Immunology

Question 1

Immunohematology:

1. ) A Blood: Possible genotype? RBC Antigen? Ab’s in plasma? Can donate? Receive? Common?
2. ) B Blood: Possible genotype? RBC Antigen? Ab’s in plasma? Can donate? Receive? Common?
3. ) AB Blood: Possible genotype? RBC Antigen? Ab’s in plasma? Can donate? Receive? Common?
4. ) O Blood: Possible genotype? RBC Antigen? Ab’s in plasma? Can donate? Receive? Common?
   - Isohemoglutanins? Primarily made of? When you first come into contact? On each cell type? Ab’s to these? Bombay? Blood match? Typed as?

Answer 1

1. ) AA, AO; A; Anti B; A & AB; A & O; 42%W,27%B
2. ) BB, BO; B; Anti A; B & AB; B & O; 9%W, 21%B
3. ) AB; A, B; None; ABonly; A,B,AB, O; 3%W; 4%B
4. ) OO, Bombay; None; Anti A/ Anti B; A,B,AB,O; O only; 46%W; 48%B
   - Blood antigens primarily glycolipids (lipid backbone with terminal sugar); young in nature; H, A, B, h; IgM made against what you don’t have; LAck transferase gene that places final sugar so does not express even H; Only bombay; “O” but have antigens to O, A, B in plasma

Question 2

Immunohematology:

• Cross match: Blood tested for? (7) Reverse typing? 1.) Plasma of patient mixed with? Testing for? 2.) Direct anti-globulin test to check for?
• Direct antiglobulin test? Detects?
• Indirect anti-globulin test? Detects?
• Heterophile ab? Ex? (2)
• Hemolytic Blood Disease: Consequences? (3)
  1. ) Erthro. Fetalis: Genotypes? Happens why? Type of Ab’s? Prevention? Given when?
  2. ) ABO hemolytic disease: Occurs when? Common in what group?

Answer 2

• ABO, Rh, Hep B, C, HIV, WNV, Syphallis; Add patients serum to RBC’s to test for Ab’s; RBC’s of donor; IgM; IgG
• Take RBC’s, wash them, add sheep anti-globulin, checks if ab’s on cell in vivo
• Take RBC’s, add patient plasma, add sheep anti globulin; is there Ab to RBC’s in recipients plasma
• Ab to one antigen cross reacts to another; Mono ab reacts with sheep blood; syphallis ab reacts with phospholipids of beef heart
  1. ) Rh(+) kids with Rh(-) mom; 3rd trimester has some RBC’s cross placenta and mom makes IgG ab’s which is fine for first kid, but bad there after; Give mom IgG ab to Rh immunoglobulin (Rhogam) before she makes immune response; 28 weeks
• Mom makes IgG isohemglunins to B blood; (O)

Question 3

Immunomodulators:

• Biological response modifiers? Ex? (3)
• Monoclonal ab’s: Made how?
• 1st gen? Made from? Works? Gene? Drugs?
• 2nd gen? Made from? Leads to? Drugs?
• 3rd gen? Made from? Leads to? Drugs?
• 4th gen? Made from? Drugs?
• MAB’s often made against?

Answer 3

• Mimics things body does naturally; receptor antagonist, cytokine, ab
• Progeny of a single B cell that has been fused with multiple myeloma plasma tumor cell
  1. ) Pure mouse; works first time then Human Against Anti Mouse AB (HAMA); murine; (omab)
  2. ) Chimeric: Only Vh and VL are mouse; leads to HACA; chimeric (ximab)
  3. ) Humanized; only HVR’s are mouse; leads to HAHA; humanized (zumab)
  4. ) SCID mouse with human immune organs; all human; human (umab)
• TNFa, IL1, anti inflamm agents

Question 4

Immunomodulators:

• NK cells: Type of lymphocytes? Work similar to? But? Why? 2 tricks: 1? Part of what response? 2? Ex? Implications with MHC? Have what receptor?
• Chimeric Antigen receptors: Combine 2 single chain? What are the 2?
• Cancer therapy with MAB’s: 4 ways this is done?

Answer 4

• Large granular; CTL but no VDJ regions since not from thymus; 1.) Have a few markers to see if cell is stressed (innate response) 2.) Ab dependent cell mediated toxicity (ADCC): Tumor cells down regulate stress markers and up regulate CD80/PD1; Ab binds; NK do their thing; Not MHC resitricted like CTL so anyones cells work; Receptor for Fc end of IgG
• Ab’s; 1.) CD3 to bring CTL close 2.) Bind antigen receptor (presumably cancer); brings both together
• Activate compliment, invoke ADCC, tagged with poison, radioisotope to kill cell

Question 5

Immunodiagnosis:

1. ) Serum protein electrophoresis: Measure what? Indirect test of? 5 peaks? Normal? IgA deficiency? Multiple myeloma? Pus infection? Hypogamma?
2. ) Radial Immunodiffusion: Measures? Could also measure? (2) Size of circle tells you? Compared to?
3. ) Mixed cyroglobulin test: Works how? Good for?
4. ) RF test: Done how?
5. ) ANA: Done how?
6. ) Direct immuno test: Steps? (2)
7. ) Indirect: Steps? (3)

Answer 5

1. ) Globulin proteins in blood; humoral immune response; albumin, a1, a2, b, gamma globulins; small bump, can’t tell; single sharp peak; peaked gamma; low/no bump
2. ) Individual globulin counts; compliment, clotting factors; how much IgA in blood (example); standard
3. ) Immune complexes insuluble in cold; add to fridge; type 3 is suspected
4. ) Latex particles coated with IgG then add IgM
5. ) Permeable human cells then add pt’s serum
6. ) Tissue on slide; add flourescent ab to know bacteria (checking for antigen)
7. ) Bacteria on slide; add florescent ab’s; goat ab; test for presecene of antibody

Question 6

Immunodiagnosis:

8. ) ELISA steps? (3) Now used?
9. ) Sandwhich ELISA? Steps? (3) Used to test? 2 MABs must have? Amount of color change?
10. ) Passive agglutination: Measure what? Percipitation test? Passive test? Measures titer which is? No agglut? Agglut?
11. ) Skin Test: Test for what? Read how long after?
12. ) DTH Test: Done how? Test for?
13. ) Steps to positive TB test? (6)
14. ) Flow cycometry: Evaluates? Measured by adding? Then?
15. ) T cell function measured how?
16. ) Chest x ray?
17. ) Lymphoid biopises to look at?

Answer 6

8. ) Add ag to plate; add goat IgG with radioisotope; Mouse MAB with an enzyme
9. ) Add Plate with 1 MAB; Add pt’s serum; Wash and add second MAB with enzyme; detect antigen; epitopes for antigen; amount of antigen
10. ) Amount of a specific ab in pt’s serum; primitive, mix pt’s serum and Ag looking for ppt; more sensitive; ag is added to RBC/bead then add dilutions of pt’s serum; lowest amount of serum to make agglut; point; diffused
11. ) TH1 via hypersensitivity; 24-48 hours
12. ) Good test for T cells; paint on skin
13. ) Ab endo by DC; Ag digested; Ag on Class 2 MHC; anti TB TH1 come by; Release IFNg; mac’s activated
14. ) T cell #; MABs to CD3,CD4,CD8
15. ) Add serum to mitogen and measure cytokines
16. ) Examine size and presecense of thymus
17. ) Markers

Question 7

Tumors:

• Immunosureilanve theory? Malignancy =? Evidence for? (3) Evidence against? (2)
• Immunoediting: 3 stages and definitions?
• Tumor associated antigen? 3 gene products? (ex)
• Carcinoembryonic antigen? Often found it what patients? Kit example? But? Better use?
• CTL cells role in cancer? Mediated by? (2)
• NK role in cancer? 2 tricks? Supressed by?

Answer 7

• Role of immune system (part. t cells) is to monitor cell surfaces and destroy abnormal cells; failed immune system; immunodeficient pt’s get cancer, presence of T cells on tumor is good sign; some tumors regress due to immune system; immunodef. pts get certain types of cancer; nude mice get few cancers
• 1.) Elimination = malignant cells recognized and cleared
  2. ) Equilibrium = Tumor not destroyed but not growing
  3. ) Escape = Escapes surveilence via tricks
• not found on normal cell, if recognized then destroyed; viral=HPV, EBV; mutant = chemical/physical carcinogenesis (often vary pt. to pt.); normal = oncofetal lineage
• Oncofetal antigen; colon cancer; CEA; many false positives; use if suspicious or track progress
• CD8’s recognize TAA via class 1; Fas mediated apoptosis or IFNgamma to bring in Macs
• Don’t have to be from host; check for stress markers (innate); ADCC (adaptive); MHC class 1 T cells

Question 8

Tumors:

• Adoptive Cell Transfer Therapy: Use what? Steps? (4)
• Hellstrom experiment: 3? Blocking T cell function? Possible blocking factors?
• Treatment: 3 B cell methods? T cell method?
• BCG treatment?
• Problem with MABs? (3)
• Nude mice with no immune system: Why no cancer?

Answer 8

• Pt’s own immune response; Pt’s Tumor Infiltrating lymphos taken; expand in culture with IL2; excise some tumor; add TIL’s back
• 1.) T cells regressing tumors added to melanoma = killed
  2. ) T cells progressing tumors added to melanoma = killed
  3. ) T cells with progressive serum added = not killed
• something in serum; Ab’s shielding tumor
• MAB’s to increase compliment/ADCC/ tagged with poision; MAB to decrease autocrine; AB with chain for CD3 and target marker…Activate RE system to clear blocking factors
• Inject it into tumor; delayed hypersensitivity with innocent bystander (tumor)
• Ab’s not best against tumors; cancer evolve to down reg certain epitopes; many false positives as screen
• High NK cell

Question 9

AIDS:

• HIV seropositive means?
• AIDS? (2)
• Virus: Genes? Oncogene? Reproduce via? Contain? (7)
• Orgin: When? Where? From? US when? Came via?
• Epi: In US? Don’t know? Worldwide? Stabilized?
• Pathogenesis: Blood virus peaks? Ab’s peak? Latency - average incubation? 10 steps? Initially infected cells cleared? But? CD4:CD8 goes from? To?

Answer 9

• Have Ab to HIV

- CD4

Question 10

AIDS:

• Potential drug target? (4)
• 32 BP deletion of CCR5: Need? Infected? Sick?
• Elite controllers?
• TH2/TfH in HIV patients? Ab’s? CTL’s?
• Common infections: Primarily? (6) What’s fine?
• Lab diagnosis algorithm: (4?)
• Vaccine problems: Most vaccines stimulate? Problem with this? (2) HIV in general problems? (2) What may help?

Answer 10

• CCR5, integrase, RT, protease
• 2 mutated alleles; yes; CCR5 not expressed so not sick
• HLA-B57 make great CTL response; harbor virus but don’t get sick (F/A pockets have high affinity for virus)
• Prominant; not effective (hidden epitopes); not stimulated
• T cell mediated ones; CMV, HSV, Candida, TB, Karposis; extra cellular bacteria response
• OraQuick; ELISA to check Ab; Western for gp120/41; PCR
• Ab response; epitopes hidden and evolving; high mutation rate with a high tolerance of mutations; mAB’s