Immunology 7 - Immune-modulating therapies 1 & 2 Flashcards
By what mechanism can B cells provide immunological memory?
High affinity IgG remains circulating in blood
What is the best predictor of immunity to influenza following a vaccine?
IgG against haemaglutinnin (moreso than CD8 T cells)
Why is adjuvant used in some vaccines?
It stimulates an innate immune response
Describe the process of antibody replacement in patients with a B cell immunodeficiency
- Prepare from a pool of donors
- Infusion will contain IgG to a wide range of unspecified organisms
- Administer either IV or subcutaneously
What does PEP for HIV contain?
Specific immunoglobulin for HIV
Give 2 examples of where adaptive cell transfer can be used as a therapy
- In EBV-related B cell lymphoma, can use virus-specific T cells
- In other haematological malignancies, can use T cell replacement and CAR T cell therapy
What monoclonal antibody can be used in melanoma treatment?
Ipilimumab (anti-CDL4)
This blocks an immune checkpoint –> enhanced T cell response
In what disease can IFN gamma be given therapeutically?
Chronic granulomatous disease
In what disease can IL2 be given therapeutically?
Renal cell carcinoma
IL-2 expands NK and T cell responses via the IL-2 surface receptor
In what diseases can INF alpha be given therapeutically?
CML
Multiple myeloma
How do steroids inhibit the immune response?
Inhibit PLA2 which is a key enzyme in prostaglandin formation
Also decrease phagocyte trafficking (hence there is a transient increase in neutrophil count)
Recall 3 examples of anti-proliferative agents
Cyclophosphamide
Azothioprine
Mycophenalate
What is the mechanism of action of cyclophosphamide?
Alkylation of guanine –> inhibition of DNA synthesis
What is the mechanism of action of azothioprine?
Anti-metabolite to purine
What must always be checked before prescribing azothioprine?
TPMT activity
How can plasma exchange be used to treat autoimmune diseases?
Removes problematic antibody
Need to give alongside an antiproliferative agent
Only for severe disease
How do calcineurin inhibitors work?
Calcineurin causes an upregulation of IL2 - inhibition of this allows cell proliferation
Give an example of a calcineurin inhibitor?
Ciclosporin
Give 2 diseases in which JAK2 inhibitors can be useful?
Rheumatoid and psoriatic arthritis
By what mechanism do PDE4 inhibitors work, and in what disease are they useful?
Inhibition of PDE4 –> inceased cAMP
cAMP modulates cytokine production
–> fewer cytokines
Useful in psoriasis
Recall 2 immune-modulating therapies that are useful in the prophylaxis of allograft rejection
Anti-thymocyte globulin
Anti-CD25
Wha type of antibody is rituximab?
Anti-CD20
What monoclonal antibody can be used in IBD treatment?
Vedolizumab
Anti - alpha4beta7 integrin
What is infliximab?
Anti-TNF alpha
