Immunologie 2 Flashcards
What is atopy?
A predisposition to become IgE-sensitized to environmental allergens
Name 5 different forms of IgE-mediated allergic reactions.
- systemic anaphylaxis
- acute urticaria
- seasonal rhinoconjuctivitis (hay fever)
- asthma
- food allergy
Systemic anaphylaxis
Name 2 common stimuli, route of entry, clinical symptoms
- Drugs, venoms, food (e.g. peanuts), serum
- Intravenous – directly or following absorption into the blood after oral intake
- edema, increased vascular permeability, death
Acute urticaria
Name 2 common stimuli, route of entry, clinical symptoms
- Post-viral, animal hair, bee stings, allergy testing
- Through the skin, systemic
- local increase in blood flow and vascular permeability, edema
Seasonal rhinoconjuctivitis (hay fever):
Name 2 common stimuli, route of entry, clinical symptoms
- Pollens, dust-mite feces
- Contact with conjunctiva of eye and nasal mucosa
- edema of conjuctiva and nasal mucosa, sneezing
Asthma:
Name 2 common stimuli, route of entry, clinical symptoms
- Dander, pollens, dust-mite feces
- Inhalation leading to contact with mucosal lining of lower airways
- bronchial constriction, increased mucus production, airway inflammation, bronchial hyperreactivity
Food allergy:
Name 2 common stimuli, route of entry, clinical symptoms
- Peanuts, tree nuts, shellfish, milk, eggs, soy, wheat
- oral
- vomiting, diarrhea, itching, hives, rarely anaphylaxis
What type of immune response is mandatory for developing an IgE mediated allergic disease?
- The cytokine responses are type 2 immune responses.
- Differentiation of naïve T cells to the Th2 phenotype; then Th2 secretes cytokines IL-4, IL-5, IL-13, and co-stimulatory signals stimulate B cells to class switch and produce IgE.
At which sites in the body is most of IgE localized?
Predominantly in the linings of the tissues where mast cells are found: skin, mucosal, and submucosal tissues
Note: the mast cells are already covered by the IgE, and the release of granule content is triggered by antigen binding to these IgE antibodies.
Which functional feature do papain and Der p1 have in common and how is it related to allergy propagation?
- They are both enzymatic allergens (they bind to B cells, engage IgE molecules of B cells and promote B cell response); both cysteine proteases. They break barriers so they can go through the skin or mucosa. Then they can be taken up by DCs which then migrate to the lymph node and prime Th2 cells.
Many (not all) inhaled allergens share following features. Explain shortly how they relate to their allergenic properties:
- Protein, often with carbohydrate side chains
- Low dose
- Low molecular weight
- Highly soluble
- Stable
- Contains peptides binding to host MHC class II Molecules
- Protein, often with carbohydrate side chains
- Protein antigens induce T-cell responses
- Low dose
- Favors activation of IL-4-producing CD4+ T cells
- Low molecular weight
- Allergen can diffuse out of particles into the mucosa
- Highly soluble
- Allergen can be readily eluted/dissolved from particles
- Stable
- Allergen can survive/remain effective in desiccated/dried particle
- Contains peptides binding to host MHC class II Molecules
- Required for T-cell priming/activation of T cells at first contact
Explain shortly why it makes sense that genetic polymorphism of IL-13, IL-33, FcεR are linked to susceptibility to Asthma?
IL-13 favors CD4+ T cell differentiation into Th2 cells; Th2 cytokines help stimulate B cells to switch to IgE production.
IL-33 (and IL-13) can be produced by activated mast cells and damaged or injured epithelial cells, and contributes to amplification of the Th2 response. IL-33 acts directly on Th2 cells via IL-33 receptors.
FcεR is an IgE receptor found on mast cells (FcεRI = high affinity IgE receptor). Soluble IgE binds to the FcεR on the mast cell; Antigen binding to IgE cross-links the receptors, causing release of chemical mediators from mast cells.
- IgE-mediated allergic disease
How can allergy to non-peptide allergens such as Penicillin be linked to MHC polymorphism?
Some drugs can interact with specific HLA alleles in a way that changes the structure of peptide antigens bound in the groove of the HLA molecule -> altered peptides -> autoimmune-type response
Particular peptide:MHC combinations favor a Th2 response -> allergy
Certain MHC allele products can bind the peptide and others cannot. So this is how it is linked to MHC polymorphism.
Name the term, which describes the function of a drug such as penicillin in terms of inducing a B-cell response.
Involved in hapten-carrier response
Penicillin can bind to various proteins which then makes it able to bind to the B cell receptor
Antigen specific B cell presents to peptide specific helper T cell
What is desensitization and how might it work?
- Immunotherapy to restore a patient’s ability to tolerate exposure to an allergen.
The allergen is injected in tiny amounts and is increased over subsequent injections.
- The IgE antibody response is changed over time to an IgG dominated response.
- Desensitization also seems to induce Treg cells that secrete IL-10 and/or TGF-β which skews the response away from IgE production.
This works really well with wasp venom as well as bee venom.
What exactly does an allergen in triggering IgE mediated activation of mast cells (keep it simple)? Name the receptor to which it binds.
- A multivalent allergen binding to IgE which is already bound to Fcε receptors of mast cells causes cross-linking of the Fcε receptors.
- This induces mast cells to release inflammatory lipid mediators, cytokines, and chemokines.
- FcεRI is the high-affinity IgE receptor on mast cells.
Which compounds are immediately released after triggering the IgE receptor of mast cells and where have they been stored?
Tryptase, chymase, cathepsin G, carboxypeptidase, histamine, heparin, some TNF-α – stored in preformed granules inside the mast cell.
Which cells are recruited by Prostaglandin D2?
Th2 cells, eosinophils, and basophils
What is the physiological role of eosinophils and which protein compound released by them triggers degranulation of mast cells and basophils?
- Defense against parasites (helminths).
- Release toxic granule proteins and free radicals to kill microorganisms and parasites
- Synthesize chemical mediators to amplify the inflammatory response, activate epithelial cells, recruite and activate more eosinophils and leukocytes (Production of prostaglandins and leukotrienes)
- They may also play a role in restoring tissue homeostasis after infection and tissue damage
- major basic protein
Which phase of allergy is affected by antihistamines and which phase by glucocorticoids?
The immediate phase/immediate response is affected by antihistamines (because the immediate phase is caused by histamine, prostaglandins, and other preformed or rapidly synthesized mediators released by mast cells).
The late phase is affected by glucocorticoids (the late phase is cause by factors which result in vasodilation, vascular leakage, edema, recruitment of eos, basos, monos, and lymphs).
Explain the term “endotype” with respect to asthma.
Endotypes are various different phenotypic subtypes of asthma characterized by differences in the nature of the inflammatory cell infiltrates present in the airways, and in the molecular signature of inflammatory mediators that can be recovered from the airways.
This can also lead to differences in patients’ responsiveness to different therapies.
Common endotypes include:
- common allergic asthma – Th2 cells, eos, basos – most common
- exercise-induced asthma
- neutrophil-predominant asthma
- steroid-resistant asthma – Th17 cells, neutrophils
- eosinophil-predominant asthma is another one
- allergic bronchopulmonary aspergillosis (ABPA) is another one – Th17 cells
What are the major effector molecules in Arthus reaction and serum sickness?
- Antibodies forming immune complexes
- Fc receptors (FcγIII) on leukocytes
- complement - C5a and C3a
Differentiate between Arthus reaction and serum sickness?
Serum sickness – response against foreign immunoglobulins, formation of immune complexes which then activates complement which then causes damage.
Immune complexes localize in certain areas.
Arthus reaction has preformed IgG against the allergen, thats why it may appear in booster vaccines.
Serum sicknes develops IgG after antigen is introduced to the body. So for serum sickness: normal immune response development
Which antigen (molecule) classes induces delayed type hypersensitivity, and which contact sensitivity?
DTH –proteins: insect venoms, mycobacterial proteins
Contact – haptens, small metal ions
Which are the target molecules in induction of nickel allergy.
i) in terms of the T-cell response to divalent cations
ii) induction of a proinflammatory signal, which is needed to develop the reaction.
- The divalent cations can alter the conformation or the peptide binding of MHC class II molecules, which provokes a T cell response
- Can bind to receptor TLR-4 to produce a pro-inflammatory signal
Which food protein causes Celiac disease?
Gluten (probably more specifically α-gliadin found in gluten)
Please explain the role of Transglutaminase in development of Celiac disease.
The enzyme transglutaminase deamidates the gluten protein gliadin enabling it to bind strongly to HLA-DQ2.
-> activation of gliadin-specific CD4+ T cells -> secrete IFN-γ in lamina propria -> intestinal inflammatory response
Give an example for a hypersensitivity:
-
Immediate - Type I – allergic rhinitis, allergic asthma
- IgE mediated, Th2
-
Antibody mediated - Type II – penicillin allergy
- takes longer to appear than immediate hypersensitivity. Is due to binding of soluble IgG bound to surfaces.
- Type III – serum sickness
- IgG mediated by immune complexes
- Type IV (Th1/Th17/CTL) mediated – contact dermatitis to poison ivy, tuberculin reaction
- delayed type hypersensitivity. Classic is tuberculin reaction. Appears later, not immediate. Cell mediated.
What is sensitization?
involves class switching to IgE production on 1st contact with an allergen
Induction of Type II cytokine producing T cells induces class switch
What is an ‘autologous’, ‘syngeneic’, allogeneic’ and ‘xenogeneic’ graft?
- Autologous graft: graft transplanted from one individual to the same individual (self)
- Syngeneic graft: graft transplanted between to genetically identical individuals
- Allogeneic graft: graft transplanted between 2 genetically different individual of same species
- Xenogeneic graft: graft transplanted between individuals of different species
Please fill in the following table indicating as to which graft will be accepted and which rejected!
see picture
Will an animal of strain x accept a graft from strain y after prior transplantation of a graft from strain x?
No
An animal of strain x receives a skin allograft from strain z which is rejected within 3 days. Has this animal had a previous skin allograft and if yes of which strain?
- Yes, this is a 2nd set rejection. The animal had a previous allograft from strain z/same strain as the 1st time.
In humans, will a child accept a skin graft from one of its parents?
- No, in humans, the child only inherits half of the HLA genes from each parent, so the other half of the HLA molecules would be foreign.
In these experimental mice, they are inbred and homozygous for these alleles, whereas humans are heterozygous.
After transplantation of a kidney, which molecules are responsible for direct versus indirect allorecognition by the recipient’s T cells?
see picture
Are the peptides presented by donor MHC molecules in a solid organ graft ‘self’ or ‘foreign’ to the host?
foreign
What are the frequencies of cells specific for a foreign peptide in the context of self-MHC molecules versus a foreign MHC molecule plus foreign peptide among naïve CD4+ T cells?
- 1 to 10% of an individual’s T cells will directly recognize an allogeneic/foreign MHC molecule
- Only 1 in 105 or 106 T cells recognize a microbial peptide displayed by self-MHC molecules.
Up to how many alleles are there for a given HLA molecule in the human population?
- Over 10,000 total; more than 3,000 for HLA-B (ch. 6, p 124)
- Definitely several thousand. This is the most polymorphic locus in the genome.
Are alloantigens also indirectly presented to CD8+ T cells and if yes by what mechanism?
- Yes, by cross-presentation (cross-priming). Host dendritic cells ingest proteins of graft cells, deliver the proteins to the cytoplasm where they are processed by proteasomes, and then the peptides are presented on class I MHC molecules.
If indirect allostimulation of recipient CD8+ T cells occurred, would these cells lyse donor cells and if not why?
- No, because CD8+ CTLS generated by indirect recognition of allogeneic MHC are restricted to recognition of peptides from these allogeneic MHC molecules bound to recipient (self) MHC molecules. The donor cells do not express recipient MHC molecules, so the CTLs will not be able to lyse them.
What is an allogeneic mixed leukocyte reaction (allo-MLR)?
- An in vitro reaction of alloreactive T cells from one individual against MHC antigens on blood cells from another individual. The MLR involves proliferation of and cytokine secretion by both CD4 + and CD8 + T cells.
- This is widely used in vitro readout to study alloreactivity of T cells
- Can also use this to check for reactivity between recipient T cells and donor MHC molecules
Please indicate the mechanisms of graft rejection?
see picture
Why does the binding of preformed antibodies cause greater damage to a xeno than to an allograft?
They activate complement, and complement regulatory proteins made by xeno cells cannot interact with human complement proteins, so they cannot limit the extent of injury induced by the human complement system.
May a human individual with blood group A receive a blood transfusion from a donor with blood group 0 and if yes, why?
Yes, because Group 0 donor red blood cells do not contain A nor B antigens. The blood group A individual will have preformed anti-B IgM but will not react to 0 blood which has no B antigen present.
Please name the mechanism of action of immunosuppressants Cyclosporine and Tacrolimus used to prevent allograft rejection.
- Inhibits Calcineurin-dependent NFAT activation and thus transcription of T cell genes encoding cytokines such as IL-2. This blocks IL-2 dependent proliferation and differentiation of T cells.
- Cyclosporine, Tacrolimus
Which cells cause Graft-Versus-Host-Disease?
Donor T cells
Which tumours preferentially occur in patients receiving prolonged immunosuppressive therapy after allotransplantation?
Virus-associated tumors such as uterine cervical carcinoma (associated with HPV) and lymphomas (associated with EBV).
Please name the main classes of tumour antigens.
- Neoantigens, produced by mutated genes in different tumor cell clones
- Products of oncogenic viruses
- Overexpressed cellular proteins/self antigens
- May be silenced in normal cells; may be expressed at abnormally high levels; may be expressed by more cells
- De-repressed expression – e.g. cancer/testes antigens
- Normally methylated
- During cancer, gets demethylated and can cause T cell reaction
- Strong overexpression of oncogenic protein due to gene amplification – e.g. HER2/neu in breast carcinomas
- Increased # of cells expressing tissue-specific protein – e.g. tyrosinase in melanomas
- Others
- Oncofetal antigens
- AFP – comes up in hepatic carcinoma. Can be used as a tumor marker. Genes not strongly expressed in adults but only in fetal life, so there is not tolerance mechanisms in adults
- CEA is also a fetal antigen
- Altered glycolipid and glycoprotein antigens
- Oncofetal antigens
Which cells are the main mediators of anti-tumor immunity?
T cells, especially CD8+ CTLs; and CD4+ Th1 cells to maintain the response
How do tumors manage to escape anti-tumor immunity?
- Active inhibition of antitumor immune responses by production of immunosuppressive proteins
- Expression of inhibitory cell surface proteins
- Loss of immune-stimulating tumor antigens/neoantigens
- Mutations in MHC genes or genes needed for antigen processing, leading to lack of T cell recognition of the tumor
- Induction of regulatory T cells
- Stimulation of macrophages to go from pro-inflammatory to anti-inflammatory phenotype
What is a checkpoint inhibitor?
- A method of inhibiting immune checkpoints.
- Immune checkpoints are blocks in immune responses.
- CTLA-4 is expressed on regulatory T cells which blocks and removes B7 on APCs -> costimulation signals through B7-CD28 binding are blocked -> T cell response is blocked
- PD-1 on antigen-activated T cells interacts with PD-L1 on tumor cells -> inhibits signals from TCR coreceptor complex, CD28, and other costimulatory receptors -> inactivation of T cells
- Checkpoint inhibitors block PD-1, PD-L1, or CTLA-4 -> removes T cell inhibition -> allows anti-tumor T cell response to resume
Which approaches are employed for active therapeutic vaccinations against cancer?
- Identify tumor-specific mutations, mutated HLA-binding peptides, and T cells from the patient that are neoantigen-specific
- Use proinflammatory molecules such as CpG DNA, dsRNA mimics, and cytokines to enhance the number of activated dendritic cells at the vaccination site
- DC-based: Purify dendritic cells from the patient, incubate with tumor antigens, and inject back into the patient
- DNA vaccines and viral vectors encoding tumor antigens which are synthesized in the cytosol of dendritic cells, for example, and can then be presented via class I MHC to CD8+ T cells to induce CTL response
- Need an inflammatory component to drive T cell response