IMMUNOLOGY Flashcards
What are toll-like receptors?
Recognize pathogen associated molecular patterns PAMPs in innate immunity (LPS, ssRNA.etc)
HLA subtypes associated with diseases
A3–Hemochromatosis.
B27—Psoriatic arthritis, Ankylosing spondylitis, arthritis of Inflammatory bowel disease, Reactive arthritis (formerly Reiter syndrome).
DQ2/DQ8—Celiac disease.
DR2—Multiple sclerosis, hay fever, SLE, Goodpasture syndrome.
DR3—Diabetes mellitus type 1, SLE, Graves disease, Hashimoto thyroiditis.
DR4— Rheumatoid arthritis, diabetes mellitus type 1.
DR5—Pernicious anemia vitamin B12 deficiency, Hashimoto thyroiditis.
Difference between CD4 +T cells Th1 and Th2
Th1
Secretes : IFN gamma
Activated by IFN gamma , IL-12
Inhibited by: IL 4 - IL10
Th2
Secretes : IL4,IL5, IL 10, IL 13
Activated by : IL-4
Inhibited by: IFN gamma
What are regulatory T cells?
CD3,CD4,CD25 FOXP3 ✅
Suppressing CD4 CD8
Production of IL10 TGF-beta
What are acute phase reactants?
POSITIVE C-reactive protein Ferritin Fibrinogen Hepcidin Serum amyloid A
NEGATIVE
albumin
Transferrin
Some complement functions
Opsonization. C3b
Anaphylaxis C3a. C4a. C5a
Neutrophil chemotaxis C5a
Cytolysis by MAC C5b-9
What is the function of Decay-accelerating factor and C1estarasa inhibitor?
Prevent complement activation
Explain the activity of important cytokines (9) from macrophages
IL-1: fever (hot).
IL-2: stimulates T cells.
IL-3: stimulates bone marrow.
IL-4: stimulates IgE production.
IL-5: stimulates IgA production.
IL-6: stimulates aKute-phase protein, fever
IL-8: MAJOR CHEMOTACTIC!!!
IL-12: T cells to Th1 , Activates NK
TNF alpha: septic shock WBC recruit, vascular leak , CACHEXIA
Explain cytokines from T cells
IL-2 Stimulates growth of helper, cytotoxic, and regulatory T cells, and NK cells.
IL-3 Supports growth and differentiation of bone marrow stem cells. Functions like GM-CSF.
Cytokine from Th1
Interferon gamma order to KILL to NK and macrophages
Cytokines from Th2
IL - 4 Differentiation to Th2 , grow B cells g Ig E. Ig G
IL- 5 Differentiation to B cells grow eosinophils
IL- 10. Slow down!!!! Inhibit. MCH II Th1 macrophages dendritic cells
What are type III hypersensitivity reaction (5)?
Arthus reaction
SLE
Polyarteritis nodosa
Poststreptococcal glomerulonephritis
Serum sickness
What are type IV hypersensitivity reaction(4)?
Contact dermatitis
Graft-versus-host disease
Multiple sclerosis
PPD
AUTOANTIBODIES (23)
Anti-ACh receptor. Myasthenia gravis
Anti-basement membrane Goodpasture syndrome
Anticardiolipin, lupus anticoagulant. SLE ,antiphospholipid syndrome
Anticentromere Limited scleroderma (CREST syndrome)
Anti-desmosome (anti-desmoglein)Pemphigus vulgaris
Anti-dsDNA, anti-Smith SLE
Anti-glutamic acid decarboxylase (GAD-65) Type 1 diabetes mellitus
Antihemidesmosome Bullous pemphigoid
Anti-histone. Drug-induced lupus
Anti-Jo-1, anti-SRP, anti-Mi-2 Polymyositis, dermatomyositis
Antimicrosomal, antithyroglobulin Hashimoto thyroiditis
Antimitochondrial 1° biliary cirrhosis
Antinuclear antibodies SLE no specific
Antiparietal cell Pernicious anemia
Anti-Scl-70 (anti-DNA topoisomerase I) Scleroderma (diffuse)
Anti-smooth muscle Autoimmune hepatitis
Anti-SSA, anti-SSB (anti-Ro, anti-La) Sjögren syndrome
Anti-TSH receptor Graves’ disease
Anti-U1 RNP (ribonucleoprotein) Mixed connective tissue disease
IgA anti-endomysial, IgA anti-tissue transglutaminase Celiac disease
MPO-ANCA/p-ANCA Microscopic polyangiitis, eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)
PRa3-ANCA/c-ANCA. Granulomatosis with polyangiitis (Wegener)
Rheumatoid factor (IgM antibody that targets IgG Fc region), anti-CCP (more specific) Rheumatoid arthritis
What time of infections are most probable in patients Whit humor all inmuniti deficiency?
Infections caused by extra doulas encapsulates organisms
Deficiency of C1,C2 y C3 are associated with…
Lupus like syndrome
What cells are involved in cell-mediated immunity (8)?
Macrophages
CD4 helper
CD8 cytotoxic
Natural killer
What type of cells participate in class IV hypersensitivity?
T-CD8
T-CD4 Th1
What type of hypersensitivity are neutrophils more involved in?
Neutrophils
What type of hypersensitivity is a poison ivy dermatitis ?
Type IV hypersensitivity
What are the clinical features of sarcoidosis?
Macrophages actives and formation of noncaseating granulomas
Affect lungs ,skin, eyes
Bilateral Hilar adenopathy difuse infiltrates
Angiotensin converting enzyme ACE
1,25 hydroxylation-cholecalciferol leads to hypercalcemia
CD4/CD8 ratio >2:1
⬆️Th1 , IL-2, IFN gamma
What is the order of Immunoglobulin synthesis?
IgM–IgD–IgG–IgE–IgA
What is the problem in hyper-IgM syndrome?
A deficit of CD-40L in T lymphocytes
What immunoglobulins are able to fix complement?
IgM. IgG
What substances are released by basophils and mast cells (6)?
Histamine Protease Heparin Leukotriene Prostaglandins Tryptase (mast cells)
Where is the complement binding site in the antibody?
In the middle of heavy chain
What is the mechanism of actin of omalizumab?
Anti-IgE antibody given subcutaneous
What are clinical finding in ankylosing apondylitis?
HLA-B27
Narrowing,erosion ,scleroses of sacroiliac joints
Bamboo siping cervical vertebral fusion
Explain de ubiquitin proteasoma pathway
Foreign intracellular protein is tagged by ubiquitin ligase which attach ubiquitin to the foreign protein
Proteasoma Brock it out
The particles goes to endoplasmic reticulum where they are attached to MHC-I and then they will go to the membrane
What type of hypersensitivity is acute hemolytic transfusion reaction?
Type 2 hypersensitivity
Humoral components of hypersensitivity reactions
Type I. IgE
Type II IgG IgM autoantibodies COMPLEMENT ACTIVATION
Type III Atibody-antigen complex. Complement activation
Type IV. None T cells macrophages
Diagnosis of CGD?
Nitroblue tetrazolium NORMAL BLUE!!!
Dihydrorhodamine NORMAL FLUORESCENT GREEN!!!!
OTHER RESULT IS EQUAL TO CGD!!!!!!
What is the triad of gonorrhea?
Arthritis
Dermatitis
Tenosynovitis
What is the function on of IgA protease?
Cleave IgA and facilitates bacterial adherent ion to mucosa
What is the function of staphylococcal protein A?
Bind the IgG in the Fc portion not in the Fab portion preventing complement fixation
Main kind of infections in pure T cells deficiency?
Viral and fungal infections
What cells contain TB infection ( granuloma)
CD4+ and. MACROPHAGES
What disorders are caused by deficient DNA-repair enzymes?
Ataxia telangiectasia Xerox era pigmentosum Fanconi anemia Bloom Syndrome Hereditary nonpolyposis colorectal cancer
What lobule is involve in ataxia telangiectasia
Cerebellar lobules
What means anti-HBc Ig M. And IgG?
anti-HBc Ig M acute phase of disease good in window period
anti-HBc IgG Recovery
How appear Langhans giant cell?
Macrophage phagocytosis and antigen presentation of M. Tuberculosis – activation of CD4 Th1 which stimulate macrophages which in turn can change to epithelioid cells and LANGHANS GIANT CELLS
What type of antibody is anti-Rh(D) immune globulin ?
It is IgG anti-D antibodies
Which prevent the interaction of Rh positive fetal erythrocytes whit maternal immune system
What substances are produced in the formation of granuloma in TB?
IL-12 by macrophages which help to Th1 differentiation
Interferon gamma by Th1 which activates macrophages to epithelioid cells
TNF Alfa by macrophages which recruit monocytes and macrophages
How work IFN- gamma?
When virus or fungus are into macrophages,IL 12 is released and stimulate T cells to become Th1 which in turn secretes IFN gamma
IFG gamma acts in its receptor at macrophage infected , this activate Janus kinase 1 -2 and a second messenger STAT1 goes to the nucleus where enhance intracellular killing
Also IFG gamma increase MHC expression
What is the defect in leukocyte adhesion deficiency?
Defect in CD18
delayed separation of umbilical cord
No pus formation
Poor wound healing
What are the steps of cellular migration in inflammation?
N. E. C.
MARGINATION
ROLLING Sial Lewis X , PSGL1. E- selectin/P-selectine
ACTIVATION activation of integrines
TIGHT ADHESION. MAC-1 LFA-1. ICAM-1
TRANSMIGRATION PECAM-1
What are the different leukocyte deficiency(3)?
LAD type 1 absence of CD18 ( beta2 integrines Mac-1,LFA 1) umbili
LAD type 2 milder condition
LAD type 3 plus bleeding complications ( Beta 3 integrines platelets)
What are the lab findings in anti-phospholipid syndrome?
aPTT prolongation
Anticardiolipin antibody
Beta-2-glycoprotein -I antibody
Which cells prevents candida infections(2)?
T lymphocytes SUPERFICIAL CANDIDA (VIH)
neutrophils HEMATOGENUS CANDIDA (chemotherapy)
Deficiency of C1,C2 ,C4 predispose to…
Infections by encapsulated bacteria
SLE like disease
Characteristics of Chediak-Higashi syndrome (4)
Immunodeficiency
Albinism
Nystagmus
Peripheral cranial defects
Wiskott-Aldrich syndrome features (3 WATER)
Wiskott Aldrich Thrombocytopenia Eczema Recurrent infections
What molecule is important to secrete IgA dimmers ?
Polymeric immunoglobulin receptor (plgR) secretory component
SYNTHESIZED BY EPITHELIAL CELLS!!!
What type of immunoglobulins are present in fetus?
Maternal Ig G
>20wks fetal IgM
What is the objective of Tetanus vaccine?
Stimulate the production of antibodies against the protein exotoxin tetanospasmin
What process is necessary to mast cells degranulation?
Aggregation of IgE receptor-IgE attach to Multivalent antigen
To produce DEGRANULATION
Explain the physiopatology process of EBV infection
EBV affects B-lymphocytes which in turn stimulate CD8+ T
Atypical CD8+ much larger , abundant cytoplasm ,eccentrical nucleus
Why ABO- mediated hemolytic disease is less severe ?
Maternal anti-A and -B antibodies are IgM and cannot cross placenta
What type of interferons are synthesized in viral infections?
Interferon Alfa and Beta
Induce MHC-I expression
Interfere in viral protein synthesis only in cells whit dsRNA
What is the risk of C1 inhibitor deficiency patients when they are transfused?
HEREDITARY ANGIOEDEMA
What is the second messenger which is inactivated by cyclosporine and Tacrolimus in order to inhibit the immune response?
CALCINEURIN!!!
Which in turn dephosphorilate NFAT
Which in turn activates the IL- 2 translation
What is the order of lymphocyte B differentiation?(7)
Lymphoid stem cell Pro B cell Tdt➕ , MHC II➕ CD19➕ CD20➕ Pre B cell cytoplasmic μ➕ Immature B cell surface Ig M ➕ Mature B cell surface Ig M and Ig D ➕ Plasma cell cytoplasmic Ig G ➕
Action of IL-10?
❎ Th1 cytokines
❎ Expression of MCH II
What are the genes which produce MHC I and MHC II?
MHC I HLA-A. HLA-B. HLA-C
MHC II. HLA-DM. HLA-DP. HLA-DR
What are the first line cells of defense ?
Tissue macrophages!!!!!
Like Langerhans cells!!!
How is the T-cell differentiation?
PRETIMIC: Tdt ➕
TIMIC CORTEX :Rag ➕, CD2➕, CD3➕, TCR➕, CD4➕,CD8➕
TIMIC MEDULLA CD2➕,CD3➕,TCR➕ , CD8➕ ↔️ CD4➕
Which mutations of chemokine receptor of HIV virus are reponsable by its rapid progression?
CXCR1
Which kind of T helper cells are low in lepromatous and tuberculous leprosy?
LL ⬇️ Th1
TL ⬇️ Th2
Hoy a Rh ➖ Woman can have Rh➕ children whit out produce anti-Rh antibodies ??
She has ABO incompatibility whit her husband so the erythrocytes are removed before formate anti Rh antibodies. …. FUCK!!!!
What are the test to demonstrate compatibility in transplants?
Cross- match
What type of immunity produce the hepatitis B vaccine ( Ag surface)
HUMORAL!!!
Lymphocytes B!!!!
After a bug sting what is the secure cue of events an its timing?
5 min pain, vasodilation, swelling
1 hour eosinophilic and neutrophil infiltration
What type o f cells predominate in infectious mononucleosis??
T CD8!!!!!!
What happen tan CD4 count whit go low 400 cells , which make the patient susceptible for intracellular microorganisms?
Immunologic deviation from Th1 to Th2
⬇️Th1
What are the most important immune response against P. Vivax?
Antibodies
Complement
Mechanism of action and use of etanercep?
Inhibits TNF
Rheumatoid arthritis
Psoriasis
How TNF induce apoptosis?
Trough activation of Fas (TNF receptor)
JUST IN T LYMPHOCYTES
How a T cell can be anergic?
When T cells are activated by MHC but there is no costimulatory signal ( CD28 from T cell ➕ B7 from antigen-presenting cell)
What molecules have to interact in order to develop isotope switching ( IgM to IgG)?
CD40 from Bcell
➕
CD40 ligand from T cell
Which interleukins induce Th1 or Th2 differentiation?
To Th1 ⬅️ INF gamma , IL12
To Th2 ⬅️ IL4
Which kind of hypersensitivity has reactive arthritis?
Type III
Immunocomplex
Drugs which cause drug-induced lupus erythematosus? (5)
Hydralazine Procainemide Isoniazide Minocycline Quinidine
Triad of Wiskott-Aldrich syndrome and etiology?
ECZEMA
RECURRENT INFECTIONS
THROMBOCYTOPENIA
lymphocytes B and T (susceptibility to encapsulated bugs)
Cytokines which differentiate Th0 into Th1 or Th2
🔹Th1. IL-12 , IFN- gamma (macrophage)
🔹Th2. IL-4
Nokolsky sign (bulla rupture with tangential pressure) is. Positive and negative in..
Positive PEMPHIGUS VULGARIS (oral mucosa✅)
Negative BULLOUS PEMPHIGOID
Function of NF-kB?
Pro inflammatory transcription factor
⬆️cytokines
Which T cell receptors are used by tumor cells in order to inhibit T cells?
PD-1 (programmed dead receptor)
CTLA-4
Pathophysiology of urticary?
mast cells degranulation
edema of superficial epidermis
