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3 - Immunology & Haematology > Immunology > Flashcards

Immunology Flashcards

1
Q

A hypersensitivity reaction is…

A

An excessive immune response to antigens* that do not normally cause tissue damage

Autoreactive T cells or autoantibodies cause tissue damage through hypersensitivity reactions types II, III, IV

*antigens could be infectious agents, environmental substances or self-antigens

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2
Q

Autoimmunity reactions are…

A

failure of self-tolerance resulting in immune reactions against self-antigens

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3
Q

Process in which immature lymphocytes are taught to differentiate btw host and non-host. Cells that show a high affinity to self-antigens are eliminated

A

Central tolerance

In the thymus for T cells
In the bone marrow for B cells

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4
Q

Process occurring in secondary lymphoid organs, where mature lymphocytes showing a high affinity for self-antigens are eliminated

A

Peripheral tolerance

eliminated by Tregs

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5
Q

Causative factors contributing to a breakdown of tolerance causing autoimmunity

A

Genetic predisposition

  • familial
  • different MHC alleles
  • common polymorphisms
  • rare genetic diseases

Environmental factors

  • infections
  • drugs
  • UV radiation
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6
Q

Examples of organ specific autoimmune diseases

A

Brain: MS

Thyroid: hashimoto’s

Stomach: pernicious anaemis

Adrenals: addison’s disease

Pancreas: type I DM

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7
Q

examples of non-organ specific (systemic) autoimmune diseases

A 
Dermatomyositis
SLE
Scleroderma
Rheumatoid arthritis
Coeliac
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8
Q

General management of autoimmune conditions

A

Anti-inflammatory drugs (e.g. corticosteroids)
Immunosuppressive drugs
Replacement of function of damaged organ (e.g. hypothyroidism, type I DM)

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9
Q

Neutrophils target infections caused by…

A

Bacteria

Fungus

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10
Q

Monocytes target infections caused by…

A

Fungus

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11
Q

Eosinophils target infections caused by…

A

Parasites

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12
Q

T- lymphocytes target infections caused by…

A

Funcus
Viruses
PJP

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13
Q

B-lymphocytes target infections caused by…

A

Bacteria

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14
Q

Type I hypersensitivity is also known as…

A

Allergy

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15
Q

Type II hypersensitivity is also known as…

A

Antibody mediated hypersensitivity

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16
Q

Type III hypersensitivity is also known as…

A

Immune complex mediated hypersensitivity

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17
Q

Type IV hypersensitivity is also known as…

A

delayed hypersensitivity

(usually a 48-72hr delay btw antigen exposure and clinical effect)

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18
Q

a genetic tendency to produce IgE to normally innocuous environmental allergens

A

Atopy (40% of the population in Western society are atopic)

Have the genetic potential to produce allergic reactions but most won’t as allergy arises through a combination of genetic and environmental factors

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19
Q

Pathogenesis of allergy (type I hypersensitivity)

A 
Allergen exposure 
-->
B-cell --> IgE 
--> 
Early Phase Response (mins): degranulation of mast cells (release of preformed mediators: histamine, heparin...)
\+
Late Phase Response (hours): 
 - Synthesis of new mediators (prostaglandins, leukotrienes)
 - Th2 cytokines
eosinophil mediators 
-->
Allergic reaction 
 - mucosal oedema
 - capillary leakage
 - secretions
 - smooth muscle contraction
 - vasodilation
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20
Q

Diagnosis of allergy

A

Skin prick tests
IgE levels (RAST)
Histamine levels

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21
Q

Treatment of allergy

A

Patient education
Allergen avoidance

Antihistamines
Corticosteroids
Leukotriene antagonists

Desensitisation immunotherapy

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22
Q

Type II hypersensitivity is mediated by which antibodies

A

IgG or IgM

((antibodies bind to antigens and cause damage through complement activation, stimulation of phagocytes, ADCC or directly affecting the target cell))

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23
Q

Examples of clinical disorders caused by type II hypersensitivity reactions

A

Haemolytic reactions (autoimmune/ following transfusions)
Haemolytic disease of the newborn
Hyperacute graft rejection
Some organ specific autoimmune diseases (graves, myaesthenia gravis)

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24
Q

Treatment + prevention of type II hypersensitivity reactions

A

Prevention:

  • cross matching of blood
  • tissue typing
  • detection of rhesus incompatibility in pregnancy

Immune suppression

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25
Q

Type III hypersensitivity clinical conditions arise due to…

A

abnormal/excessive formation of antigen-antibody (immune) complexes and deposition in tissues

Caused by defects in the antigen or antibody

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26
Q

Presentation of a type III hypersensitivity reaction

A
  1. Serum sickness
    - caused by immune complexes formed in the circulation and deposited throughout many tissues
    - a systemic illness
  2. Arthus reaction
    - immune complexes are formed in tissues
    - a localised disorder
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27
Q

Clinical disorders caused by type III hypersensitivity reactions

A

Extrinsic allergic alveolitis (farmer’s/bird fancier’s lung)
Post-streptococcal glomerulonephritis
Chronic infections (e.g. leprosy, malaria)
Tumours
SLE

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28
Q

Diagnosis of type III hypersensitivity caused conditions

A

Clinical features
Tissue biopsy
Circulating immune complex tests
Precipitating antibody tests

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29
Q

Treatment of type III hypersensitivity caused conditions

A

Antigen elimination (e.g. infection/tumour)
Removal of immune complexes
Immunosuppressive therapy

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30
Q

Type IV hypersensitivity reactions are mediated by…

and directed against…

A

TH1 and/or TH17 cells
and the cytokines they secrete

Directed against

  • inert environmental substances*
  • infectious agents that have evolved to evade the immune response (e.g. mycobacteria)

*often in the form of a HAPTEN (as too low in molecular weight to produce a response themselves) bound to a host protein CARRIER

((only hypersensitivity reaction to not involve antibodies))

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31
Q

Pathogenesis of type IV hypersensitivity reaction

A

hapten+carrier or microorganism
–>
presented on HLAII on an antigen presenting cell
–>
TH1/TH17 cytokine overproduction/dysregulation
–>
inflammation

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32
Q

Treatment of type IV hypersensitivity caused conditions

A

prevention / avoidance of contact with antigens*
anti-inflammatory drugs (e.g. corticosteroids)
Immunosuppressants (eg block TNF, IL-6, B cells – often monoclonal antibodies)

*contact dermatitis is caused by type Iv hypersensitivity

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33
Q

Clinical disorders caused by type I hypersensitivity reactions

A 
Allergic rhinoconjunctivitis
asthma
urticaria, angioedema, eczema
food allergy
anaphylaxis (due to foods, insect venoms, drugs, latex)
34
Q

Major histocompatibility protein I (MHCI) is expressed on…

and its function is…

A

Expressed on all nucleated cells and platelets

Present self-antigens / antigens produced by intracellular pathogens…
…to CD8+ cytotoxic T lymphocytes

35
Q

Major histocompatibility protein II (MHCII) is expressed on…
and its function is…

A

Expressed on professional antigen presenting cells (APCs)
(e.g. dendritic cells, macrophages, B lymphocytes)

Present exogenous/extracellular antigens from pathogenic invaders…
…to CD4+ helper T lymphocytes

36
Q

Difference btw B and T lymphocytes in antigen detecting

A

B-cells express a B cell receptor (functionally an antibody) which detects antigens directly

T-cells only recognise antigens that are processed by an APC* and presented by an MHC molecule

*professional or non-professional

37
Q

T helper cells (Th) (CD4+)

Function

A

Activated by antigen presentation by MHCII
Secrete cytokines which have different functions

TH1 - IFNγ, IL-2, TNF (host defence against intracellular pathogens, role in autoimmunity + chronic inflammation)

TH2 - IL-4, IL-5, IL-13 (host defence against helminths, role in allergy)

TH17 - IL-17, IL-22 (host defence against extracellular bacteria and fungi, role in autoimmunity and inflammation)

((*IFN = interferon 
TNF = tumour necrosis factor
IL = interleukin))
38
Q

T cells that exert a controlling and regulatory influence on immune responses

A

T regulatory cells (TReg)

39
Q

Cytotoxic T cells (Tc) (CD8+)

function

A

Activated by antigen presentation by MHCI

Secrete IFNγ
Kill cells infected by intracellular microbes and tumour cells

40
Q

Primary lymphoid organs

+ functions

A

Thymus - where T cells mature and those responding to self-antigens are deleted

Bone marrow - where B cells mature and those responding to self-antigens are deleted

41
Q

Secondary lymph organs

+ functions

A

Lymph nodes
Spleen
Tonsils + adenoids
Gut associated lymphoid tissue (GALT) (e.g. Peyer’s patches)

where lymphocyte responses to foreign antigen are initiated

42
Q

Structure of antibodies

A

2 longer heavy chains
2 shorter light chains

Each chain has a variable region (at the “top”) and a constant region

2 antigen binding sites (Fab) (at the “tips” of the Y)

an Fc region (the “stalk” of the Y)

43
Q

Functions of antibodies

A 
Antigen binding
Immune complex formation
Opsonisation
Complement activation
Cellular cytotoxicity (ADCC)
44
Q

Components of the innate immune system

A

Physical + chemical barriers
Cells - phagocytes(macrophages, neutophils), eosinophils, basophils, mast cells, Natural Killer cells (NK)
Complement system
Pattern recognition receptors

45
Q

transfer of tissue between different sites within the same organism

A

An autograft transplant

e.g. skin graft

46
Q

transfer of tissue between genetically identical individuals

ie. identical twins

A

An isograft transplant

also known as syngeneic

47
Q

transfer of tissue between genetically non-identical members of the same species

A

An allograft transplant

(donor and recipient must be carefully tissue matched)

48
Q

transfer of tissue between species

A

A xenograft transplant

(highest risk of rejection)

49
Q

examples of transplants which are carried out with varying degrees of frequency and success

A 
kidney, 
heart, 
lung, 
skin, 
bone, 
pancreas / islets of Langerhans, 
small bowel, 
bone marrow, 
cornea, 
uterus
50
Q

damage done by the immune system to a transplanted organ

A

Rejection

51
Q

Criteria that must be met before transplantation

A
  1. Good evidence that the damage is irreversible
  2. Alternative treatments are not applicable
  3. The disease must not recur
52
Q

Criteria that must be met to minimise the risk of rejection with a solid organ transplant

A
  1. ABO matching
  2. Close tissue matching (esp. HLA)
  3. Prophylactic immunosuppressive therapy

((HLA antigens are expressed in differing densities on different organs…
so different organs require differing degrees of ‘closeness’ in tissue matching and differing degrees of immunosuppressive therapy after transplantation))

53
Q

Examples of major* antigens which donor and recipient must share in order for a graft to survive

A
  1. ABO blood group antigens
  2. Major histocompatibility antigens (HLA)*

((minor histocompatibility antigens are less well defined and mismatch is only occasionally a clinical problem))

*((HLA antigens are expressed in differing densities on different organs…
so different organs require differing degrees of ‘closeness’ in tissue matching and differing degrees of immunosuppressive therapy after transplantation))

54
Q

Tissues into which foreign grafts can be placed with no tissue or blood group matching is required because there is little blood or lymphatic supply to the tissue are called…

A

PRIVILEGED SITES

e.g. the cornea

55
Q

Graft rejection occurs due to…

A

histocompatibility (HLA) differences between donor and recipient

((ABO mismatches are very rare and are usually due to human error in matching))

56
Q

A rejection reaction that occurs within minutes of grafting is called…
and is caused by…

A

Hyperacute

caused by pre-formed antibody against HLA/ABO antigens

57
Q

A rejection reaction that occurs within 2-5 daysof grafting is called…
and is caused by…

A

Accelerated

caused by T cells

58
Q

A rejection reaction that occurs within 7-21 days of grafting is called…
and is caused by…

A

Acute

caused by T cells

59
Q

A rejection reaction that occurs within months-years of grafting is called…
and is caused by…

A

Chronic

multifactorial in cause

60
Q

A post transplant condition in which donor immune cells cause tissue damage in recipient skin, gut, liver and immune cells

A

Graft versus host disease (GVHD)

principally occurs in bone marrow transplantation

61
Q

Graft versus host disease occurs in a specific set of circumstances…

+ prevention

A
  1. functioning T cells in graft
  2. defective T cells in recipient
  3. HLA mismatch

prevention:

  • careful close tissue matching
  • deplete graft of T cells in vitrio prior to grafting
62
Q

The problem with xenografting from pigs

+ solutions

A

All humans have an IgM cantibody directed against pig antigens

Solutions:

  • remove IgM antibody from recipients
  • genetically modified (silenced) pigs
  • “humanised” transgenic pigs (chimeras)
63
Q

Potential complications of transplantation

A 
Graft rejection
Graft versus host disease (GVHD)
Infection (due to graft or immunosuppressive therapy)
Recurrence of original disease
Ethical, surgical problems etc.
64
Q

Immunosuppressive/ immunomodulatory drugs

examples

A 
Corticosteroids
Azathioprine
Cyclophosphamide
Cyclosporin & Tacrolimus
Sirolimus
Mycophenolic acid
65
Q

Monoclonal antibody production

A

Fusion of:

  • plasma cells producing the desired specific antibody
  • neoplastic myeloma cells

Results in an immortalised single clone cell line that indefinitely produces the pure desired antibody

Can be used:

  • unconjugated = as they are harvested
  • conjugated = linked to drugs which are delivered to target cells
66
Q

Aims of cytokine therapy

+ examples

A

To inhibit the activity of harmful cytokines

  • anti-IL-1
  • anti-TNF
  • anti-IL-2

or

To enhance the activity of beneficial cytokines

  • IFNα
  • IFNγ
67
Q

Immunoglobulin therapy consists of…

A

purified immunoglobulin preparations containing IgG extracted from pooled donor blood

Given to patient by IV infusion (can be I/M or S/C)

68
Q

Indications for immunoglobulin therapy

A
  1. replacement therapy in antibody deficiency
  2. immune modulating therapy in certain inflammatory/autoimmune conditions, e.g…
    - allergic disorders
    - ITP
    - GVHD
    - vasculitis
    - myaesthenia
    - SLE
    - autoimmune neuropathies
69
Q

Problems associated with immunoglobulin therapy

A

Adverse reactions during infusions

Transmission of infection (particularly hepC)

70
Q

Process in which patient’s plasma is filtered off and replaced by normal donor plasma

A

Plasma exchange

(used in some autoimmune disorders which involve formation of autoantibodies or immune complexes)

71
Q

Process in which patient’s plasma is filtered off and replaced by albumin solutions

A

Plasmapheresis

(used in some autoimmune disorders which involve formation of autoantibodies or immune complexes)

72
Q

Non pharmacological immunotherapies

A

Monoclonal antibodies
Cytokine (receptor) therapy
Plasma exchange/ plasmapheresis

73
Q

Antibody isotypes

A

The 5 shapes of antibody found in humans

IgA
IgD
IgE
IgG
IgM
74
Q

IgA is present in…

A

Secretions such as tears and breast milk

Important in mucous membrane immunity

75
Q

IgE is involved in..

A

The immune response to parasites

The pathogenesis of allergy

76
Q

The primary antibody response to an antigen is characterised by…

A
  1. a lag phase while B cells are differentiating into plasma cells and no antibodies are produced
  2. a low volume of IgM produced

((memory B cells are then formed))

77
Q

The secondary antibody immune response to an antigen (at reinfection) is characterised by…

A

Memory B cells quickly proliferate + create plasma cells which produce…

fast release of a high volume of IgG

((IgG is also the only antibody isotype to cross the placenta))

78
Q

Causes of secondary immune deficiency

A

More common than primary

Malnutrition	
infection	
immunosuppressive therapy
malignant disease	
diabetes	
chronic renal failure
splenectomy	
burns / surgery
79
Q

Heterogeneous group of conditions that produce severe dysfunction / defective development in both T and B cells

management

A

Severe combined immune deficiency (SCID)

Management: early bone marrow transplantation (only cure)

80
Q

Infections common in conditions with antibody defects

A

Bacteria: staphylococci, streptococci, haemophilus
Protozoa: guiardia
Viruses: echo, polio

81
Q

Infections common in conditions with T cell defects

A

Viruses (CMV, herpes, measles)
Bacteria (mycobacteria, listeria)
Fungi (candida, arpergillus)
Protozoa (pneumocystis, cryptosporidiosis, toxoplasma)

3 - Immunology & Haematology (3 decks)

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