Immunology Flashcards
1
Q
what is the site of B cell localization and proliferation in the lymph node?
A
Follicle
2
Q
Where are the follicles in a lymph node located?
A
Outer cortex
3
Q
What do primary follicles look like in a lymph node?
A
Primary follicles are inactive and are dense and dormant
4
Q
What do secondary follicles look like in a lymph node?
A
Secondary follicles have pale central germinal centers and are active
5
Q
where are macrophages located in the lymph node?
A
medullary sinus
6
Q
Where are plasma cells located in the lymph node?
A
Medullary cords
7
Q
Where are T cells located in a the lymph node?
A
Paracortex
8
Q
were do T and B cells enter the lymph node from the blood?
A
They enter via endothelial venules into the paracortex
9
Q
What part of the lymph node enlarges in a cellular immune response?
A
Paracortex enlarges
10
Q
where do lymph from the upper limb and lateral breast drain?
A
Axillary lymph node
11
Q
where do lymph from the stomach drain?
A
Celiac lymph node
12
Q
Where do lymph from the duodenum and jejunum drain?
A
Superior mesenteric lymph node
13
Q
Where does lymph from the sigmoid colon drain?
A
Colic to inferior mesenteric lymph node
14
Q
Where does lymph from the lower portion of the rectum of the anal canal above the pectinate line drain to?
A
Internal iliac
15
Q
Where does lymph from the anal canal below the pectinate line drain to?
A
Supericial inguinal lymph node
16
Q
Where does lymph from the testes drain to?
A
Superficial and deep plexuses to the para-aortic
17
Q
Where does lymph from the scrotum drain?
A
Superficial inguinal lymph node
18
Q
Where does lymph from the superficial thigh drain?
A
superficial inguinal lymph node
19
Q
Where does lymph from the lateral side of the dorsum of the foot drain?
A
Popliteal lymph node
20
Q
What drains the lymph of the right arm, right chest and right half of the head?
A
Right lymphatic duct
21
Q
Where are T cells located in the spleen?
A
Periarterial lymphatic sheath (PALS) within the white pulp of the spleen
22
Q
Were are B cells found in the spleen?
A
In follicles within the white pulp of the spleen
23
Q
What do macrophages in the spleen do?
A
Remove damaged RBCs and remove encapsulated organisms
24
Q
What do you see with splenic dysfunction?
A
Decreased IgM –> decreased complement activation –> decreased C3b opsonization –> increased susceptibility to encapsulated organisms
25
What are the encapsulated organisms you can have problems with in asplenia?
SHiNE SKS
- Strep penumo
- Haemophilus influenza type B
- Neisseria meningitides
- Salmonella
- Klebsiella pneumoniae
- group b Strep
- E. coli
26
A patient presents with Howell jolly bodies (nuclear remnants), target cells and thrombocytosis - what don't they have?
The patient doesn't have a spleen
27
Name 3 situations where a patient would be missing a spleen
sickle cell patient with auto infarction
Trauma
Hereditary spherocytosis
28
What is the purpose of the thymus?
The thymus is the site of T cell differentiation and maturation
29
Is the thymus encapsulated?
Yes
30
What is the thymus derived from?
Epithelium of the 3rd bronchial pouches
note that lymphocytes are of mesenchymal origin
31
What type of cell is located in the cortex of the thymus?
The cortex is dense with immature T cells
32
What type of cell is located in the medulla of the thymus?
The thymus is pale with mature T cells and epithelial reticular cells containing Hassall's corpuscles.
33
Where does positive and negative selection of T cells occur in the thymus?
Positive selection (MHC restriction) occurs in the cortex and negative selection (non-reactive to self) occurs in the medulla
34
What type of immunity consists of neutrophils, macrophages, dendritic cells, eosinophils, basophils, mast cells, natural killer cells (lymphoid origin), and complement
Innate immunity
35
What type of immunity has receptors that recognize pathogens that are germline encoded?
Innate immunity
36
Which form of immunity has no memory
innate immunity
37
Which form of immunity has receptors that recognize pathogens by undergoing VDJ recombination during lymphocyte development?
Adaptive immunity
38
What form of immunity has a slow response on first exposure but the memory response is faster and more robust?
Adaptive immunity
39
Which type of immunity consists of T cells, B cells and circulating antibodies?
adaptive immunity
40
What is the purpose of MHC?
They present antigen fragments to T cells and bind TCR
41
what do MHC-I bind?
TCR and CD8
42
What cells express MHC-I?
Expressed on all nucleated cells, not expressed on RBCs
cells use MHC-I to show CD8 cells that they are normal healthy cells
43
Which MHC mediates viral immunity?
MHC-1
44
Which MHC pairs with Beta2-microglobulin to get to the cell surface?
MHC-I
45
What do MHC-II bind?
TCR and CD4
46
What cells express MHC-II?
Antigen presenting cells
47
Which MHC loads the antigen following release of invariant chain in an acidified endosome?
MHC-II
48
What disorder is HLA-A3 associated with?
Hemochromatosis
49
What disorders is HLA-B27 associated with?
Psoriasis, Ankylosing spondylitis, Inflammatory bowel disease, Reiter's syndrome
(PAIR)
50
What disorder is HLA-DQ2/DQ8 associated with?
Celiac disease
51
What disorders is HLA-DR2 associated with?
Multiple sclerosis, hay fever, SLE, Goodpasture's
52
What disorders is HLA-DR3 associated with?
DM type 1, Grave's disease
53
What disorders if HLA-DR4 associated with?
Rheumatoid arthritis, DM type 1
54
What disorders are HLA-DR5 associated with?
Pernicious anemia (B12 deficiency), Hashimoto's thyroiditis
55
what is the only lymphocyte that is a member of the innate immune system?
NK cells
56
what CD markers are found on an NK cell?
CD16 and CD56
57
what do NK cells secrete to activate macrophages?
IFN-gamma
58
What's so great about CD16?
Helps cells to recognize and kill Ig-coated cells via antibody dependent cell mediated cytotoxicity
59
Which cytokines are known to increased the activity of NK cells?
IL-2, IL-12, IFN-Beta, IFN- alpha
60
when are NK cells induced to kill another cell?
When exposed to a non-specific activation signal on a target cell and/or to an absence of class I MHC on target cell surface
61
What do B cells secrete to neutralize viruses?
IgG
62
what do CD4 T-cells do?
Help B cells make antibody and produce cytokines to activate other cells of the immune system
63
What do CD8 T-cells do?
Kill virus-infected cells directly
64
In what part of T cell selection occurs in the thymic cortex and involves T cells expressing TCRS that are capable of binding surface self MHC molecules will survive?
Positive selection
65
In what part of T cell selection occurs in the thymic medulla and involves TCRs with high affinity for self antigens undergoing apoptosis?
negative selection
66
What are the two necessary signals for naïve T cell activation?
Signal 1 - foreign antigen is presented on MHC II and recognized by TCR on Th cells. Antigen is presented on MHC-I to Tc cells
Signal 2 - "costimulatory signal" is given by interaction of B7 and CD28
67
What are the two necessary signals for B cell activation and class switching?
Signal 1 - b cell receptor mediated endocytosis; foreign antigen is presented on MHC II and recognized by TCR of Th cells
Signal 2 - CD40 receptor on B cell binds CD40 ligandon TH cell
68
what cytokine(s) does Th1 cells secrete?
IFN-Gamma
69
what cytokine(s) does Th2 cells secrete?
IL-4, IL-5, IL-10, IL-13
70
What do Th1 cells do?
activate macrophages
71
What do Th2 cells do?
recruits eosinophils for parasite defense and promotes IgE production by B cells
72
What inhibits TH1 cells?
IL4 and IL10
73
What inhibits TH2 cells?
IFN-gamma
74
what is the macrophage-lymphocyte interaction?
Activated lymphocytes released IFN gamma and macrophages release IL1 and TNF alpha which they each stimulate each other
75
what cells kill virus infected, neoplastic and donor graft cells by inducing apoptosis?
Cytotoxic T cells
76
what makes cytotoxic T cells so toxic?
They release cytotoxic granules containing preformed proteins like perforin which helps to deliver the content of granules into the target cell and granzyme which is a serine protease, activates apoptosis inside the target cell
granulysin is antimicrobial and also induces apoptosis
77
which T cells express CD3, CD and CD25?
Regulatory T cells
78
What T cells suppress CD8 and CD4 cells?
Regulatory T cells
79
what cytokines to activates regulatory T cells secrete?
anti-inflammatory cytokines like IL10 and TGF-Beta
80
what portion of IgM and IgG fix complement?
The Fc portion (CH2 part of Fc)
81
how many antigenic specificities are expressed per B cell?
one
82
What occurs following antigen stimulation that allows for antibiotic diversity?
Somatic hypermutation
83
what is the only immunoglobulin that can directly opsonize?
IgG
84
What is the only immunoglobulin that can cross the placenta?
IgG
85
What is the only immunoglobulin that participates in Antibody dependent cellular cytotoxic ?
IgG
86
What immunoglobulins are on the surface of mature naïve B cells?
IgM and IgD
87
Which cytokines cause class switching to IgA?
IL5 and TGF Beta
88
What is the valence of a secreted IgM?
IgM is a pentamer which gives a valence of 10 - can bind a total of 10 antigens
89
What immunoglobulin is at the lowest concentration in the serum?
IgE
90
What cytokines cause class switching to IgE?
IL4 and IL 13
91
what is a thymus independent antigen?
Lacks a peptide component so it can't be presented by MHC to T cells - stimulates release of antibodies but does not result in immunologic memory
92
What is a thymus dependent antigen?
Contains a protein compound which causes class switching and immunologic memory as a result of direct contact of B cells with Th cells via the CD40/CD40L interaction
93
A patient presents with an anaphylactic response to a bee sting - what's the first antibody made in this response?
IgM
94
What is the function of C3b?
Opsonization
C3b also helps to clear immune complexes
95
What is the function of C3a and C5 a?
anaphylaxis
96
What is the function of C5a?
Neutrophil chemotaxis
97
What is the function of C5b-9?
MAC
98
how does activation of the alternative pathway of complement occur?
by microbe surface molecules or it can also occur spontaneously
99
What two inhibitors help prevent complement activation on self cells?
C1 esterase inhibitor and DAF (decay-accelerating factor)
100
which two cytokines inhibit complement C9 binding?
CD55 (DAF) and CD59
101
A patient presents with hereditary angioedema - what is the disorder?
C1 esterase inhibitor deficiency
102
What drug is contraindicated in patients with C1 esterase inhibitor deficiency and why?
ACE inhibitors
it's thought that the deficiency is due to increased bradykinin and ACE inhibitors also increase this
103
A patient presents with severe, recurret pyogenic sinus and respiratory tract infections and increased susceptibility to type III HS reactions (especially in glomerulonephritis) - what is the disorder?
C3 deficiency
104
A patient presents with recurrent Neisseria bacteremia - what is the disorder?
C5-9 deficiency
105
A patient presents with complement-mediated lysis of RBCs and paroxysmal nocturnal hemoglobinuria - what is the disorder?
DAF (GPI anchored enzyme) deficiency
| DAF=CD55
106
This cytokine is an endogenous pyrogen - causing fever and inflammation. It also activates endothelium to express adhesion molecules; induces chemokine secretion to recruit leukocytes.
IL-1
107
What is the mnemonic for cytokines?
"Hot T-Bone stEAk"
```
IL-1: fever (hot)
IL-2: stimulates T cells
IL-3: stimulates Bone marrow
IL-4: stimulates IgE production
IL-5: stimulates IgA production
```
108
This cytokine is an endogenous pyrogen that is also secreted by TH2 cells - causes fever and stimulates production of acute phase proteins
IL6
109
This cytokine is a major chemotactic factor for neutrophils
IL8
110
This cytokine induces differentiation of T cells into TH1 cells, activates NK cells and is also secreted by B cells
IL-12
111
This cytokine mediates Septic shock - activates endothelium causing leukocyte recruitment and a leaky vasculature
TNF-alpha
112
What cytokines are secreted by TH1 cells?
IL2, 3, IFN-G
113
What cytokines are secreted by TH2 cells?
IL2, 3, 4, 5, 10
114
This cytokine stimulates growth of helper, cytotoxic and regulatory T cells
IL2
115
This cytokine supports the growth and differentiation of bone marrow stem cells - functions like GM-CSF
IL3
116
This cytokine activates macrophages and TH1 cells. It also suppresses TH2 cell and has antiviral and antitumor properties
IFN-Gamma
117
This cytokine induces differentiation into TH2 cells, promotes growth of B cells and enhances class switching to IgE and IgM
IL4
118
This cytokine promotes differentiation of B cells, enhances class switching to IgA, and stimulates growth and differentiation of eosinophils
IL5
119
This cytokine modulates the inflammatory response. It also inhibits actions of activated T cells and TH1, also secreted by regulatory cells.
IL 10
120
Which two cytokines are involved with shutting down the immune response?
IL10 and TGF beta
121
What is the function of interferons?
They place uninfected cells into an antiviral state and they also activate NK cells to kill virus-infected cells
122
What do interferon alpha and beta do?
They inhibit viral protein synthesis (by degrading viral mRNA) to help neighboring cells avoid viral infection
123
What does Interferon gamma do?
Increases MHCI and II expression and antigen presentation in all cells
124
What CD marker binds to B7 on APCs?
CD28
125
What CD markers are found on TH cells?
TCR, CD3, CD28, CD4, CD40L
126
What CD markers are found on TC cells?
TCR, CD3, CD28, CD8
127
what cell surface proteins are found on B cells?
Ig
CD19, CD20, CD21
MHC-II, B7
128
what cell surface proteins are found on macrophages?
CD14, CD40
MHC-II, B7
Fc and C3b
129
What cell surface proteins aer found on NK cells?
CD16 (binds Fc portion of IgG for ADCC) and CD56
130
what is anergy?
Self reactive T cells become non-reactive without costimulatory molecule. B cells also become anergic, but tolerance is less complete than in T cells
131
how do superactigens cause problems?
Superactigens cross link the Beta region of the T cell receptor to the MHC class II on APCs. They can activate any T cell, leading to massive release of cytokines.
132
How do endotoxins/lipopolysaccharides from gram neg cells cause an effect?
they directly stimulate macrophages by binding to endotoxin receptor CD 14, TH cells are not involved
133
what is the duration of passive immunity?
Short span of antibodies - half life of 3 weeks
134
What are some examples of passive immunity?
IgA in breast milk, antitoxin, humanized monoclonal antibody, Palivizumab TX for RSV
135
what are some exposures that a patient can have that may make you give them passive immunity via pre-formed antibodies?
Exposure to: tetanus toxin, botulinum toxin, HBV, or Rabies
"To Be Healed Rapidly"
136
What are some examples of active immunity?
Natural infection, vaccines, toxoid
137
what type of vaccination produces a mainly cellular response with memory T cells?
Live attenuated vaccine
138
What type of vaccination produces a humoral immunity with the production of antibodies?
Inactivated or killed vaccine
139
what are examples of live attenuated vaccines?
Measles, mumps, polio (sabin), rubella, varicella, yellow fever
140
What type of hypersensitivity: Reaction develops rapidly after antigen exposure because of preformed antibodies
Type I hypersensitivity
141
What type of hypersensitivity: Anaphylactic and atopic
Type I HS
142
What type of hypersensitivity: Free antigen crosslinks IgE on presensitized mast cells and basophils, triggering release of vasoactive amines that act at postcapillary venules
Type I HS
143
What type of hypersensitivity: Cytotoxic (Ab mediated)
Type 2 HS
144
What type of hypersensitivity: IgM, IgG bind to fixed antigen on a cell leading to cellular destruction
Type 2 HS
145
What type of hypersensitivity: Antibody and complement lead to membrane attack complex
Type 2 HS
146
what are the 3 mechanisms of Type 2 HS?
1. opsonization leading to phagocytosis or complement activation
2. complement-mediated lysis
3. antibody-dependent cell mediated cytotoxicity (ADCC) usually due to NK cells
147
What type of hypersensitivity: Immune complexes
Type 3 HS
148
What type of hypersensitivity: Antigen-antibody (IgG) complexes activate complement, which attracts neutrophils and the neutrophils release lysosomal enzymes
Type 3 HS
149
What type of hypersensitivity: An immune complex disease in which antibodies to foreign proteins are produced (takes 5 days) - immune complexes are formed and deposit in membranes where they fix complement leading to tissue damage
Type 3 HS - serum sicknes
150
What type of hypersensitivity: A local subacute antibody mediated HS reaction with intradermal injection of antigen inducing antibodies which form antigen-antibody complexes in the skin - characterized by edema, necrosis and activation of complement
Type 3 HS - arthus reaction
151
What type of hypersensitivity: Antigen + antibody + complement
Type 3 HS
152
What type of hypersensitivity: Delayed (T-cell mediated)
Type 4 HS
153
What type of hypersensitivity: Sensitized T lymphocytes encountered antigen and then release lymphokines leading to macrophage activation, no antibody involvement
Type 4 HS
154
What type of hypersensitivity: Delayed, cell mediated, is not transferable by serum
Type 4 HS
155
What type of hypersensitivity: rhinitis, hay fever, bee sting, allergies, eczema
Type I HS
156
What type of hypersensitivity: Autoimmune hemolytic anemia
Type II HS
157
What type of hypersensitivity: Pernicious anemia
Type II HS
158
What type of hypersensitivity: Idiopathic thrombocytopenic purpura, erythroblastosis fetalis, acute hemolytic transfusion reaction
Type II HS
159
What type of hypersensitivity: Rheumatic fever, Goodpastures syndrome
Type II HS
160
What type of hypersensitivity: Bullous pemphigoid, Pemphigus vulgaris
Type II HS
161
What type of hypersensitivity: SLE
Type III HS
162
What type of hypersensitivity: Polyarteritis nodosa
Type III HS
163
What type of hypersensitivity: Serum sickness, arthus reaction
Type II HS
164
What type of hypersensitivity: Poststreptococcal glomerulonephritis
Type III HS
165
What type of hypersensitivity: Multiple sclerosis
Type IV HS
166
What type of hypersensitivity: Guillain barre
Type IV HS
167
What type of hypersensitivity: Graft versus Host disease
Type IV HS
168
What type of hypersensitivity: PPD
Type IV HS
169
What type of hypersensitivity: Contact dermatitis, poison ivy, nickel allergy
Type IV HS
170
This is a type of blood transfusion that is severe, example being that patients that are IgA deficient have to receive blood products that lack IgA
Anaphylactic reaction
171
Type II HS reaction where host antibodies act against HLA antigens and leukocytes
Febrile nonhemolytic transfusion reaction
172
Type II HS reaction where intravascular hemolysis (ABO blood group incompatibility) or extravascular hemolysis (host antibody reaction against foreign antigen on donor RBCs) occurs
Acute hemolytic transfusion reaction
173
A patient presents with recurrent bacterial infections after 6 months of birth and has normal pro-B, decreased maturation, decreased number of B cells and decreased immunoglobulins of all classes - what is this?
X linked Bruton's agammaglobulinemia
Problem occurs after 6 months due to a decrease in maternal IgG - opsonization defect resulting in recurrent bacterial infections
174
What is the deficiency associated with a defect in BTK, a tyrosine kinase gene which results in no B cell maturation?
X linked Bruton's agammaglobulinemia
175
A patient presents mostly asymptomatic but they sometimes have sinopulmonary infections, GI infections, autoimmune diseases and anaphylaxis to IgA containing blood products - what is the deficiency?
Selective IgA deficiency
176
A patient has <7mg/dl of IgA, with normal IgG, IgM and IgG vaccine titers.
Selective IgA deficiency
Patient may have false positive beta-hCG tests due to the presence of heterophile antibody
177
A patient presents with tetany, recurrent viral/fungal infections, and congenital heart and great vessel defects - what is the deficiency?
Thymic aplasia - DiGeorge syndrome
178
What is the defect in DiGeorge syndrome?
22q11 deletion, failure to develop 3rd and 4th pharyngeal pouches
The thymus and parathyroids fail to develop leading to decreased T cells, decreased PTH, decreased calcium, and absent thymic shadow on chest X ray
179
A patient presents with disseminated mycobacterial infections and decreased IFN-gamma - what is the defect and what is the deficiency?
IL-12 receptor deficiency - the defect is a decrease in Th1 response
180
A patient presents with FATED: coarse Facies, cold (noninflamed) staphylococcal Abscesses, retained primary Teeth, increased igE, Dermatologic problems (Eczema) - what is the disorder?
Hyper-IgE syndrome (Job's syndrome)
181
What is the defect seen in hyper-IgE syndrome?
Th1 cells fail to produce IFN-gamma and therefore there's an inability of neutrophils to respond to chemotactic stimuli
182
a patient presents with a T cell dysfunction with constant candida albicans infections of the skin and mucous membranes - what is the disorder ?
Chronic mucocutaneous candidiasis
183
What are some of the possible defects that can cause SCID?
IL2 receptor defect (most common, X linked)
| adenosine deaminase deficiency
184
A patient presents with decreased T cell recombinant excision circles, an absent thymic shadow, absent germinal centers on LN biopsy and absent T cells on flow cytometry - what is the disorder?
SCID
185
A patient presents with failure to thrive, chronic diarrhea, thrush, recurrent viral, bacterial, fungal and protozoal infections. What is the disorder?
SCID
186
How do you treat SCID?
Bone marrow transplant (no allograft rejection)
187
A patient presents with cerebellar defects leading to ataxia, spider angiomas and IgA deficiency - what is the disorder?
Ataxia-telangiectasia
188
A patient presents with a AR defect in the ATM gene, which codes for DNA repair enzymes and they have increased AFP - what is the disorder?
Ataxia-telangiectasia
189
A patient presents with severe pyrogenic infections early in life and as a CD40L defect on helper T cells - what is the disorder and what immunoglobulin findings would they have?
This is Hyper-IgM syndrome
They would have increased IgM, decreased IgG, IgA, and IgE
The defect in CD40L keeps them from being able to class switch
190
A patient presents with thrombocytopenic purpura, infections and eczema - what is the disorder?
Wiskott Aldrich syndrome
191
What is the defect seen in Wiskott Aldrich syndrome?
X linked, in WAS gene on X chromosomes so T cells are unable to reorganize actin cytoskeleton
192
WHat are the findings seen in Wiskott Aldrich syndrome?
Increased IgE and IgA and decreased IgM, and thrombocytopenia
193
A patient presents with recurrent bacterial infections, absent pus formation, and delayed separation of the umbilical cord. They also have neutrophilia. What is the dysfunction and what is the defect?
Dysfunction: leukocyte adhesion deficiency type 1
defect: Defect in LDA-1 integrin (CD18) on phagocytes
194
A patient presents with recurrent pyogenic infections by staph and strep, partial albinism and peripheral neuropathy and they also have giant granules in their neutrophils - what is the dysfunction and the defect?
This is Chediak-Higashi syndrome which is an AR defect in lysosomal trafficking regulator gene. Microtubule dysfunction in phagosome-lysosome fusions
195
A patient presents with increased susceptibility to catalase positive organisms and abnormal dihydrohodamine flow cytometry test. Their nitroblue tetrazolium dye reduction test is negative - it doesn't change from yellow to blue/black. what is the dysfunction and what is the defect?
Chronic granulomatous disease
Lack of NADPH oxidase leading to decreased reactive oxygen species and absent respiratory burst in neutrophils
196
What is an autograft?
From self
197
What is a syngeneic graft?
From identical twin or clone
198
What is a allograft?
From nonidentical individual of the same species
199
What is a xenograft?
From different species
200
When is the onset of rejection after transplantation with a hyperacute rejection?
Within minutes
201
When is the onset of rejection after transplantation with a acute rejection?
Weeks later
202
When is the onset of rejection after transplantation with a Chronic rejection?
months to years
203
When is the onset of rejection after transplantation with a Graft versus host?
Varies
204
A patient has occluded graft vessels causing ischemia and necrosis - what is the type of rejection that occurred?
Hyperacute rejection
205
A patient has vasculitis of graft vessels with dense interstitial lymphocytic infiltrate - what is the type of rejection that occurred?
Acute rejection
206
A patient has irreversible damage with T cell and antibody mediated vascular damage that has caused obliterative vascular fibrosis - there is fibrosis of the graft tissue and blood vessels - what is the type of rejection that occurred?
Chronic rejection
207
A patient presents with a maculopapular rash, jaundice, hepatosplenomegaly and diarrhea. what is the type of rejection that occurred? When is this seen and in what cases can it be beneficial?
This is a graft versus host transplant rejection
Usually occurs in bone marrow and liver transplant (organs rich in lymphocytes)
This can potentially be beneficial in bone marrow transplant
208
What is the pathogenesis of hyperacute transplant rejection?
Antibody mediated (Type II) because of the presence of preformed anti-donor antibodies in the transplant recipient
209
What is the pathogenesis of acute transplant rejection?
Cell-mediated due to Cytotoxic T cells reacting against foreign MHCs. Reversible with immunosuppressants
210
What is the pathogenesis of chronic transplant rejection?
Irreversible! class I-MHC non-self is perceived by cytotoxic t cells as class I-MHC self that is presenting a non-self antigen
211
What is the pathogenesis of graft-versus-host transplant rejection?
Grafted immunocompetent T cells proliferate in the irradiated immunocompromised disease host and reject cells with "foreign" proteins, resulting in severe organ dysfunction
212
What drug binds to cyclophilins and the complex blocks the differentiation and activation of T cells by inhibiting calcineurin - thus preventing the production of IL-2 and its receptor
Cyclosporine
213
What drug has the following toxicity: nephrotoxicity, hypertension, hyperlipidemia, hyperglycemia, tremor, gingival hyperplasia, hirsutism?
Cyclosporine
214
What drug binds to FK-binding protein, inhibiting calcineurin and secretion of IL2 and other cytokines?
Tacrolimus
215
What drug has the following toxicity: nephrotoxicity, hypertension, hyperlipidemia, hyperglycemia and tremor?
Tacrolimus
216
What drug inhibits mTOR and inhibits T cell proliferation in response to IL2?
Sirolimus
217
What drug is used for immunosuppression after kidney transplantation in combo with cyclosporine and corticosteroids, also used to drug eluting stents?
Sirolimus
218
What drug has the following toxicity: Hyperlipidemis, thrombocytopenia, leukopenia?
Sirolimus
219
What drug is an antimetabolite precursor of 6-mercaptopurine that interferes with the metabolism and synthesis of nucleic acids making it toxic to proliferating lymphocytes?
Azathioprine
220
What drug is used in kidney transplants and autoimmune disorders like glomerulonephritis and hemolytic anemia?
Azathioprine
221
What drug has the following toxicity: bone marrow suppression, active metabolite mercaptopurine is metabolized by xanthine oxidase so there can be toxic effects increased with use of allopurinol
Azathioprine
222
What drug is a monoclonal antibody that binds to CD3 on the surface of T cells and blocks cellular interaction with CD3 protein responsible for T cell signal transduction?
Muromonab
223
What is the toxicity seen with muromonab-CD3?
Cytokine release syndrome, hypersensitivity reaction
224
what drug binds to CD25 and blocks IL2 signaling?
Daclizumab
225
What drug inhibits IMP-dehydrogenase thereby preventing synthesis of guanine resulting in decreased cell replication?
Mycophenolate
226
When can you use mycophenolate?
Transplants and lupus nephritis
There's increased risk of lymphoma though and it's teratogenic (not used in pregnancy)
227
What recombinant cytokine can you use to treat renal cell carcinoma or metastatic melanoma?
Aldesleukin (IL2)
228
What recombinant cytokine can you use to treat Anemias (especially in renal failure)?
Epoetin alfa (Epo)
229
What recombinant cytokine can you use to treat Recovery of bone marrow?
```
Filgastrim (G-CSF)
or Sargramostim (granulocyte macrophage colony stimulating factor)
```
230
What recombinant cytokine can you use to treat Hepatitis B and C, Kaposi sarcoma, leukemia, or malignant melanoma?
Alpha interferon
231
What recombinant cytokine can you use to treat Multiple sclerosis?
Beta interferon
232
What recombinant cytokine can you use to treat thrombocytopenia?
Oprelvekin (IL-11) or Thrombopoietin
233
What drug is not a monoclonal antibody but rather is a decoy receptor that's anti-TNF alpha so it binds up all of the TNF-alpha?
Etanercept
234
What is the target for infliximab?
TNF-alpha
235
What is the target for Adalimumab?
TNF-alpha
236
What is the target for Abciximab?
Glycoprotein IIb/IIIa
237
What is the target for Trastuzumab (Herceptin)?
HER2
238
What is the target for Rituximab?
CD20
239
What is the target for Omalizumab?
IgE
240
What is infliximab used to treat?
Crohn's disease, rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis
241
What is Adalimumab used to treat?
Crohn's disease, RA, psoriatic arthritis
242
What is Abciximab used to treat?
Prevents cardiac ischemia in unstable angina and in patients treated with percutaneous coronary intervention
243
What is Trastuzumab used to treat?
HER-2 overexpressing breast cancer
244
What is Rituximab used to treat?
B cell non-Hodgkin lymphoma
245
What is Omalizumab used to treat?
Additional line of treatment for severe asthma
