Immunology - Immune-modulating therapies 1 & 2 Flashcards by Yasmin Kamara

By what mechanism can B cells provide immunological memory?

High affinity IgG remains circulating in blood

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

IgG against haemaglutinnin (moreso than CD8 T cells) detected using a Haemagluttinin (HA) assay

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Why is adjuvant used in some vaccines?

increase the immune response without altering its specificity:

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What does PEP for HIV contain?

Specific immunoglobulin for HIV

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What monoclonal antibody can be used in melanoma treatment? Its specific for what antibody?

Ipilimumab (anti-CTL-A4)
This blocks an immune checkpoint by binding to CTLA4, forces CD80 and CD86 to go through stimulatory CD28 pathway –> enhanced T cell response

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In what disease can IFN gamma be given therapeutically?

Chronic granulomatous disease

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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

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In what 2 diseases can IFN alpha be given therapeutically?

CML
Multiple myeloma

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How do steroids inhibit the immune response?

Inhibit phospholipase A2 which is a key enzyme in prostaglandin formation, reducing inflammation

Also decrease phagocyte trafficking (hence there is a transient increase in neutrophil count)

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Recall 3 examples of anti-proliferative agents

Cyclophosphamide
Azothioprine
Mycophenalate

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What is the mechanism of action of cyclophosphamide?

alkylating agent
Alkylation of guanine –> inhibition of DNA synthesis
affects B cells > T

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What is the mechanism of action of azothioprine?

purine analogue

coverts purine to 6 mercaptopurine (6-MP

inhibits de novo purine synthesis and acts as an antiproliferative
affects T cells > B

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What must always be checked before prescribing azothioprine?

TPMT activity
Thiopurine methyltransferase

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How can plasmapheresis be used to treat autoimmune diseases? What should you give in conjunction

emoves problematic antibody
Need to give alongside an antiproliferative agent such as cyclophosphamide to prevent rebound antibody production

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How do calcineurin inhibitors work?

blocks IL2 production

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Give 2 examples of a calcineurin inhibitor? What cells do they inhibit

inhibit t lymphocytes

Cyclosporine
tacrolimus

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Give 2 diseases in which JAK2 (janus kinase) inhibitors can be useful?

Rheumatoid and psoriatic arthritis

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

increased cAMP
activates PKA (protein kinase A)
leads to decrease in cytokine production

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

Anti-thymocyte globulin (rabbit)
Anti-CD25 (Basiliximab)

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Wha type of antibody is rituximab?

Anti-CD20

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What monoclonal antibody can be used in IBD treatment?

Vedolizumab
Anti - alpha4beta7 integrin

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What is infliximab?

Anti-TNF alpha

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What monoclonal therapy can be used in osteoporosis?

anti-RANK/RANK-ligand = Denosumab

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What is the mechanism of action of tofacitinib

JAK inhibition

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What is the mechanism of action of apremilast?

Anti-PDE4

What is the mechanism of action of basilixumab?

Anti-CD25 (alpha chain of interleukin 2)

What is the mechanism of action of Abatacept?

CTLA4 Ig opposite of ipilimumab it turns off T cells reducing autoimmunity hence why used in RA

What is the mechanism of action of rituximab?

Anti-CD20

What is the mechanism of action of natalizumab?

Anti-alpha4 integrin

What is the mechanism of action of tocilizumab?

Anti-IL6-Receptor

What is the mechanism of action of muromonab

Mouse monoclonal against CD3

What is the mechanism of action of alemtuzumab?

Anti-CD52

What is the mechanism of action of adalizumab?

Anti-TNF alpha

What is the mechanism of action of certolizumab?

Anti-TNF alpha

What is the mechanism of action of golimumab?

anti-TNF alpha

What is the mechanism of action of etanercept?

TNFa antagonist

What is the mechanism of action of ustekinumab?

Anti-IL12/23

What is the mechanism of action of sekukinumab? Treats what 2 conditions

Anti-IL17a psoriasis/psoritatic arthritis ankylosing spondy

What condition can be treated with apremilast?

Psoriasis

What conditions can be treated with natalizumab?

MS Crohn's

What conditions can be treated with abatacept?

Rheumatoid arthritis

give 2 live attenuated vaccines

BCG MMR

give 4 inactivated vaccines

influenza pertussis polio hep A

what's the mechanism of mycophenelate

anti metabolite blocks guanosine nucleotide synthesis, prevents DNA replication prevent T cell proliferation \> B cell

give an example of a JAK2 inhibitor

ruxolotinib

give an example of a PDE4 inhibitor

apremilast

give 3 classes of drug that inhibit cell signalling

calcineurin inhibitors JAK inhibitors PDE4 inhibitors

give 4 anti TNFa drugs

infliximab adalimumab certolizumab golinmumab

anti IL-12 and IL-23 can be used for what 2 conditions

psoriasis/psortiatic arthritis crohns

guselkumab is used to treat what?

psoriasis

guselkumab is anti IL...

IL 23

What infection should be ruled out before commencing inflximab for cronhs

TB via mantoux test if mantou +ve then an interferon gamma release assay (IGRA) if ve = latent TB mist treat before immune modulating therapy

whats a recombinant vaccine? give 2 examples

accine contains proteins found on the surface of the viruses in addition to an adjuvant. Examples include Hep B and HPV.

what a conjugate vaccine? what are they used against? give 3 examples

For encapsulated bacteria. Consist of bacterial polysaccharides conjugated to an immunogenic toxin (diphtheria toxin). Used for Haemophilus influenzae, meningococcus and pneumococcus.

What antigen is injected intradermally as part of the mantoux screening test for tuberculosis?

**Tuberculin** Purified Protein Derivative

how is the mantoux test interpreted

The size of the induration (not erythema) is measured after 48-72 hours. ## Footnote \>5mm is positive in HIV or immunosuppressed patients or people at very high risk of TB (such as living with someone with active TB) \>10mm is positive in IVDU, medium risk populations such as healthcare workers or children \<4 years old \>15mm is positive in low risk populations.

give a complication of the use of natalizumab, mycophenelate & rituiximab

Progressive Multifocal Leukoencephalopathy caused by the john cuNNINGHAM vIRUS

What mouse monoclonal antibody targets CD3 on the surface of T cells?

Muromonab

what antibody targets cd 25? whats its use

basiliximab allograft rejection

what is tocfatinib and its use

JAK inhibitor used in rheum arthritis

what monoclonal antobody targerts CD52. whats the effect

alemtuzumab depletion of all lymphocyte subsets

state 4 anti TNFa drugs

Infliximab/Adalimumab/Certolizumab/Golimumab directly bind to TNFa

give the se's of prednisolone, cyclophosphamide and tacrolimus

pred - osteoporosis cyclo - infertility tacro - nephrotixicity