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EV ACVD Study > Immunology (Fadock NAVDF notes) > Flashcards

Immunology (Fadock NAVDF notes) Flashcards

1
Q

Phenotype vs endotype

A

Endotypes are disease subtypes that are defined by a specific pathophysiological mechanism and biomarkers.

Phenotypes are clinical descriptions of a disease or patient.

Endotypes are important for precision medicine, to prescribe targeted therapies.

Various amounts of Type 2, Type 1, Type 17, and
Type 22 cells and cytokines in atopic dermatitis depending on endotype.

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2
Q

Epigenetic definition

A

How the environmental (pollutants, chemicals, drugs, diet) and behaviorial factors (e.g. stress, anxiety) affect gene expression without changing the sequence of the DNA. These changes are known to be passed from pregnant women to their offspring, affecting prevalence of atopic diseases in the children

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3
Q

How does a damaged barrier promote inflammation?

A

Alarmins from damaged keratinocyte
IL-33, IL-25, TSLP

More allergen penetration to langerhans cells

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4
Q

What are epidermal alarmins?

A

IL-25, IL-33, TSLP

Endogenous molecules that are released by the epidermis in response to tissue damage

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5
Q

How do epidermal alarmins promote the Type 2 immune response?

A

Act on ILC2 cells, which release IL-5 (eosinophils) and IL-13 (Th2 inflammation)

Act on Th2 cells to release IL-4 and IL-13 (Th2 molecules)

Act on Langerhan and dermal dendritic cells

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6
Q

What physical changes to the barrier promote antigen penetration?

A
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7
Q

What cells are involved in a Type 2 response

A

*Keratinocytes (alarmins, chemokines, IL-1)
*ILC2 (IL-5, IL-13)
*Th2 (IL-4, IL-13; express CTLA, CCR4, CRTH2)
*DC2 (OX40L)
*B cells (respond to IL-4 to make IgE)
*Eosinophils (express H4R, CRTH2 for prostaglandin binding)

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8
Q

What cytokines are involved in a Type 2 response

A

IL-4
IL-6
IL-13
IL-31

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9
Q

Path of an allergen from the skin to the lymph node

A

Allergen → through keratinocyte layers → Langerhan cell or DC2 processed, presented → Th2 stimulated → DC2 migrates to the LN →trains naive T cells to be Th2 → Th2 stimulates B cells to make IgE → Th2 and B cell go back to skin to release Type 2 cytokines

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10
Q

How does the Type 2 response affect the skin barrier?

A

1) Downregulates ceramide synthesis
2) Downregulates Filaggrin expression
3) Downregulates antimicrobial peptide expression
4) Alters skin protein and limit content

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11
Q

Define the hygiene hypothesis

A

Lack of microbial exposure in early life may increase the risk of developing allergies

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12
Q

How does skin dysbiosis contribute to
allergy?

A

If more pathogenic Staphylococcus, more superantigen release –> abundant nonspecific T cell signaling (IL-4 production!). Also Basophil activation. Can lead to increased Fas expression and keratinocyte apoptosis –> damage to skin barrier

Superantigens promote Type 2 polarization

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13
Q

How does gut dysbiosis contribute to allergy? Is there anything we can
do about it?

A

Western diet
Glycosylation of proteins = more allergenic (from high T cooking!!

The resident microbiota is important in maintaining structural and functional integrity of the gut and in immune system regulation. It is an important driver of host immunity, helps protect against invading enteropathogens, and provides nutritional benefits to the host. Disruption of the microbiota (dysbiosis) may lead to severe health problems.

Yes! Feeding skin barrier fortified diets can improved cAD symptoms

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14
Q

How does the environment contribute to atopic dermatitis?

A

Several environmental inputs: not only allergens, but pollutants,
temperature, changes in humidity, psychosocial factors

Risk factors:
*Pollutants –> ROS via skin, hair follicles, glands.
*Tobacco smoke associated with cAD
*Urban environment = risk factor for cAD
*Climate change? Changes in duration and severity of pollination; temperature and humidity; UV light
*Western, processed diet

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15
Q

Aryl hydrocarbon receptor (AHR)

A

*Transcription factor, binds to chemicals (like smoke)
*Can activate or repress gene transcription
*Activated AHR induces neurotrophic factor (artemin) to cause hyperinnervation of the epidermis

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16
Q

How does allergen immunotherapy work? 4 major mechanisms

A

1) Desensitization of mast cells, basophils, eosinophils (QUICK): increase inhibitory Fc receptors, increase H2 receptors (block action of histamine)
2) Tolerance: generation of Treg, DCreg, IL10+ ILC (ILCreg), Breg, Tfreg; Reduction of Th2 to Th1 ratio
3) Decrease IgE, increase IgG1, IgG2, IgG4, IgA
4) Decreased # mast cells, basophils, eosinophils in tissue

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17
Q

Inhibitory cytokines from Tregs

A

IL-10, TGFb, IL-35

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18
Q

What is FoxP3

A

Transcription factor
Binds DNA to induce expression of Treg development and functional proteins

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19
Q

What is atopic-like dermatitis

A

Failure to identify allergen-specific IgE by intradermal or serum testing

Like “intrinsic” atopic dermatitis in humans

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20
Q

Mechanisms of epigenetics

A

*DNA methylation

Also histone acetylation and methylation, chromatin strucrual changes, expression of noncoding microRNAs that affect gene transcription through repressing translation

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21
Q

How do ROS affect the skin

A

*Oxidize lipids in cell membranes
*Activate proteases –> damage skin barrier
*Release proinflammatory mediators from WBC

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22
Q

Which topical product binds aryl hydrocarbon receptor?

A

Tar

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23
Q

Which neurotrophic factor does aryl hydrocarbon receptor induce?

A

Artemin

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24
Q

What do Staphylococcus have to promote Type 2 inflammation?

A

Superantigens (endotoxin)

(Forces MHC cl II on APC and TCR on T cells to bind –> activate nonspecific, robust T cell response!)

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25
Q

Cytokines and chemokines released by keratinocytes

A

IL-1
Alarmins (IL-25, IL-33, TSLP)
Chemokines (TARC/CCL17, MDC/CCL22)

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26
Q

TARC/CCL17: Cell that produces it

A

Keratinocyte

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27
Q

TARC/CCL17: cell that responds to it

A

T cells (Th2, Treg)

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28
Q

TARC/CCL17: receptor that binds it

A

CCR4

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29
Q

MDC/CCL22: cell that produces it

A

Keratinocyte

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30
Q

MDC/CCL22: cell that responds to it

A

Macrophages, DC2

31
Q

MDC/CCL22: receptor that binds it

A

CCR4

32
Q

Cytokine made by activated B cells

A

IL-4

33
Q

Cytokines made by activated ILC2

A

IL-5, IL-13

34
Q

Costimulatory molecule expressed by DC2

A

OX40L

35
Q

Role of OX40L on DC2

A

Induce T cells to make IL-4, IL-5, IL-13

36
Q

Which receptor is upregulated by DC2 as they mature, which guides them to the lymph node

A

CCR7

37
Q

Which cells express CCR7

A

DC2, T cells, B cells, Treg,

38
Q

CCR7 function

A

Receptor that binds CCL19, CCL22

Brings lymphocytes, DCs to lymph node

39
Q

Ligands for CCR7

A

CCL19, CCL22

40
Q

Which receptor on lymphocytes & DCs hones them to the lymph node

A

CCR7

41
Q

Which cell helps B cells produce IgE

A

Tfh2 cells via IL-4

Th2 also help

42
Q

Which cytokine helps B cells produce IgE

A

IL-4

43
Q

Which cytokines are produced by Type 2 CD8+ cells

A

IFNgamma
IL-4
IL-6
IL-13
IL-31

44
Q

Which cytokines are produced by cutaneous Type 2 T cells and B cells

A

IL-4
IL-6
IL-13
IL-31

45
Q

Which receptors do T cells have to hone them to the skin

A

1) CLA (cutaneous lymphocyte antigen)
2) CCR4 (binds TARC/MDC)
3) PgD2R2/CRTH2 (binds prostaglandin D2 for chemotaxis)

46
Q

Which receptors do eosinophils express?

A

1) PgD2R2/CRTH2 (binds prostaglandin D2 for chemotaxis)
2) H4R

47
Q

Which cytokine is implicated in inducing epidermal hyperplasia in more chronic disease

A

IL-22

48
Q

Which cell is implicated in inducing epidermal hyperplasia in more chronic disease

A

Th22

49
Q

Blocking _____ and _____ cytokines has the biggest impact on skin INFLAMMATION

A

IL-4
IL-13

50
Q

Blocking _____ cytokine has the best control for ITCH

A

IL-31

51
Q

In addition to keratinocyte, epidermal lipid, and inflammatory cells changes, which other cell is affected by atopic dermatitis

A

Nerves! Hyperinnervation

52
Q

Which 3 cell signals are implicated in hyperinnervation in cAD?

A

1) IL-31
2) NGF
3) Artemin (made when AHR is bound to pollutants)

53
Q

Other than itch, what other sensation is experienced with severe cAD?

A

Pain

54
Q

Receptors for which cytokines are present on neurons (5)

A

1) IL-31
2) IL-4
3) IL-13
4) TSLP
5) IL-33

55
Q

How do TRegs work? (5)

A

1) Produce inhibitory cytokines (IL-10, TGFbeta)
2) Suppress antigen presentation and ILCs via CTLA-4, ICOSL (inhibitory surface molecules)
3) Inhibit target cell metabolism
4) Induce cytolysis with Granzyme A and B
5) Impair B cell production of IgE

56
Q

What does IgE bind to?

A

IgE has two types of receptors: FcεRI, which is high-affinity, and FcεRII, which is low-affinity.

57
Q

T or F: IgE can be heat inactivated

A

True at 56C

58
Q

Which cell is increased in dogs with cAD, that may produce IL-22 (epidermal hyperplasia) and IL-17A (attract neutrophils)

A

γδ T cells

59
Q

Which 2 cytokines do γδ T cells produce that may increase epidermal hyperplasia and neutrophil attraction in dogs?

A

IL-22 (epidermal hyperplasia)
IL-17 (neuts)

60
Q

Name the Staphylococcus virulence factors (7)

A

1) Superantigen (endotoxin)
2) Protein A: (Protein A binds to the Fc region of Igs)
3) Toxins: SEA-U enterotoxin, TTST-1 exotoxin
4) Adhesins
5) Invasins: hyaluronidase, coagulase, staphylokinase
6) Microcapsule
7) Cell wall

61
Q

Which cytokines does Th1 make? (viral, intracellular pathogens)

A

TNF alpha
IFN gamma
LT

62
Q

Which cytokines does Th2 make? (allergy, parasites)

A

IL-4
IL-6
IL-13
IL-31

63
Q

Which cytokines does Th17 make (extracellular pathogens)

A

IL-17
IL-22
TNF alpha

64
Q

Which cytokines does IL-22 make? (Epidermal hyperplasia, resistance to staphylococcus overgrowth)

A

IL-22
TNF alpha

65
Q

Which cytokines does Th9 make? (Chronic inflammation, potential role in food allergy)

A

IL-9
IL-10

66
Q

Which cytokines does Tfh2 make? (induce IgE, B cell function in LN)

A

IL-4
IL-6
IL-21

67
Q

Which cytokines does ILC2 make?

A

IL-4
IL-5 (eos)
IL-13
IL-9 (chronic inflam, food allergy?)

Enhance Type 2 immune response in cAD

68
Q

What stimulates ILC2 cells?

A

Epidermal alarmins (IL-25, IL-33, TSLP)

69
Q

T or F: Filaggrin mutations are necessary and sufficient to induce cAD

A

False

70
Q

How does Staphylococcus affect basophils?

A

Enterotoxin can stimulate basophils to make IL-4

71
Q

T or F: histamine is the most important molecule for induction of itch in atopic dermatitis

A

FALSE

NONhistaminergic pathway is more important (TSLP, IL4, IL13, IL31)

72
Q

Which cytokine has a vaccine against it, which shows some efficacy against IBH in horses

A

IL-5

IL-31 (itch not assessed, but decreased lesional scores)

73
Q

Does medication during ASIT affect its efficacy?

A

We don’t know.

In human medicine, it seems like it may help with efficacy of ASIT

74
Q

How does SLIT work to induce tolerance?

A

Antigen bound by sublingual oral DC –> presented to naive CD4+ T cell in LN –> naive T cell converted to FoxP3 Treg cell –> goes to tissue to induce tolerance

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