1

Describe Clonal expansion in T cells?

Answer 1

If an antigen is presented to a T cell receptor which has high specificity for it, the T cell proliferates and differentiates into T helper, Cytotoxic and memory cells

Question 2

List 3 vaccines given to the elderly aged over 65?

Answer 2

Pneumococcal vaccine (Pneum PPV)
Flu vaccine
Shingles

Question 3

Describe clonal expansion in B cells ?

Answer 3

If the B cell receptor has high specificity for the antigen presented, the B cell will become activated and undergo proliferation and differentiation into IgM secreting plasma cells and B memory cells

Question 4

Where do B cells undergo Isotype switching ?

Answer 4

Germinal centres

Question 5

Where do plasma cells reside ?

Answer 5

Bone marrow

Question 6

which bacteria is in the BCG vaccine ?

Answer 6

Bovine tuberculosis

Question 7

Give 3 examples of live attenuated vaccines ?

Answer 7

MMR
Yellow fever
Typhoid

Question 8

Give 2 examples of Toxoid vaccines (Inactive toxins) ?

Answer 8

Diphtheria

Tetanus

Question 9

Give 3 examples of subunit vaccines ?

Answer 9

Hep B (HBsAG)
HPV (capsid)
Influenza (HA)

Question 10

Give one advantage of a life vaccine compared to a component/inactivated vaccine ?

Answer 10

Longer lasting immunity (life long)

Immunity is broader (protects against more strains)

Question 11

Give an advantage of a component/inactivated vaccine compared to a live vaccine ?

Answer 11

Can be given to immunocompromised patients

Question 12

Give 3 examples of conjugate vaccines ?

Answer 12

HiB (haemophilus influenza B)
Meningococcus
Pneumococcus

Question 13

List 2 indications for Haematopoeitic stem cell transplantation ?

Answer 13

SCID

Haematological malignancy

Question 14

List 3 primary immunodeficiency diseases in which Antibody replacement (pool of antibodies to variety of organisms) is indicated ?

Answer 14

Bruton’s X-linked agammaglobulinaemia
X-linked hyper IgM syndrome
Common variable immunodeficiency

Question 15

In which 2 Haematological malignancies is Antibody replacement indicated ?

Answer 15

CLL

Multiple myeloma

Question 16

List 3 diseases in which IgG immunoglobulin therapy can be used ?

Answer 16

Shingles infection (varicella zoster)
Rabies (post exposure)
Hepatitis B

Question 17

Give one example of an infection in which adoptive cell transfer (ACT) can be used to infuse a donor’s T cells ?

Answer 17

EBV infection in immunocompromised patients.

T cells from a donor are isolated and exposed to EBV antigen to stimulate Clonal expansion of specific T cells. These T cells are infused into the immunocompromised recipient to treat EBV infection.

Question 18

How does Ipilimumab work in treatment of advanced melanoma ?

Answer 18

Ipilimumab blocks CTLA4 which is an inhibitory receptor on T cells
This causes increased T cell activation and boosts the immune response

T cells have CD28 (activator receptor) and CTLA4 (inhibitory receptor).
CD80 and CD86 on APCs can bind to either to activate/inhibit T cells

Question 19

How does Pembrolizumab and nivolumab work in the treatment of advanced melanoma ?

Answer 19

They inhibit PD-1 receptors on T cells.
This causes increased T cell activation because PD-1 is an inhibitory pathway.

PD-1 receptors on T cells cause an inhibition of T cells when activated by PD-ligand 1 or 2 on APC or tumour cells

Question 20

What side effects are more common in patients receiving monoclonal antibodies for advanced melanoma ?

Answer 20

Auto-immune diseases (arthritis, thyroid disease, Diabetes)

Because the T cell response is over stimulated

Question 21

Match up the recombinant cytokine treatment with the disease that they are used in ?

IFN alpha Chronic granulomatous disease
IFN beta Hepatitis B
IFN gamma Behçet’s disease

Answer 21

IFN alpha Hepatitis B
IFN beta Behcet’s disease
IFN gamma Chronic granulomatous disease

Question 22

what happens when B cells with appropriate specificity get selected

Answer 22

proliferate
differentiate into T cell independent IgM plasma cells
undergo germinal centre reaction and differentiate into T cell dependent IgG producing memory and plasma cells

Question 23

list 3 types of APC

Answer 23

dendritic cells
macrophages
B lymphoctes

Question 24

features of memory B and T cells

Answer 24

memory T - different pattern of expression of cell surface proteins involved in chemotaxis and cell adhesion, allowing rapid access to non-lymphoid tissues
memory B - circulating pre-formed high-affinity IgG antibodies present

Question 25

name the membrane fusion glycoprotein of influenza virus

Answer 25

haemagglutinin (HA)

target for antibodies

Question 26

describe a use for virus specific T cell adaptive cell transfer

Answer 26

for EBV in the immunocompromised
to prevent development of B cell lymphoproliferative disease
functional EBV specific T cells
blood taken from pt/ matched donor - mononuclear cells isolated and stimulated with EBV peptides - expansion of EBV specific T cells

Question 27

what is tumour infiltration T cell therapy

Answer 27

remove tumour
stimulate T cells within the tumour with cytokines in the presence of the tumour so they develop resistance to it
select and expand tumour infiltrating lymphocytes and reinfuse into the patient

Question 28

what is TCR and CAR T cell therapy

Answer 28

T cells taken from patient
viral/non-viral vectors are used to insert fragments of genes into these T cells
these gene fragments encode receptors
for TCR therapy - insert a gene that encodes a specific TCR against a tumour cell antige
for CAR therapy (chimeric antigen receptor) - receptors contain both B and T cell components

used in ALL and NHL

Question 29

how can we block immune checkpoints

Answer 29

Iplimumab - antibody specific to CTLA4 - advanced melanoma

Pembrolizumab and Nivolumab - antibodies specific to PD1 - activates T cells - advanced melanoma

Question 30

list clinical uses of recombinant cytokines

Answer 30

interferon alpha - adjunt in treatment of hep B, C, kaposi sarcoma, CML, multiple myeloma
interferon beta - behcets disease, relapsing MS
interferon gamma - chronic granulomatous disease