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Year 5 😊✌🏼 > Immunomodulation 1&2 > Flashcards

Immunomodulation 1&2 Flashcards

1
Q

Cells involved in immune memory

A

pool of specific B and T cells

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2
Q

How do follicular T helper cells provide help to B cells for expansion and isotope swiching?

A

CD40L and cytokines

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3
Q

antibody order in immune response

A

IgM initial response
IgG than takes over

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4
Q

what criteria are important for generating a vaccine?

A
  1. Memory
  2. no adverse effects
  3. safe, easy to administer, one dose only if possible
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5
Q

Haemagglutiniation inhibition assay

A

wells with RBC only - dot where RBCs sink

wells with RBC plus virus - haemagglutination

wells with RBC and effective antibody - dot where RBCs sink because antibodies bind and neutralises to the HA -> no haaemaagglutiinataion

for influenza vaccination

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6
Q

Manatoux test - immune reaction

A

Type IV

(delayed response, have to read the results around 72h post injection)

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7
Q

Cytokine therapy -

A

used to be used

goal waas to induce interleukin 2 (two stimulate T cell response)

some of the TT-cells

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8
Q

Cytokine therapy - interlukin 2, where useful?

A

renal cell cancer

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9
Q

IFN-gamma cytokine therapy

A

add from lecture

can be used in chronic granulomatous disease

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10
Q

INF-alpha cytokine therapy

A
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11
Q

Replacing missing components of the immune system as immune modulating therapy

A

HSCT

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12
Q

Antibody replacement

A

noramal

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13
Q

How is human normal IgG made?

A

prepared form pools or >1000 people

….

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14
Q

human IgG when uussed.

A

primary and secondary antibody deficiencies

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15
Q

Specific Ig - when used?

A

PEP (Hep B)

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16
Q

Specific Ig - How made?

A

derived from plasma donors with high titres of IgG Abs to specific pathogens.

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17
Q

When do you use VZVIgG rather tthan

A

<20w pregnant

or

immunocompromised?

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18
Q

ACT - what is it?

A
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19
Q

ACT - when is it used?

A
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20
Q

TIL T-cell therapy

A
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21
Q

what does IL-2 do?

A

proliferation of T-cells

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22
Q

TCR and CAR-T cell therapy

A
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23
Q

Issue with checkpoint inhibitors

A

often develop autoimmune diseases (because of the T-cell activation)

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24
Q

Examples of what checkpoint inhibitors bind to?

A

PD1
PD2
CTLA4

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25
Q

Examples of checkpoint inhibitors

A
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26
Q

Which vaccines are live?

A

BCG
Polio (oral)
MMR

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27
Q

What do steroids block?

A

Phospholipase A2

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28
Q

Why are neutrophil counts high in poeple on high dose steroids?

A

interfere with trafficking and function in the innate immune system

….

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29
Q

effects of corticosteroids on lymphocyte function

A

lymphopenia (sequestration of lymphocytes ion lymphoid tissue)

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30
Q

Side effects of ssteroids

A

diabetes
central obesity
moon face
lipid abnormalities
osteoporosis
hirsutism
adrenal suppression
infection
cataracts
glaucoma
peptic ulcer
pancreatitis

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31
Q

Anti-proliferative immunosuppressaants - examples

A

cyclophosphamide (most toxic)
mycophenolate
azathioprine (caban be used in pregnancy)

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32
Q

Anti-proliferative immunosuppressaants - MoA

A

inhibitt DNA synthesis

33
Q

Aside effects of cyclophosphamide

A

bone marrow depression
hair loss
sterility (men&raquo_space;> women -> sperm storage)

haaemorrhagic cysts
malignancy (bladder cancer, haematological malignancies, non-melaonma skin cancer)
Infection (pneumocystsitis jiroveci)

34
Q

Azathioprine SE

A

bone marrow suppression (1 in 300 individuals are extremely susceptible to this because of TPMT polymorphisms)
hepatotoxicity
Infection (less common)

35
Q

Azathioprine SE

A

bone marrow suppression (1 in 300 individuals are extremely susceptible to this because of TPMT polymorphisms)
hepatotoxicity
Infection (less common)

36
Q

What do you do before staarting azathioprine?

A

check TPMT for polymorphisms

if homozygous: don’t use
if heterozygous: use 50% dose

37
Q

SE of mycophenolate mofetil

A

bone marrow suppression
herpes virus reactoncation
progressive multifocaal leukoencepaahlopathy (JC virus)

38
Q

How does plasma exchange work?

A

remove patients blood, filter out antibodies and return blood without the anttibodies

temporary effects until the

useful in severe antibody mediated disease or antibody mediated transplant rejection

T2 hypersensitivity reaction

39
Q

What immune reaction type does plasma exchange work for>

A

type 2 (AB mediated)

40
Q

What diseases can plasma exchange help wth ?

A

Myasthenia gravis
Goodpaasture syndrome

41
Q

Tacrolimus

A

calcineurin inhibitor

42
Q

where is tacrolmus used?

A

transplant

AI-diseasse e.g.SLE, psoriatic arthritis

43
Q

examples of calcineurin inhibitors

A

tacrolimus

44
Q

Rapamycin

A

mTOR inhibitor

45
Q

mTOR inhibitor examples

A

Sirolimus
Rapamycin

46
Q

Jakinibs

A

JAK inhibitors

effective in RA, psoriatic arthritis, axial spondyloarthritis.

more SE than some of the monocolonals

oraal agent so some people prefer it to monoclonals

47
Q

Why do some people prefer Jakinibs to monoclonal despite more SE?

A

because they are an oral agent

48
Q

Why do some people prefer Jakinibs to monoclonal despite more SE?

A

because they are an oral agent

49
Q

anti-thymocyte globulin - how is it made?

A

inject human thymocyte into rabbit ???

more

50
Q

toxic effects of anti-thymocyte immunoglobulin

A
51
Q

CD25 antibody

A

IL-2R alpha chain

blocks the effect of IL-2

given before and after transplant surgery for prophylaxis of rejection

52
Q

Toxicity associated with IL-2Ralpha chain monoclonla

A
53
Q

CTLA4-Ig fusion protein mAb - indications

A

RA (IV 4 weekly, sc weekly)

54
Q

How does CTLA4-Ig work?

A

reduces co-stimulation of CD28 + T cells

55
Q

Rituximab - what is lit against?

A

CD20 = B-cells

depletes mature B cells but keeps plasma cells

56
Q

Indications for rituximab

A

lymphoma
RA
SLE

2 doses IV every 6-12 months (RA)

57
Q

toxicities of rituximab

A

Infusion reactions
infection (PML)
exacerbation CV disease

NOT mlaignancy

58
Q

Vedolizumab - alpha4beta7 integrin - indication and frequency

A

IBD

IV every 8w

59
Q

How does Vedolkizumab work?

A

inhibits leukocyte migration?

60
Q

Toxic effects of Vedolizumaab

A
61
Q

TNF-alpha blocker examples

A

Infliximab
Adalimumab
Certoliizumab
Golimumab

62
Q

Conditions where you can use TNF-alpha inhibitors

A

RA
psoriasis
psoriatic arthritis
IBD
FMF
ankylosing spondylitis

sc or IV

63
Q

Toxicity of TNF-alpha inhibitors

A

infusion or injection site reactions
infection (TB, HBV, HCV) - screen for latent TB infection before you start
lupus like conditions
demyelination
malaignancy

64
Q

Etanercept

A

TNF - alpha inhibitor

works differently?

65
Q

IL-1 blocl

A
66
Q

IL-6 / IL-6 R block

A

in RA, GCA, LV vasculitis

affects T-cells, B-cells, synoviocytes

67
Q

IL-23 and IL-17 pathway

A

important in spondyloarthriitides and related conditions

68
Q

Important pathway in spondyloarthtitides

A

IL-23 ->

TH17 differentiation ->

IL-17 anad IL-22

can block this pathway with Secukinumab (anti IL17) and guuselkumab (anti IL 23)

69
Q

IL 4, 5 13 axis

A

asthma

eczema

70
Q

Where was Rank Rank ligand useful?

A

osteoporosis

71
Q

Immunosuppression - advice to give aaptients

A

2x risk of infection

wash hands / avoid contact
vaccination /avoid live vaccines…
,,,,

72
Q

what vaccines are we particularly worried about in immunosuppressed patients?

A

chronic infections, particularly TB

-> CXR and elispot/quantiferon usually done before starting treatment

73
Q

latent TB in someone you want to start immunosuppressive treatment in

A

generally, treat latent TB before starting immunosuppressive treatment

if the disease is very severe you may not want to wait

74
Q

JCV

A

John Cunningham virus

common polyomaviru s….

75
Q

what malignancies are we worried about in immunosuppressed individuals.

A

lymphoma (EBV) - 3-4x risk
non-melanoma skin cancer (HPV)
?melanoma

76
Q

AI side effects of iimmunosuppression

A

SLE and lupus like syndromes
APS
vasculitis
interstitial lung disease
sarcoidosis
autoimmune hepatitis
…

77
Q

when do you see lupus like syndromes?

A

in TNF alpha therapy

78
Q

Psoriasis and psoriatic aarthritis - what type of autoimmunity

A

T-cell mediated autoimmunity

Year 5 😊✌🏼 (53 decks)

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