Immunology Flashcards
Muromonab
Anti CD3
Active rejection: corticosteroid resistant renal/heart/liver rejection
SE: fever leucopenia
Aka OKT3
Risk of anaphylaxis due to mouse murine protein
Cytokine release syndrome risk: TNFalpha + IFNgamma
Basiliximab
Anti CD25 IL 2 alpha receptor Reduces T cell proliferation Prophylaxis vs allograft rejection SE: GI disturbance
Tocilizumab
Anti IL6 receptor
For RA if anti TNF drugs fail
SE: infections, hepatotoxic, raises cholesterol
For castlemans + RA
Reduced macrophage, neutrophil + lymphocyte activation
Abatacept
Anti CTLA-4 Ig
Bind b7 protein (cd80 +86) on APCs
RA if anti TNF drugs fail
SE: infections + cough
What are the antiproliferative agents?
Cyclophosphamide
Mycophenolate mofetil
Azathioprine
Cyclophosphamide
Alkylates guanine base of DNA: b cells> t cells
For multi system connective tissue disease + cancer
SE: hair loss, BM suppression, sterility, haemorrhagic cystitis
Mycophenolate mofetil
Blocks de novo nucleotide synth: T cells > B cells
For AI, vasculitis, transplants
SE: BM suppression, hepatotoxicity
What are the inhibitors of cell signalling?
Tacrolimus
Ciclosporin
Sirolimus
Tacrolimus
Inhibits calcineurin which usually activates IL2 transcription = reduced IL2
For rejection prophylaxis
SE: diabetes
Ciclosporin
Inhibits calcineurin which usually activates IL2 transcription = reduced IL2
For rejection prophylaxis
SE: gingival hypertrophy, htn + reduced GFR
Sirolimus
Binds FKBP-1a
Blocks clonal proliferation
For rejection prophylaxis
Low nephrotoxicity
Prednisolone
Inhibits phospholipase a2
Reduces: platelet activating factor, Abs, arachidonic acid, apoptosis, trafficking phagocytes
SE: DM, adrenal suppression, cataracts, glaucoma, pancreatitis, osteoporosis, central obesity, neutrophilia, htn
Plasmapheresis
50% plasma replaced with donor plasma
For Goodpasture’s, MG, and other type II HS
SE: rebound Ab production limits efficacy
Adalimumab
Fully human anti TNF alpha mab
For RA, ank spondylitis, Crohns
Infliximab
Mouse-human chimeric Anti TNF alpha mab
For psoriasis, Crohns, RA
SE: TB, lymphoma, pneumonia, AI
Etanercept
TNF alpha mab
Fusion protein between TNF-R2 and Fc if IgG1
SE: incr risk infection, demyelination, malignancy
Ustekinumab
Anti IL 12/23 - binds to p40 subunit
For psoriasis
SE: infections + cough
Rituximab
Anti CD20 - decreases B cells
For AI disease + lymphoma
Incr risk hep B reactivation + progressive multifocal leukoencephalopathy
Natalizumab
Anti alpha-4 integrin
Prevent T cell migration
For MS + Crohns
Alemtuzumab
Anti CD 52
For CLL + MS
SE: incr susceptibility to CMV
Methotrexate
Dihydrofolate reductase inhibitor - decr DNA synth
For AI disease: RA, psoriasis, Crohns
Chemo
Abortifacient
SE: teratogenicity, hepatotoxicity, pneumonitis, pulm fibrosis, cirrhosis
Folate deficiency! Macrocytic megaloblastic anaemia
Components of a T cell immunosuppressive regime
Antiproliferative agent
T cell signalling inhibitor
Cytokine production inhibitor
Options for boosting the immune system
Vaccination
Human normal Ig
Specific Ig
Recombinant cytokines
Human normal Ig
Preformed IgG vs full range of organisms from >1000 donors
3-4 wkly admin
For: primary Ab deficiencies: Bruton’s + CVID
secondary Ab deficiencies: CLL, MM, BMT
Passive vaccination
? Anaphylaxis
Specific Ig
Can be given to give passive vaccination for: Rabies VZV Hep B Tetanus ? Anaphylaxis
Recombinant cytokines
INF alpha: hep B, hep C + Kaposi’s sarcoma, CML, MM, hairy cell leukaemia
IFN beta: relapsing MS, MOA unknown
IFN gamma: chronic granulomatous disease
Allergen desensitisation
To reduce sx in mono allergic disorders
Good for: bee + wasp venom, grass pollen, house dust mite
Tiny doses titrated up over wks under close supervision
Maintenance dose then monthly for 3-5 yrs
Costly, laborious, risk of adverse reaction
Only treatment to alter natural course of disease
Azathioprine
Metabolised by liver to 6-mercaptopurine
Blocks de novo purine synth
For AI, transplants
SE: BM suppression, hepatotoxicity
Bare lymphocyte syndrome
Defect of regulatory factor X or class II transactivator
Absent expression of HLA molecules within thymus
Lymphocytes don’t develop
- type 1: MHC 1 absent = decr CD8
- type 2: MHC 2 absent = decr CD4 more common
B cell class switch requires CD4 so also less IgA + IgG
Assoc with sclerosing cholangitis
Unwell at 3 months
Di George
Impaired development of 3rd + 4th pharyngeal pouches
22q11.2 del 75% sporadic
= impaired development of thymus
= v low numbers mature T cells
Treatment = thymus transplant
Also infection prophylaxis, Ig replacement as req
Which primary immune deficiencies are T cell deficiencies?
Bare Lymphocyte Syndrome
Di George syndrome
Which primary immune deficiencies are B cell deficiencies?
Bruton’s agammaglobulinaemia
Selective IgA deficiency
Common variable immuno deficiency
Hyper IgM syndrome
Which primary immune deficiencies are mixed B + T cell deficiencies?
SCID
Which primary immune deficiencies are phagocyte deficiencies?
Kostmann syndrome
Leukocyte Adhesion deficiency
Chronic granulomatous disease
Cyclic neutropenia
Bruton’s agammaglobulinaemia
X linked mutation in BTK gene = no mature B cells, no antibodies Incr susceptibility to bacterial infections \+ some viral + some toxins Sx from ~ 3-6 months Req IV IgG
Selective IgA deficiency
Most common immune deficiency
70% asymptomatic
Recurrent resp + gastro infections
Common variable immune deficiency
Defect in B cell differentiation- many genetic causes
Low Ig A, G + E
FTT
AI + granulomatous disease
Hyper IgM syndrome
X linked q26
CD 40 L, CD 40, AICDA or CD 154 defect
Prevents activated T cells interacting with B cells
No class switch = B cells can’t make IgA + IgG but Incr amt IgM
Less lymphoid tissue
1 yr old boys with recurrent bacterial infections, PCP + FTT
Req IV IgG
How are T cell deficiencies treated?
Infection prophylaxis
Ig replacement as required
How are B cell deficiencies treated?
Ig replacement
BMT in some
Vaccination only effective in selective IgA deficiency
SCID
Defects in lymphoid precursors
E.g. IL2 receptor or adenosine delaminates gene
Recurrent infections -> FTT + persistent diarrhoea + early infant death
Low/normal B cells, low T cells, low antibodies
BMT only established treatment
45% x linked
Kostmann syndrome
AR HAX-1 Severe congenital neutropenia BM: arrest of neutrophil precursor maturation Infections shortly after birth Treatment: GCSF, prophylactic abx, BMT
Leukocyte adhesion deficiency
Failure to express lymphocyte adhesion markers
Neonatal bacterial infections
1: deficiency of beta -2 integrin subunit of CD18 on the leucocytes adhesion mol
2: much rarer, severe growth restriction + mental retardation
High neutrophil count + delayed umbilical cord separation
BMT
Chronic granulomatous disease
Failure of oxidative killing - NADPH oxidase defect
= decr reactive O2 species
-ve NBT test : nitrobluetetrazolium -ve DHR test : dihydrorhodamine
Pneumonia, abscesses, suppurating arthritis
Susceptible to catalase +ve: listeria, pseudomonas, aspergillus, candida, e.coli, staph aureas, serratia
Treatment: prophylactic trimethoprim, itraconazole, interferon
Cyclic neutropenia
Episodic neutropenia every 3 wks lasting a couple days
Mutations in ELA 1 gene
Treatment: GCSF
List the inflammatory cytokines
Il 1
IL 12
TNF
IL 6
List the anti-inflammatory cytokines
IL 10
TGF beta
Cytokine deficiencies
IFN gamma, IFN gamma-R, Il 12, IL 12-R
Involved in signalling betw T cells + macrophages
To stimulate TNF and Acyivate NADPH oxidase
Predisposes to: salmonella, TB, atypical mycobacteria, BCG
Unable to form granulomata
Reticular dysgenesis
Most sever for of SCID
Absolute deficiency of: neutrophils, lymphocytes, monocytes, macrophages, platelets
Fatal in early life without BMT
Wiskott-Aldrich syndrome
X linked mutation in WASp gene Decr IgM Incr IgA + E Thrombocytopenia Recurrent bacterial infections
What are the complement deficiencies?
Incr susceptibility to encapsulated bacterial infection Classical pathway deficiency Lectin pathway deficiency Alternative pathway deficiency Common + terminal pathway deficiency
Classical pathway deficiency
Lack of C1 q/r/s C2 (commonest) or C4 (removes immune complexes) Abnormal CH50 test Associated with SLE + RA
Lectin pathway deficiency
V common
Up to 10% are MBL deficient
Not clinically important
Alternative pathway deficiency
Involves factors B/I/P
Usually kill bacteria
Susceptible to GBS, s.pneumoniae, h.influenzae, n.meningitidis
AP50 test abnormal
Common + terminal pathway deficiency
Lack of C 3, 5, 6, 7, 8, 9
Susceptible to meningitis + pneumonia
Assoc with membranous proliferation glomerulonephritis
Can’t form MAC to kill bacteria
Both CH50 + AP50 abnormal
Treatment: vaccination, prophylactic abx, high level suspicion
How might you detect deficiency of an alternative pathway factor?
AH50: reduced
CH50: normal
Hereditary angioedema
C1 inhibitor deficiency
Increased bradykinin
Spontaneous complement activation
When might high CH50 be seen?
Acute or chronic inflammation
Demonstrates classical and final complement pathway activity
E.g. SLE, RA
What might be seen with reduced C4?
SLE
What might be seen with reduced C3?
Membranoproliferative glomerulonephritis
What are the three mechanisms of mast cell activation?
Direct injury e.g. Toxin or drugs
IgE -R cross linking
Activated complement proteins
What are the three subtypes of MHC class I
HLA A
HLA B
HLA C
What are the three subtypes of MHC class II?
HLA DP
HLA DQ
HLA DR
What composes MHC class III?
Complement components
What AI condition is associated with HLA B27?
Ankylosing spondylitis
What AI condition is associated with HLA DQ2?
Coeliac disease
What AI conditions are associated with HLA DR3?
Graves
SLE
MG
What AI conditions are associated with HLA DR4?
DM
RA
What HLA markers are associated with Goodpasture’s ?
HLA DR2
HLA DR15
Azathioprine
6 mercaptopurine
Blocks de novo protein synthesis, blocks DNA synth
Inhibits T cell proliferation
SE: BM suppression, hepatotoxicity, hypersensitivity
For AI disease + transplants
Denosumab
Anti RANK ligand
Inhibits osteoclast function + differentiation
For osteoporosis, MM, bone mets
Toxicity: resp infections, UTIs
What are the type I hypersensitivity disorders?
Atopic dermatitis Food allergy Oral allergy syndrome Latex food syndrome Allergic rhinitis Acute urticaria Anaphylaxis
What are the features of type I hypersensitivity?
IgE mediated, immed reactions
Provoked by re-exposure to allergen
Mast cell degranulation = vasodilation, SM spasm, incr permeability
Atopic dermatitis
Irritants, food, environmental factors
Defects in beta defensin predispose to S.aureas superinfection
Rx: emollients, topical steroids, abx, PUVA
Food allergy
Milk, egg, peanut, treenut, fish, shellfish
Dx: food diary, skin prick tests, RAST, challenge test
Rx: dietician, food avoidance, epi pen, control asthma
Oral allergy syndrome
Allergen -> IgE with cross reactivity to other substance
Birch pollen/ stone fruit (rosacea), ragweed/melons
Sx limited to mouth
A clinical diagnosis + skin prick test
Rx: avoid food, if ingested wash mouth + po antihistamines
Latex food syndrome
Chestnut, avocado, banana, potato, tomato, kiwi, aubergine, mango, papaya, wheat, melon
Skin prick test
Avoid food
Allergic rhinitis
Seasonal: grass/tree pollen
Perennial: pets/ dust mite
Occasional: latex/ animals at work
Nasal itch + obstruction, sneezing, anosmia, eye sx
Dx: clinical= pale blueish, swollen nasal mucosa, skin prick test, RAST
Rx: allergen avoidance, antihistamine, steroid nasal spray, pollen desensitisation
Acute urticaria
50% idiopathic 50% food, drugs, latex, viral infection, febrile illness Wheals which completely resolve in 6 wks Clinical diagnosis Rx: allergen avoidance + antihistamines
What mediators are released upon mast cell degranulation?
Histamine Proteases Serotonin Heparin Thromboxane Prostaglandin Leukotriene Platelet activating factor
How do antihistamines work?
H1 receptor antagonists
Negate effects of histamine
Take longer to take effect than IM adrenaline
What mediators are released upon mast cell degranulation?
Histamine Proteases Serotonin Heparin Thromboxane Prostaglandin Leukotriene Platelet activating factor
How do antihistamines work?
H1 receptor antagonists
Negate effects of histamine
Take longer to take effect than IM adrenaline
Anaphylaxis
Severe systemic allergic reaction: resp difficulty + hypotension
IgE med mast cell degranulation: peanut, penicillin, stings, latex
Non IgE med mast cell degranulation: NSAIDs, IV contrast, opioids, exercise
Management of anaphylaxis
Elevate legs 100% O2 IM 500mcg adrenaline Inhaled bronchodilators IV 100 mg hydrocortisone IV 10 mg chlorphenamine IV fluids
Skin prick tests
To confirm clinical hx, -ve test exclude IgE mediated allergy
+ve control = histamine
-ve control = dilutant
+ve result = wheal >= 2mm> -ve control
Discontinue antihistamines 48hrs prior to test
RAST: radioallergosorbent test
quantitative specific IgE to putative allergen
Measures levels of IgE in serum against particular allergen
Confirms diagnosis of allergy and monitors response to anti IgE treatment
Indications: inability to stop antihistamines, anaphylaxis hx, extensive eczema
Component resolved diagnostics
IgE response to a specific allergen protein
E.g.
Arah2- high risk anaphylaxis to peanuts + nuts
Arah8- localised oral reaction to peanuts + stone fruit only
Challenge test
Gold standard
Double blind oral food challenge
Incr volumes of food ingested under close supervision
But risk of severe reaction
What should be measured during acute allergic reactions?
Mast cell tryptase
Peak at 1-2 hrs
Baseline by 6 hrs
Type II hypersensitivity reactions
IgG or IgM antibody vs cell/ matrix assoc protein
Haemolytic disease of the newborn
Mat IgG vs neonatal erythrocyte antigens
Reticulocytosis + anaemia
+ve DAT
req exchange transfusion
AIHA
Vs RBC antigens e.g. Rhesus RBC destruction by autoantibody, complement + phagocytes = anaemia \+ve DAT Req steroids
AITP
Vs platelet gpIIb/IIIa
Antiplatelet antibody
Req steroids, IVIG, splenectomy
Goodpasture’s
Vs type IV collagen
Glomerular nephritis, pulm haemorrhage
Anti GBMab
Req steroids + immune suppression
Pemphigus vulgaris
Vs epidermal cadherin: demoglein 1 + 3
Direct IF showing IgG
Req corticosteroids + immune suppression
Graves’ disease
Vs TSH receptor
Hyperthyroid sx
Anti TSH receptor
Req carbimazole + propylthiouracil
Myasthenia Gravis
Vs ACh receptor
Fatigueable muscle weakness
Anti ACh R Ab
IVIG, plasmapheresis, neostigmine/pyridostigmine
Acute rheumatic fever
Vs M proteins on GpAstrep
Req aspirin, steroids, penicillin
Pernicious anaemia
Vs intrinsic factor / gastric parietal cells
Reduced Hb, B12
Anti gastric parietal cell Ab
Req B12 supplementation
Churg Strauss
Med + small vessel vasculitis
Allergy -> asthma -> systemic disease
pANCA
Req prednisolone, azathioprine, cyclophosphamide
Wegener’s Granulomatosis
Med + small vessel vasculitis
Pulm haemorrhage, epistaxis, saddle nose, crescenteric GN
cANCA
Req corticosteroids, cyclophosphamide, co trimoxazole
Microscopic Polyangitis
Small vessel vasculitis
Pauci immune, necrotising, purpura
pANCA
Req prednisolone, cyclophosphamide/ azathioprine, plasmapheresis
Type II Hypersensitivity and complement
C1
C3a + C5a
C5-9
MAC
Type II Hypersensitivity and complement
C1
C3a + C5a
C5-9
MAC
Type III hypersensitivity
IgG or IgM immune complex mediated tissue damage Mixed essential cryoglobulinaemia Serum sickness Polyarteritis nodosa SLE
Mixed essential cryoglobulinaemia
Joint pain, splenomeg, skin, nerve, kidney involvement
Assoc with Hep C
Clinical dx + biopsy
Req NSAIDs, corticosteroids, plasmapheresis
Serum sickness
Rashes, itching, arthralgia, LNpathy, fever, malaise
Antiserum proteins (IV non-human antiserum)
Reduced C3, immune complexes + vessel inflammation
Ex: Stop drug, steroids, antihistamines
Polyarteritis nodosa
Fever, fatigue, wkness, arthralgia, skin, nerve, kidney, heart
Small + med vessel vasculitis -> multiple aneurysms
Complex deposition -> fibrinoid necrosis + neutrophil infiltration
Assoc with hep B
Clinical incr ESR, CRP, WCC, + biopsy
Rx: prednisolone + cyclophosphamide
SLE
ANA +ve, anti ds DNA, anti smith = interstitial lung involvement
Reduced C4
Normal CRP, incr ESR
Drug induced= hydralyzine, procainamide, isoniazid
Rx: analgesia, steroids, cyclophosphamide
Extrinsic allergic alveolitis
Aka farmers lung
Actinomycetes
Immune complex deposition in alveoli
Chronic exposure = pulmonary fibrosis, sob, cyanosis cor pulmonale
Type IV hypersensitivity
Delayed hypersensitivity, 48-72 hrs, T cell mediated Macrophage -> IL12 -> mem CD4 Th1 Sens mem cell releases IFN gamma, IL2 + IL3 -> macrophage activ = TNF alpha production, injury + inflammation Contact dermatitis T1DM MS RA Crohns Mantoux
T1DM
Pancreatic beta cell proteins -> insulinitis beta cell destruction
GAD-Ab, islet cell Ab
Antibodies to tyrosine phosphatase: anti-IA-2Ab + anti phogrin Ab
MS
Oligodendrocyte proteins (proteolipid + myelin basic protein) -> patchy demyelination
Perivascular inflammation
CSF: oligoclonal IgG bands on electrophoresis
Rx: corticosteroids, interferon beta
Uhthoff worse sx at higher than ambient T
RA
Synovial membrane antigen -> chronic arthritis, rheum nodules, lung fibrosis
Incr ESR + CRP
Anti CCP
Rx: analgesia, steroids, DMARDs
Contact dermatitis
Chemicals / poison ivy / nickel (hapten binds skin proteins)
1-2 days -> blisters/ wheals, desquamation
Clinical patch test
Rx: avoidance, corticosteroids
Crohns
TH1 mediated skip lesions in GIT
Biopsy
Rx: mesalazine, infliximab, steroids
Mantoux
Tuberculin
Skin induration indicates TB exposure
CREST- limited scleroderma
Calcinosis Raynauds Esophageal dysmotility Sclerodactyly Telangiectasia Primary pulmonary htn Only peri oral + forearm skin TNF beta central to pathogenesis Anti centromere Ab
Diffuse scleroderma
CREST + GIT + interstitial lung disease + renal problems Female 4 : male 1 Anti topoisomerase Fibrillarin Ab RNA pol I, II, III
Sjogrens
Dry mouth, eyes, nose + skin Kidneys, blood vessels, lungs, liver, pancreas, PNS Parotid + salivary gland enlargement Anti Ro, Anti La Schiller test
IPEX syndrome
Immune dysregulation, polyendocrinopathy, enteropathy, x link Eczematous dermatitis, nail dystrophy Alopecia, pemphigoid Most affected die in first 2 yrs BMT is only cure
Coeliac disease
Gluten -> villous atrophy + enteropathy Constipation, diarrhoea, bloating, fatigue Malabsorption: Fe, folate, lipid soluble vitamins, Ca deficiency IgA anti endomysial Ab IgA anti tissue transglutaminase IgG anti Gliadin Ab = most persistent Dermatitis herpetiformis Linked to Downs DQ 2 or DQ8 Gold standard = duodenal biopsy
cardiolipin Ab
Lupus anticoagulant
Beta2glycoprotein Ab
Antiphospholipid syndrome
Anti SM
Ant LKM - 1
Anti SLA
AI hepatitis
Anti rhesus blood gp antigen
AIHA
Anti Gp IIb / IIIa
AITP
pANCA
Churg strauss
Aka
eGPA
Anti TTG
Anti EMA
DQ 2
Coeliac
Anti Ro
ENA
Congenital heart block + maternal SLE
Anti Jo
Dermatomyositis
Anti topoisomerase
Fibrillarin
Diffuse scleroderma
Anti glomerular basement membrane Ab
Goodpasture’s
Anti TSH R Ab
Grave’s
Thyroglobulin Ab
Thyroperoxidase Ab
Hashimoto’s thyroiditis
Anti centromere Ab
CREST - limited scleroderma
pANCA
Microscopic Polyangitis
Anti UIRNP
Speckled pattern
Mixed connective tissue disease
Anti AChR Ab
MG
Gastric parietal cell Ab
IF Ab
Pernicious anaemia
Anti Jo -1
tRNA synthase
Polymyositis
anti mitochondrial Ab
PBC
Anti CCP
Rheumatoid factor
Incr CH50
HLA DR4
RA
Anti Ro
Anti La - speckled
Sjogrens
ds DNA
Histone Ab
Incr CH50
HLA DR3
SLE
Glutamate decarboxylase (GAD) HLA DR3/4
T1DM
Wegener’s / GPA
cANCA
PTPN22
Assoc with RA, SLE, T1DM
CTLA4
Assoc with SLE, T1DM, AI thyroid
Human normal Ig
Every 3-4 wks
Primary Ab deficiencies: CVID, Bruton’s
Secondary Ab deficiencies: CLL, MM, BMT
Passive vaccination
Specific Ig
Passive immunisation - lasts 3wks Rabies VZV Hep B Tetanus Hep A
Recombinant cytokines
INF alpha: hep B, hep C, Kaposi’s, CML, MM, hairy cell leuk
INF beta: relapsing MS
INF gamma: chronic granulomatous disease
Pre transplant induction agents
Suppress T cell response:
Alemtuzumab -CD 52
Basiliximab -CD 25
Post transplant immunosuppressant
Calcineurin inhibitors: Tacrolimus + ciclosporin
Mycophenolate mofetil
Treating acute rejection
Cellular: steroids + IVIG
Ab mediated: IVIG + plasmapheresis
How does HIV bind to CD4 cells?
Via gp 120 + gp41
CCR5 + CXcR4
Describe progression to AIDS
Median timescale = 8-10 yrs post infection
10%: Rapid progressors = 2-3 yrs
Diagnosing HIV
Screening: anti HIV Ab via ELISA
Confirmation: HIV Ab detected via western blot
+ve test req seroconversion ~10 wks post infection
What CD4 count correlates with the onset of AIDS?
HIV monitoring
Viral load: via PCR
CD4 count: via FACS - flow cytometry
How do CD8 cells block HIV entry?
MIP-1a
MIP- 1b
RANTES
APECED
AIRE mutation Normally kills T cells which bind self antigens Mild immune deficiency Dysfunctional parathyroids + adrenals Hypothyroidism Gonado failure Alopecia + vitiligo
Which are antigen presenting cells?
Macrophages
Dendritic cells
B cells
Isograft
Transplant from monozygotic twin
Allograft
Same species donor
Genetically different
HLA + ABO matched
Split transplant
Liver that might be divided between two recipients
Autograft
Transplant of tissue to same patient
E.g. Skin graft + CABG
Xenograft
Transplant from another species
E.g. Porcine heart valve in aortic valve replacement
High risk rejection + disease
Hyperactive rejection
Mins-hrs
Mediated by preformed antibodies vs antigens on surface of donor organ
Activates complement + clotting cascade
Rejection
Acute cellular rejection
1 wk post transplant T cell mediated HLA mismatch APCs-> CD4-> macrophages, CD8, B cells, IFN gamma, TNF alpha Vs donor organ
Acute vascular rejection
With Xenograft
Antibody reaction
Similar to hyper acute but after 4-6 days
Chronic rejection
Smooth muscle growth blocks graft vessel lumens -> ischaemia + fibrosis
rf: HLA mismatch, multiple acute rejections, htn, hyperlipidaemia
GVHD
Complication of allogeneic SCT
Immune cells donated recognise recipient tissue as foreign
List some AIDS defining illnesses
Mycobacterium Acium intracellulare
Candida albicans oesophagutus
Toxoplasmosis
Examples of inactivated vaccines
Cholera
Hep A
Rabies
Examples of live attenuated vaccines
CI in the immunocompromised
MMR
Sabin polio
Typhoid
Yellow fever
Sub unit vaccines
Hep B recombinant Pneumococcal Diptheria Tetanus Pertussis
Conjugated vaccines
Vs encapsulated bacteria
Influenza
Pneumococcus
Neisseria meningitidis
INF alpha
In treatment of : Hep B Hep C Kaposi's sarcoma CML
INF beta
Used in MS
Unknown mech of action
Which are antigen presenting cells?
Macrophages
Dendritic cells
B cells
INF gamma
In treatment of:
Chronic granulomatous disease
Auto immune hepatitis type 1
ANA
Anti SM Ab
Responds well to steroids
10yrs - elderly
Auto immune hepatitis type 2
Paediatric population
Anti LKM Ab
Assoc with IgA deficiency
Guillain Barré
Ganglioside LM1(A), P2, galactocerebroside
Ascending paralysis
Following CMV or Campylobacter
Cross reactivity betw pathogen and peripheral nerve myelin components
PSSN: para neoplastic subacute sensory neuropathy
Assoc with small cell
Anti Hu proteins of peripheral nerves
Para neoplastic cerebellar degeneration
Anti Purkinje cells of CNS
Para protein assoc polyneuropathy
Anti myelin-assoc glycoprotein MAG