Immunology Exam 2 Review Flashcards
_______________ the first phase of Humoral Immunity where Naive B-cells are stimulated by antigen-binding to cell surface proteins and the cross-linking of several B-cell receptors
Antigen recognition
What are 2 examples of ig involved in antigen recognition
IgM
IgD
In antigen recognition receptor associated proteins will transmit the signal to the:
cytoplasm
______________ can also be stimulated by antigens to differentiate and initiate Ig production
Memory B cells
What receptors on B-cells can co-stimulate and strengthen responses?
complement receptors
multivalent antigens that are NOT dependent on T-cell presence to create a maximal humoral immune response
T independent antigens
What is the most common TCI-Ags response produced?
IgM response
True/False: TCI-Ags have high affinity maturation or memory response.
False
T-Cells can provide assistance in activating _________ by increasing antibody production.
B cells
What two things can B cells present
antigen and costimulators
T-cells express CD40L and secrete _______
cytokines
ONLY ________ (T-cells/B-cells) recognize the same antigenic complex T-cells and B-cells will bind _________ (different/same) epitopes on the
_______ (different/same) antigen.
T cells
different
same
a molecule that is recognized by an antibody, but does NOT induce a T-cell response (antibody production) when alone
Hapten
( haptens cannot cross-link surface Ig on B-cells; haptens require a carrier protein in order for antibody production to occur)
When haptens are attached to a carrier-protein, a ______ will recognize the“foreign” peptides that are presented to the B-cell to the T-cell
T cells
The normal B-cell is isotype is IgM and the principal effector function of IgM is _________________
complement activation
True/False: affinity maturation is non-specific and occurs with both B-cells and T-
cells
False (B cell only)
The VDJ site is usually ______ (variable/fixed) even though random point mutations can occur in dividing B-cells
fixed
describes when B-cells die off because there is less antigen stimulation occurring
Humoral response decline
The humoral response decline is regulated by high-levels of which ig
IgG
Which immunoglobulin replaces IgM and IgD on the B-cell surface?
IgG
bind to free microbes and interfere with host-cell binding to prevent infection
Neutralizing
Immunoglobulins will stimulate opsonization and phagocytosis: What are the 5 steps
Step1-IgG opsonizes a microbe
Step 2 - Opsonized microbe binds to phagocyte Fc
Step3- Phagocyte is activated by Fc receptors
Step 4 -Microbe is phagocytosed
Step 5- The ingested microbe is killed
Mucosal Immunity–aids in protection; a transport molecule moves ____(IgG/IgA) across the mucosal epithelium to prevent and block microbe colonization entry to the body
IgA
The IgA antibody is mainly produced by B-cells in ______ tissues and requires high levels of TGFβ
mucosal
the ability for microbes to evade antibody recognition by altering their surface antigens/molecules
antigen variation
shift or drift: When a pathogen endures a mutation to a gene-component that causes many changes to Ag-epitopes. Rarely occurs, but when it does it can be very significant/detrimental
antigenic shift
shift or drift: When a pathogen endures one or several mutations that resultingly change a few Ag-epitopes. Occurs on an annual basis
antigenic drift
_______ – a substance, that is typically added to vaccines, that triggers an innate immune response to enhance adaptive immunity
Adjuvant
________________ composed of killed viruses and/or protein fragments of the pathogen that cannot replicate in the host
killed/subunit vaccines
True/False: The antibody response is CD8+ cell-mediated in killed/subunit vaccines
False
Dead(Non infectious) virus alone → stimulates Class ___ to _____ cells, B-cells, & TLR-
ligands
class 2 CD4+
Dead(Non-infectious) viral protein alone → stimulates Class II to CD4+ cells, B-cells
■ Will only stimulate TLR-ligands if an _______ is present to stimulate innate cells
adjuvant
most effective and provide long-term protection BUT can cause the disease in an immunocompromised host
Live/attenuated vaccines
Vaccines produce mucosal immunity, CD8+ cell-mediated protection, and antibody
production as the virus/pathogen replicates in the host over a short period of time
Live attenuated vaccine
Live (Infectious) virus alone → stimulates Class ___ to ____ cells
Class 1 CD8
Live (Infectious) virus PLUS _____________________ → stimulates Class II to CD4+ cells, B-cells, and TLR-ligands
dead virus/infected cells
occurs when an immune response is too robust and causes tissue damage
hypersensitivity reaction
What is Type 1 hypersensitivity also called
anaphylaxis
What is Type 2 hypersensitivity also called
cytotoxic
What is Type 3 hypersensitivity also called
immune complex
What is Type 4 hypersensitivity also called
delayed-type
Type 1: IgE bound to Mast Cells to produce what
an allergic reaction, stimulated by TH2 (eosinophils)
Type 2: Damage is done where the antibody binds to the tissue antigen. Antibody binds directly to antigens → antigens activate ____ cells
TH1
Type 3: Damage is done where the immune complex is deposited (not necessarily where
antigen is expressed). Antigen activate ___ cells
Th1
Type 4: T-cell-mediated usually the first contact with T-cells produces memory. Second contact with T-cells causes what
damage
IgE Production → dependent on _____ CD4+ stimulating B-cells
TH2
TH2 Cell activation is promoted by what 3 things
IL-4, IL-5, IL-13
IgE Production Inhibition → dependent on ____ CD4+ cell production
TH1
TH1 cell activation is promoted by what
IL-12, IL-2, IFN gamma
Tissue Damage occurs in Type II and Type III Hypersensitivity: Injury is caused by anti tissue antibody → ____ Cells produce more complement-fixing isotypes which recruit and activate anti-inflammatory cells
TH1
immunologically mediated via IgE; typically anaphylaxis results
Allergic
resembles an allergic reaction, but is not immunologically mediated (i.e., histamine is released but there is NO cross-linking of IgE)
pseudoallergic
Process of Type I Hypersensitivity Reaction: The antigen will bind to IgE on the surface of mast cells which causes cross-linking of IgE on mast cell. An increased influx of _____ into the mast cell
Ca2+
_______ procedure that is used when there is no other treatment option and the patient has a Type I HS reaction to the medication that is needed
Desensitization
Immunology of desensitization protocol: Two immunoglobulins dependent on IL-4→
IgE and IgG4
True/False: IgG4 only elicits tolerance to the allergen
True
_____ is key to the production of IgG4 versus IgE
IL-10
_______ tolerance self-reactive B-cells and T-cells are deleted in either the bone marrow or thymus
Central
_______ tolerance self-reactive cells that escape are usually controlled by regulatory T cells (tregs)
peripheral
Self-antigens without innate danger signals or co-stimulators that are unresponsive
anergic antigens
Treg Effector functions
inhibit APCs
secrete IL-10 and TGF beta
Use IL-2
Adenosine
a microbial peptide or protein may be recognized by a self-antigen reactive T-cell or B-cell
molecular mimicry
antibodies that arise from defects in clearance of dead/dying cells and Ag-Ab complexes
antinuclear antibodies (ANA)
A common condition that is triggered by exposure to cold or stress that leads to vasospasm in the extremities, extremities can blue:
raynauds
What are some drugs that can induce or worsen Raynaud’s syndrome?
beta blockers
bleomycin
cisplatin
amphetamine, pseudoephedrine
What drug could we use to treat Raynaud’s syndrome?
CCB (nifedipine)
- What is the non-pharmacologic therapy used to treat Psoriasis?
UV light
When should we use topical therapy VS system therapy to treat Psoriasis?
> 10% of body use systemic therapy
topical: tazarotene + halobetasol
systemic: apremilast
a systemic autoimmune disease that can affect any organ system in the body
SLE
Common ss/sx of SLE:
fatigue
malar rash
depression
What the first line medication for SLE that everyone should be on?
hydroxychloroquine
What baseline labs that we need to account for in hydroxychloroquine?
vision evaluation
What are some side effects of this medication in hydroxychloroquine?
N/V/D
rash
CNS
headaches
When to add steroids to therapy in SLE?
flares
List drugs that can cause SLE:
hydralazine
anti-TNF
methyldopa
Hydroxychloroquine agent and when to use in lupus
Primary Non-Biologic DMARD
maintenance
NASIDS when to use in lupus
flares
Glucocorticoids when to use in lupus
flares
Non-Biologic DMARDs
MXT, MMF
Biologic DMARDS
Rituximab, Belimumab
List conventical DMARDS for RA treatment, which one is first line?
methotrexate***
sulfasalazine
lefluonmide
hydroxycholoquine
What is the dose typically use for methotrexate
7.5-15 mg weekly
(use with folic acid)
What ADRs would we monitor in methotrexate
GI, hepatic, liver, Scr, CBC
joint inflammation that occurs due to decreased synthesis of chondrocytes associated with cartilage degradation–bone-on-bone; referred to as “wear and tear arthritis”
osteoarthritis
Common immunosuppressive drugs and their targets: FκBP Receptor on calcineurin
Tacrolimus
Common immunosuppressive drugs and their targets: FκBP Receptor on mTOR
Sirolimus
Common immunosuppressive drugs and their targets: 6-MP substrate of purine synthesis
Azathioprine
Common immunosuppressive drugs and their targets: IL-2Rɑ
Basiliximab
Common immunosuppressive drugs and their targets: IMPDH to inhibit purine synthesis
Mycophenolate
Common immunosuppressive drugs and their targets: Calcineurin
Cyclosporine
List Induction therapy medications:
basiliximab
alemtuzumab
high dose steroids
List maintenance therapy medications:
tacolimus
sirolimus
mycophnolate mofetil
