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Case 13: FASD > Immunology: Neonatal Immune System > Flashcards

Immunology: Neonatal Immune System Flashcards

1
Q

When does the blood cells arise in embryological development

A

Week 5

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2
Q

When does expanding of haemopoiesis occur

A

6-12 weeks

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3
Q

Where is the 1st site of haemopoiesis

A

Yolk sac

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4
Q

How does the T cells mature during embryological development

A

Colonies in thymus at week 12-14 & continue at beginning of trimester 3

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5
Q

What happens to the dendritic cell of embryo

A

Mature towards Th1 phenotype

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6
Q

What happens with the immune cells of embryo

A

Increase in number & maturation continues even after birth

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7
Q

What is the tolerance of the placenta

A

The foetal tissue is 50% parental therefor “foreign” & should thus stimulate an immune response
Tolerate fetus for 40 weeks

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8
Q

What is the placenta called & why

A

Immune privileged site
Immunoregulatory environment & make mother immunocompromised & more susceptible to infections

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9
Q

What is the job of the placenta

A

Ensure that the fetus is tolerated by the mother & regulate immune system around fetal tissue

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10
Q

What 3 things does the placenta do to down regulate immune system

A
  1. Secret decoy molecule, HLA molecules, trick NK cells into not attacking
  2. Trophoblastic cells of placenta does not express HLA molecules
  3. Placenta recruits regulatory T cells & result in T cell apoptosis
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11
Q

What is an important interaction between the mother & fetus regarding immune system

A

Transfer of immunoglobulins across placenta
Placenta secrets fetal neonatal FC receptors & actively binds IgG

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12
Q

What is the downside of immunoglobulin transfer

A

Autoimmune antibodies can also cross

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13
Q

What is hemolytic disease of fetus & neonate

A

Due to parental antigen, mother & fetus are different blood groups in rhesus blood groups

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14
Q

How does hemolytic disease occur

A

1st pregnancy Rh antibodies are formed
2nd pregnancy previous sensitization of mother cause IgG antibodies to cross placenta, bind blood cells & cause severe hemolysis leading to death of fetus

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15
Q

What is the role of T cells during pregnancy

A

Regulatory/anergic cells

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16
Q

What is the role of NK cells during pregnancy

A

Role in implantation of fetal tissue & maintenance of pregnancy

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17
Q

What can abnormal NK cells result in & what causes a change in NK cells

A

Infertility
Caused by infection

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18
Q

What occur during labor to the immune system

A

Composition of immune cells changes
Active recruitment of neutrophils, macrophages & mast cells to uterus

19
Q

What is the effect of increase in immune cells in uterus

A

Large amount of chemokines (IL-8/CXCL8) produced that is a pro-inflammatory cytokines
Lipid mediators are also produced
Inflammation occurs = act of labor

20
Q

Who is more likely to go into preterm labor

A

Women with infections either systemic or placental tissue (chorioamnionitis)

21
Q

What group of people are more likely to go into preterm labor

A

HIV + pregnant women

22
Q

Why are people with infection more likely to go into preterm labor

A

High levels of circulating cytokines causing cervix to ripen

23
Q

What is induction

A

Exploitation of immune system to induce labor

24
Q

How is labor induced

A

Insertion of prostaglandin (E2 & F2a) gels into vagina

25
Q

What is a caesarean section

A

Surgical intervention which replace normal vaginal birth

26
Q

What is the 2 effects of C-section of the baby

A

Neonatal microbiome is different (not passing through vagina but sterile enviroment)
Increased risk for infections & autoimmune disease

27
Q

What is microbiome

A

Community of microorganism which inhabit a specific environment

28
Q

What protected the fetus from infection before birth

A

Placental & maternal immune system

29
Q

What is the infants 1st exposure to microorganisms

A

Vaginal passage

30
Q

What is the effect of vaginal birth of infant microbiome

A

Leading to neonatal microbiome resembles maternal microbiome

31
Q

Why is early colonizing bacteria essential for

A

Establishing immune system especially in the GIT

32
Q

What is the 2 most important bacteria in infants exposure

A

Lactobacillus & Bifidobacterium

33
Q

What is the 3 responsibilities of the bacteria

A
  1. Educate immune cells (T cells)
  2. Development of pattern recognition
  3. Maturation of cells
34
Q

What is Lactobacillus

A

Milk-promoted bacterium

35
Q

2 reasons why breastfeeding is important for the baby

A
  1. Immunomodulatory substance that reduce autoimmune disease incidence
  2. Continued antibody delivery providing significant protection for the baby
36
Q

What is the 4 functions of colostrum

A
  1. Promotes growth of beneficial flora (Lactobacillus)
  2. Contains secretory IgA which neutralizes pathogens & helps with formation of healthy microbiome
  3. Contains proline rich polypeptide which allows for maturation of T cells
  4. High amount of lactoferrin which binds to iron & prevent bacterial overgrowth
37
Q

What is the functionality of professional antigen presenting cells in neonates

A

Poorly matured

38
Q

What is 3 examples of poorly matured professional antigen presenting cells

A
  1. Monocytes & dendritic cells express low levels of CD80/86 & MHC II
  2. Reduced production of cytokines
  3. Adhesion molecules are reduced
39
Q

What is the functionality of neonate T cells

A

Polarized towards Th2 response & poor cytotoxic against intracellular bugs

40
Q

What is 3 bacteria associated with bacterial meningitis & sepsis

A
  1. Listeria Monocytogenes (facial matter & soil)
  2. Escherichia coli (commensal flora)
  3. Group B streptococcus (major cause of UTI & recto vaginal colonization in sexually active women)
41
Q

What is the goal of the EPI

A

One dose of vaccination before 6 months

42
Q

What is the window period

A

4-6 months when it is the best time for immune exposure to develop a immune response

43
Q

What 2 vaccines are given within the first 28 days of life that is poorly developed

A

RSV & rotavirus

44
Q

What is 3 improving & expanding strategies for EPI

A
  1. Improvement of adjuvants
  2. Differential route of vaccines
  3. Improved monitoring

Case 13: FASD (9 decks)

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