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Immunology Flashcards

1
Q

What are functions of mucosal surfaces?

A

Gas exchange, food absorption, sensory activities, reproduction

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2
Q

What are mucosal surfaces portals of entry for?

A

Non-pathogenic antigens

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3
Q

Describe the stability of mucosal surfaces?

A

Highly vulnerable due to fragility and permeability

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4
Q

What are some anatomical features of gut mucosal sites?

A

Intimate relationship between mucosal epithelia and lymphoid tissues, specialised antigen uptake mechanisms

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5
Q

What are some effector features of gut mucosal sites?

A

Activated/memory T cells predominate, also natural/effector T cells and secretory IgA antibodies

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6
Q

What are immunoregulatory features of gut mucosal sites?

A

Active down regulation of immune response, inhibitory macrophages and tolerising dendritic cells

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7
Q

Where are intestinal lymphocytes found?

A

Organised tissues where immune responses are induced and scattered through the intestine

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8
Q

What are Peyer’s patches?

A

Lymph nodes in the gut found under the columnar epithelium

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9
Q

Where do lymphatics go in Peyer’s patches?

A

Out but not in

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10
Q

Where do antigens come from in terms of the gut?

A

The lumen

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11
Q

What are Peyer’s patches covered by?

A

An epithelial layer containing specialised M cells

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12
Q

What are M cells?

A

Microvilli for absorption of antigens, characterised by membrane ruffles

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13
Q

Where does cell proliferation occur?

A

Germinal centre

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14
Q

How do M cells take up antigens?

A

Endocytosis or phagocytosis

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15
Q

Once the antigen enters the M cell it is transported across it in a vesicle. Where are these released?

A

The basal surface

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16
Q

After passing through the M cell, what is an antigen bound by and what does this do?

A

Bound by dendritic cells which activates T cells (if there is the right inflammatory environment)

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17
Q

What type of cell can extend processes across the epithelial layer to capture antigens from the lumen?

A

Dendritic cells

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18
Q

Where does the effector function of immunity take place?

A

Lamina propria

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19
Q

What cells does the lamina propria contain?

A

IgA producing plasma cells, memory lymphocytes, CD8 and CD4+ T cells, dendritic cells, macrophages and mast cells

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20
Q

Where do CD4+ T cells predominate?

A

Lamina propria

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21
Q

Where do CD8+ T cells predominate?

A

Epithelium

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22
Q

What is not present in normal lamina propria?

A

Neutrophils

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23
Q

Where do T cells enter to become primed and redistributed?

A

Peyer’s patches

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24
Q

What happens to T cells becoming primed once they enter the Peyer’s patch?

A

They encounter M cells and become activated by dendritic cells

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25
Q

Where do activated T cells drain via?

A

Mesenteric lymph nodes to the thoracic duct

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26
Q

What happens to T cells at the thoracic duct?

A

Return to gut via bloodstream

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27
Q

What is secondary immune response due to?

A

Increased numbers of cloned cells

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28
Q

What are MAdCAMs?

A

Molecular addressing molecules

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29
Q

What do MAdCAMs have integrin and chemokine receptors for?

A

T cells

30
Q

Where is MAdCAM1 found?

A

Vasculature of gut and other mucosal sites

31
Q

What antibody is mainly involved in intestinal response and in what form?

A

Dimeric IgA

32
Q

Why is IgA found more in the gut than peripheries?

A

It is hard to digest

33
Q

What other antibodies are involved in gut immunity?

A

Small amounts of IgM and even smaller amounts of IgG

34
Q

What is the receptor for IgA and where is it found?

A

Poly-Ig receptor on the basolateral face of the epithelial cell

35
Q

Where is IgA transcytosed to?

A

Apical face of the epithelial cell

36
Q

What can secretory IgA on the gut surface do?

A

Bind and neutralise pathogens and toxins

37
Q

Why is selective IgA deficiency not a huge problem?

A

IgM takes over its role

38
Q

What are the main intra-epithelial lymphocytes?

A

Primarily T cells (majority CD8+ but some CD4+) and also some NKCs

39
Q

What are the two types of recognition mechanisms of T cells?

A

Class I MHC or odd stress NKC for stress cells

40
Q

What are lymphocytes in the epithelial gut lining known as?

A

Intra-epithelial lymphocytes

41
Q

What are the functions of IELs?

A

Kill infected epithelial cells by perforin/granzyme and Fas dependent pathways

42
Q

What can infection, damage or toxic peptides cause?

A

Cell stress

43
Q

What do stressed cells possess?

A

MIC-A and MIC-B

44
Q

How do stress cells get killed?

A

Natural killer cells bind to MIC A and B to activate IEL

45
Q

How do CD4+T cells differentiate during a helminth infection?

A

TH1-TH2

46
Q

What IL produced by TH2 cells in response to a helminth causes epithelial repair and mucus production?

A

IL13

47
Q

What does IL5 do when produced by TH2 cells in helminth attack?

A

Recruits and activates eosinophils

48
Q

What do TH2 cells do to B cells in helminth attack?

A

Drive them to produce IgE

49
Q

What IL produced by TH2 cells in response to a helminth causes mast cell recruitment?

A

IL3 and IL9

50
Q

What do TH1 cells do in response to helminths?

A

Activate macrophages and B cells to produce IgG

51
Q

Which is better in helminth attack, TH1 or TH2?

A

TH2

52
Q

What do mucosal immunodeficiencies usually present as?

A

Respiratory tract infections but some gut infections

53
Q

What is important to know about selective IgA deficiency?

A

Sufferers are 10x more likely to have coeliac disease. They also may have an underlying immunodeficiency

54
Q

What is common variable immunodeficiency a general term for?

A

Low immunoglobulins- failure to differentiate into Ig secreting cells

55
Q

When does CVID usually present?

A

Adulthood

56
Q

What is the problem in X-linked agammaglobulinaemia?

A

Mutation which stops B cells maturing

57
Q

What is chronic granulomatous disease?

A

Commonly X-linked- failure of phagocyte respiratory burst

58
Q

What does CGD present as?

A

Staph aureus infections or inflammatory granulomas causing pneumonia or abscesses

59
Q

What treatment does CGD not respond to?

A

Anti-TNF

60
Q

What is SCID?

A

Profound defect in T and B cell immunity

61
Q

What are common presentations of SCID?

A

Oral candidiasis, chronic diarrhoea, interstitial pneumonitis, GI infections

62
Q

What are type 1 hypersensitivity reactions initiated by crosslinking IgE on the surface of mast cells with an antigen?

A

Food allergies

63
Q

What is coeliac disease?

A

Genetically linked, autoimmune disorder which damages the small intestine leading to malabsorption and hence malnutrition

64
Q

What is coeliac disease not?

A

An allergy/IgE mediated

65
Q

What is the immunopathology of coeliac disease mediated by?

A

T cells and IEL

66
Q

What is the gene sequence required to have coeliac disease?

A

HLADQ2/8

67
Q

What can severe cases of coeliac disease lead to?

A

Complete loss of villi

68
Q

What is used to diagnose coeliac disease?

A

Biopsy in adults, serology and genetic screening in children

69
Q

What is done before a biopsy to triage patients for coeliac disease?

A

Autoantibody test

70
Q

What must the patient do for 2 weeks before a biopsy for Coeliac disease?

A

Eat gluten

71
Q

Where is ulcerative colitis?

A

Rectum and colon- surface mucosa

72
Q

What can ulcerative colitis develop?

A

Arthritis, uveitis, skin lesions

GI (17 decks)

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