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Phase 1b - Gastroenterology > Immunology of the Gut > Flashcards

Immunology of the Gut Flashcards

1
Q

What is the definition of gut microbiota?

A
  • A community of commensal organisms that are found within the gastrointestinal tract
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2
Q

What are the 4 major phyla of commensal bacteria?

A
  • Bacteroidetes
  • Firmicutes
  • Actinobacteria
  • Proteobacteria
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3
Q

Which region of the GI tract has the greatest bacterial content?

A
  • Colon - due to the absence of digestive host factors (pancreatic enzymes, bile acids and acid)
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4
Q

Why is there restricted bacterial load in the stomach (3)?

A
  • Due to acidic pH (1-4)
  • Pepsin - digestive enzymes
  • Gastric lipase
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5
Q

Which digestive factor is produced by the liver, reducing the bacterial load in the duodenum?

A

Bile acids

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6
Q

What is dysbiosis?

A
  • A reduction in microbial diversity, especially in the incumbent commensal organisms that colonise the gastrointestinal tract, and a rise in pathobionts – there is an imbalance in the immunological equilibrium
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7
Q

What is a pathobiont?

A
  • Symbiotic bacteria that have become pathogenic under specific conditions
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8
Q

What is a symbiont?

A
  • An organism that interacts with the host such that there is a mutual benefit
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9
Q

What are the main causes of dysbiosis (5)?

A
  • Infection or inflammation
  • Diet
  • Xenobiotics
  • Hygiene
  • Genetics
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10
Q

Which junctions hold the epithelial monolayer together?

A
  • Tight junctions - minimising the available space to which toxins can pass through
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11
Q

Which cells secrete mucin, forming a protective mucous layer, in the gut?

A
  • Goblet cells
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12
Q

What function is performed by goblet cells in the gut, in terms of immunology?

A
  • Secrete mucin forming a protective mucous layer that promotes immunological clearance to limit inflammation and infection
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13
Q

What happens to the distribution of goblet cells within the small intestine?

A
  • Progressively increase
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14
Q

Which part of the small bowel has the greatest proportion of goblet cells?

A
  • Ileum
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15
Q

Where do Paneth cells reside?

A
  • Reside within the base of the crypts of Lieberkühn and secrete antimicrobial peptides (defensins) & lysozyme
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16
Q

What function is performed by Paneth cells?

A
  • Secrete anti-microbrial peptides (defensins) & lysozyme
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17
Q

What is MALT?

A
  • Mucosa Associated Lymphoid Tissue (MALT)

Found within the submucosa below the epithelium, as a lymphoid mass that contains lymphoid follicles.

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18
Q

Which types of venules surround lymphoid follicles?

A
  • HEV postcapillary venules - allowing for the easy passage of lymphocyte migration into the tissue
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19
Q

What are pharyngeal tonsils?

A
  • A collection of lymphoid tissue within the mucosa of the roof to the nasopharynx (referred to adenoids when enlarged) -> Forms Waldeyer ring
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20
Q

Which zones are located within MALT?

A
  • Distinct B & T-cell zones
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21
Q

Which lymphoid structures are the first line of defence for pathogens entering the nasopharynx or oropharynx?

A
  • Pharyngeal tonsils (palatine and lingual)
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22
Q

What are secondary lymphoid organs?

A
  • Sites at which lymphocytes interact with antigen-presenting cells (dendritic cells) bearing antigens from peripheral tissues and differentiating into effector and memory cells that eliminate antigen
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23
Q

Outline the process of antigen sampling (2 / 1) and the process of that takes place in Peyer’s patch (2)

A

Antigen sampling:
1. Transepithelial Dendritic cells interfere with tight junction proteins in order to gain access to the lumen
2. Dendrites interact with antigens and (become APCs and are transported to peyers patch so present to naive b and t cells in peyers patch) and are transported to the mesenteric lymph node to activate B and T cell lymphocytes

Another way in which antigen sampling happens:
1. M (micro-fold) cells, within FAE, express IgA receptors and they facilitate the transfer of IgA - bacteria complex into Peyer’s patches

In peyers patch:
1. AFTER ANTIGEN PRESENTATION
B cells undergo antibody affinity maturation in Peyer’s patches (igm to iga) that generate dimeric IgA gut specific secreting plasma cells (in lamina propria)
2. Dimeric IgA which binds to poly-Ig receptors on the basolateral surface on epithelial cells and are internalised and enzymatically cleaved within the cells in vesicles before being secreted as secretory IgA - this bind to luminal antigen preventing its adhesion + invasion

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24
Q

Which lymphoid structures are classified as GALT?

A
  • Peyer’s patches
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25
Q

Where are Peyer’s patches predominantly found?

A
  • Within the small bowel
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26
Q

Which immune cells are associated with Peyer’s patches (5)?

A
  • B lymphocytes
  • T lymphocytes
  • Macrophages
  • Dendritic cells
  • Intra-epithelial lymphocytes
27
Q

What are intra-epithelial lymphocytes?

A
  • NK cells analogues
28
Q

What happens in germinal centres within Peyer’s patches?

A
  • B-cells undergo mutation and selection - generating high affinity antibodies by somatic hypermutation and class-switch recombination
29
Q

Which immune cell forms 20% of the intestinal epithelium?

A

Intra-epithelial lymphocytes

30
Q

Which organised GALT centres are found in the small intestine?

A
  • Peyer’s patches
31
Q

Which organised GALT centres are found within the large intestine?

A
  • Caecal patches
32
Q

What are the two main differences, immunologically between the small and large intestine?

A
  • Absence of villi & paneth cells within the large bowel in comparison to the small bowel.
  • There is a greater distribution of Intra-epithelial lymphocytes (IEL) and goblet cells in the large bowel
33
Q

Which epithelial cells are associated with Peyer’s patches?

A
  • Follicle associated epithelium (FAE)
34
Q

What is essential for the development of functional Peyer’s patches?

A
  • Development requires exposure to bacterial microbiota (50 in last trimester foetus, 250 by teens)
35
Q

How do B-cells undergo antibody affinity maturation in Peyer’s patches?

A
  • Exposed to antigens presented by dendritic cells to generate IgA gut-specific secreting plasma cells
36
Q

Which type of gut-specific secreting plasmas cells are produced by Peyer’s patches?

A

IgA

37
Q

How are antigens taken up into Peyer’s patches?

A
  • M (micro-fold) cells within FAE, which express IgA receptors
38
Q

Which type of receptor is expressed by M-cells?

A

IgA

39
Q

What function is performed by M-cells (3 steps)?

A
  1. Antigen uptake via M (microfold) cells within FAE
  2. Express IgA receptors
  3. Facilitating the transfer of IgA - bacteria complex into Peyer’s patches
40
Q

What are FAE?

A
  • Specialised epithelial cells surrounding Peyer’s patches – absent of goblet cells, no secretory IgA or microvilli
41
Q

What class switch occurs upon the interaction between antigen-presenting cells and B cells?

A

IgM to IgA

42
Q

What type of IgA is secreted from plasma cells?

A
  • Dimeric IgA which binds to poly-Ig receptors on the basal surface on epithelial cells and are internalised and proceeded within the cells before being secreted as secretory IgA
43
Q

How do dendritic cells gain access to the gastrointestinal lumen?

A
  • Interfere with tight junction proteins in order to gain access to the lumen, dendrites interact with antigens - transported to the mesenteric lymph node to activate B and T cell lymphocytes
44
Q

How are activated lymphocytes transported into mesenteric lymph nodes?

A
  • Mucosal addressin cell adhesion molecule 1 (MAdCAM1) is tissue specific and is presented by endothelial cells within the high endothelial venule
    • MAdCAM1 interacts with 𝝰4β7 integrins expressed by lymphocytes
    • Adhesion to the endothelium elicits transmigration into the lamina propria
45
Q

Which tissue-specific molecule supports lymphocyte homing?

A

MAdCAM1

46
Q

How do cholera enterotoxins cause toxicity (4 steps)?

A
  1. Binds to GM-1 receptors that irreversibly stimulates the intracellular enzyme adenylate cyclase, potentiating the action at which ADP decomposes into cAMP - an intracellular molecule
  2. Increased chloride secretion and inhibition of sodium chloride resorption increases intestinal lumen solute concentrations – promotes release of water into the lumen (movement of water along a water potential gradient).
  3. Serogroups O1 & O139
  4. Enterotoxins are released when the bacteria reach contact with the epithelium.
47
Q

How is cholera transmitted?

A
  • Transmitted through faecal-oral route – and spreads via contaminated water & food
48
Q

What are the symptoms of cholera (4)?

A
  • Severe watery diarrhoea
  • Vomiting
  • Nausea
  • Abdominal pain
49
Q

How is a cholera diagnosis made?

A
  • Bacterial culture from stool sample, grown on selective agar – rapid dipstick tests are also available, although a stool sample is first line.
50
Q

What is the main treatment for cholera?

A
  • Oral rehydration solution for diarrhoea associated symptoms
51
Q

What type of virus is rotavirus?

A
  • RNA viruses that lyrically replicates within enterocytes existing as 5 serotypes (A-E), with type A rotavirus being most prevalent in human infections
52
Q

How many serotypes are there for rotavirus?

A

5 serotypes (A-E)

53
Q

Which serotype of rotavirus is most prevalent?

A

Type A rotavirus

54
Q

What is the treatment for rotavirus?

A
  • Oral rehydration therapy
55
Q

What type of vaccine is administered as prophylaxis for rotavirus?

A

Live attenuated oral vaccine (Rotarix) against type A introduced in July 2013 – saw a significant reduction in cases within the UK

56
Q

What type of virus is norovirus?

A

An RNA virus with an incubation of 24-48 hours

57
Q

What is the transmission of norovirus?

A
  • Faecal-oral transmission
    • Individuals may shed infectious virus for up to 2 weeks
    • Outbreaks are common within closed communities
58
Q

What is the symptom of norovirus?

A
  • Acute gastroenteritis – recovery 1-3 days
59
Q

How is a diagnosis made for norovirus?

A

Sample PCR

60
Q

How is campylobacter transmitted (3)?

A
  • Undercooked meat (especially poultry), untreated water & unpasteurised milk
    • Low infective dose, a few bacteria (< 500) can cause illness
61
Q

Which standard antibiotic is administered to patients with a campylobacter infection?

A

Azithromycine (Macrolide)

62
Q

What is the number of pathotypes that exist for e.coli?

A

6

63
Q

What is the risk of E.coli 0157?

A

Haemolytic uraemic syndrome

64
Q

How is a Clostridium difficile (C. Diff.) infection managed?

A
  • Isolate patient (very contagious)
  • Stop current antibiotics
  • Treat with:
    • Metronidazole
    • Vancomycin
  • Faecal Microbiota Transplantation (FMT) – 98% cure rate

Recurrence rate 15-35% after initial infection, increasingly difficult to treat

Phase 1b - Gastroenterology (13 decks)

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