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Year 5 - Pathology ICSM1 > Immunology 7 - Immune-modulating therapies 1 & 2 > Flashcards

Immunology 7 - Immune-modulating therapies 1 & 2 Flashcards

1
Q

By what mechanism can B cells provide immunological memory?

A

High affinity IgG remains circulating in blood

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2
Q

What is the best predictor of immunity to influenza following a vaccine?

A

IgG against haemaglutinnin (moreso than CD8 T cells)

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3
Q

Why is adjuvant used in some vaccines?

A

It stimulates an innate immune response

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4
Q

Describe the process of antibody replacement in patients with a B cell immunodeficiency

A
  1. Prepare from a pool of donors
  2. Infusion will contain IgG to a wide range of unspecified organisms
  3. Administer either IV or subcutaneously
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5
Q

What does PEP for HIV contain?

A

Specific immunoglobulin for HIV

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6
Q

Give 2 examples of where adaptive cell transfer can be used as a therapy

A
  1. In EBV-related B cell lymphoma, can use virus-specific T cells
  2. In other haematological malignancies, can use T cell replacement and CAR T cell therapy
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7
Q

What monoclonal antibody can be used in melanoma treatment?

A

Ipilimumab (anti-CTL4)

This blocks an immune checkpoint –> enhanced T cell response

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8
Q

In what disease can IFN gamma be given therapeutically?

A

Chronic granulomatous disease

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9
Q

In what disease can IL2 be given therapeutically?

A

Renal cell carcinoma

IL-2 expands NK and T cell responses via the IL-2 surface receptor

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10
Q

In what diseases can INF alpha be given therapeutically?

A

Hairy Cell Leukaemia
CML
Multiple myeloma

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11
Q

How do steroids inhibit the immune response?

A

Inhibit PLA2 which is a key enzyme in prostaglandin formation
Also decrease phagocyte trafficking (hence there is a transient increase in neutrophil count)

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12
Q

Recall 3 examples of anti-proliferative agents

A

Cyclophosphamide
Azothioprine
Mycophenalate

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13
Q

What is the mechanism of action of cyclophosphamide?

A

Alkylation of guanine –> inhibition of DNA synthesis

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14
Q

What is the mechanism of action of azothioprine?

A

Anti-metabolite to purine

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15
Q

What must always be checked before prescribing azothioprine?

A

TPMT activity- TPMT Polymorphism prevents metabolism of azothioprine causing toxicity

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16
Q

How can plasma exchange be used to treat autoimmune diseases?

A

Removes problematic antibody
Need to give alongside an antiproliferative agent
Only for severe disease

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17
Q

How do calcineurin inhibitors work?

A

Calcineurin causes an upregulation of IL2
Calcineurin inhibitors interfere with cell signalling by stopping the downstream effects of calcineurin thus prevent formation or IL2 and thus preventing T cell proliferation

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18
Q

Give 2 examples of a calcineurin inhibitor?

A

Ciclosporin

Tacrolimus

19
Q

Give 2 diseases in which JAK2 inhibitors can be useful?

A

Rheumatoid and psoriatic arthritis

20
Q

By what mechanism do PDE4 inhibitors work, and in what disease are they useful?

A

Inhibition of PDE4 –> inceased cAMP
cAMP modulates cytokine production
–> fewer cytokines
Useful in psoriasis, psoriatic arthritis

E.g: Apremilast

21
Q

Recall 2 immune-modulating therapies that are useful in the prophylaxis of allograft rejection

A

Anti-thymocyte globulin

Anti-CD25 (Basiliximab, Daclizumab)

22
Q

Wha type of antibody is rituximab?

A

Anti-CD20 (found on mature B cells, plasma cells unaffected)

23
Q

What monoclonal antibody can be used in IBD treatment?

A

Vedolizumab

Anti - alpha4beta7 integrin (to do with ICAM- basically prevents cell migration)

24
Q

What is infliximab?

A

Anti-TNF alpha

25
Q

What monoclonal therapy can be used in osteoporosis?

A

anti-RANK/RANK-ligand

Denosumab

26
Q

What is the mechanism of action of tofacitinib

A

JAK inhibition

27
Q

What is the mechanism of action of apremilast?

A

Anti-PDE4

28
Q

What is the mechanism of action of basilixumab?

A

Anti-CD25 (alpha chain of interleukin 2)

29
Q

What is the mechanism of action of Abatacept?

A

Anti-CTLA4

30
Q

What is the mechanism of action of rituximab?

A

Anti-CD20

31
Q

What is the mechanism of action of natalizumab?

A

Anti-alpha4 integrin

used in MS and Chrohn’s

32
Q

What is the mechanism of action of tocilizumab?

A

Anti-IL6-R (useful in Casteman’s disease- IL6 producing tumour)

33
Q

What is the mechanism of action of muromonab

A

Mouse monoclonal against CD3

34
Q

What is the mechanism of action of dacilizumab?

A

Anti-CD25 (alpha chain of interleukin 2)

35
Q

What is the mechanism of action of alemtuzumab?

A

Anti-CD52

36
Q

What is the mechanism of action of adalizumab?

A

Anti-TNF alpha

37
Q

What is the mechanism of action of certolizumab?

A

Anti-TNF alpha

38
Q

What is the mechanism of action of golimumab?

A

anti-TNF alpha

39
Q

What is the mechanism of action of etanercept?

A

anti-TNF alpha/TNF beta fusion protein

Decreases macrophage response- used in RA, AnkoSp, Psoriasis/Psoriatic arthritis

40
Q

What is the mechanism of action of ustekinumab?

A

Anti-IL12/23

41
Q

What is the mechanism of action of secukinumab?

A

Anti-IL17a

42
Q

What condition can be treated with apremilast?

A

Psoriasis, Psoriatic arthritis (Pde4 inhibitor- increases cAmp-increases PKA- decreases cytokine production)
aPrelimast - all Ps

43
Q

What conditions can be treated with natalizumab?

A

MS

Crohn’s

44
Q

What conditions can be treated with abatacept?

A

Rheumatoid arthritis

Year 5 - Pathology ICSM1 (85 decks)

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