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Autoimmune disease > immunomodulation > Flashcards

immunomodulation Flashcards

1
Q

what is immunomodulation

A

manipulating the immune system using immunomodulatory drugs to achieve a desired effect

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2
Q

name 2 ways that immune tolerance can be induced

A

immunomodulators used in allergy

adoptive immunotherapy

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3
Q

what is adoptive immunotherapy and when is it used

A 
stem cell transplant 
BM transplant
immunodeficiencies eg SCID 
AI diseases
lymphoma and leukaemia
inherited metabolic disorders
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4
Q

name 3 types of allergy immunomodulation

A

anti-IL5 monoclonal treatment
anti -IgE monoclonal treatment
allergen specific - SC/SL/ aero allergens

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5
Q

give an example of an anti-IL5 monoclonal treatment

A

mepolizumab prevents eosinophil recruitment and activation
limited for asthma
no clinical efficacy for hyper-eosinophilic syndrome

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6
Q

name an anti-IgE monoclonal therapy and describe its use

A 
omalizumab
asthma
chronic urticarial
angioedema
may cause severe systemic anaphylaxis
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7
Q

how do aero-allergens help in allergy

A 
promote Th2-Th1 switching
Treg cells and tolerance
use if anaphylaxis to insect venoms
allergic rhinoconjuncitivitis
-ve = localised and systemic allergic reactions
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8
Q

what are biologic immunomodulators

A

substances nearly identical to the body’s own signalling proteins

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9
Q

give an example of a monoclonal antibody

A

infliximab

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10
Q

give an example of a fusion protein

A

etanercept

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11
Q

what is the mode of action of corticosteroids in immunosuppression

A 
decrease neutrophil margination
decrease inflammatory cytokines
inhibit phospholipase A2
lymphopenia
decrease T cell proliferation
decrease IgA production
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12
Q

what are the side effects of corticosteroids

A

CHO metabolism –> diabetes, hyperlipidaemia
decreased protein synthesis –> poor wound healing
osteoporosis
glaucoma, cataracts
psychiatric problems

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13
Q

what are the uses of corticosteroids

A

AI diseases e.g. CTD, vasculitis, RA
inflammatory disease eg crohns, sarcoid, GCA
malignancies e.g. lymphoma
allograft rejection

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14
Q

what are biologic DMARDs

A

disease modifying anti-rheumatic drugs

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15
Q

name 5 types of biologic DMARDs

A 
anti-cytokines
anti B cell
anti T cell activation
anti-adhesion molecules
complement inhibitors
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16
Q

name 3 types of anti-cytokines

A

anti-IL6
anti-IL1
anti-TNF

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17
Q

name a type of anti B cell biologic DMARD

A

rituximab = chimeric monoclonal antibody

targets CD20 be cell surface

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18
Q

name 4 ways that lymphocytes may be targeted

A

IL-2 receptor MABS
M-TOR inhibitors
Calcineurin inhibitors
antimetabolites (inhibit purine nucleotide synthesis in T and B cells)

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19
Q

name 2 types of antimetabolites

A

AZA and MMF

20
Q

how does AZA work

A

guanine antimetabolite

21
Q

how does MMF work

A

non competitive inhibitor for IMPDH so prevents guanosine triphosphate synthesis

22
Q

how do calcineurin inhibitors work

A

interfere with signals after TCR activation
prevent stimulate of cytokine production (c for c)
reversible inhibition of T cell activation, proliferation, clonal expansion

23
Q

name 2 clacineurin inhibitors

A

CyA and Tacrolimus FK506

24
Q

name an M-TORi and describe how it works

A

sacrolimus (rapamicin) is a macrolide antibiotic that binds to FKBP12 (and others) and inhibits mammalian target of rampamicin –> inhibits response to Il-2 so cell cycle arrect at G1-S phase

25
Q

name 2 IL-2 receptor MABs

A

basilixumab

daclizumab

26
Q

name 3 types of immunopotentiation

A

immunisation
immune stimulants
replacement therapies

27
Q

describe a replacement therapy

A

pooled human immunoglobulin (IV or SC)for antibody deficient states

28
Q

name some immune stimulants

A

G-CSF/ GM-CSF to stimulate BM to produce more neutrophils
IL2 T cell activation
a-interferon Hep C treatment
B-interferon MS
y-interferon certain intracellular infections + CGD + IL-12 deficiency

29
Q

what is passive immunisation

A

giving specific high titre antibody for immediate but transient protection
animal sera and pooled human immunoglobulin

30
Q

what are the uses of passive immunisation

A

VZV (pregnancy0 Hep B prohpylaxis and treatment snake bites botulism diptheria

31
Q

what is active immunisation and what are the negatives

A

stimulate immune response and memory with antigenic material

problems are delay, allergy to vaccine component, limited use in immunocompromised

32
Q

what is the target of methotrexate

A

folate synethesis (form of anti-metabolite)

33
Q

what is the target of cyclophosphamide

A

cross links DNA (anti metabolite)

34
Q

what is cyclophosphamide used for

A

vasculitis SLE

35
Q

what is AZA used for

A

AI disease (IBD vasculitis SLE) allograft rejections

36
Q

what is MTX used for

A

RA PSA polymyositis vasculitis

GvHD

37
Q

what are the side effects of anti-metabolites

A

hepatitis
gastric upset
susceptibility to infections
BM suppression

38
Q

what is a side effect of MTX

A

pneumonitis

39
Q

what is a side effect of cyclophosphamide

A

cystitis

40
Q

what are the side effects of calcineurin and MTORi

A 
multiple drug interactions
lymphomas
hepato-toxicity
hirsutism
nephrotoxicity
neurotoxicity
hypertension
opportunistic infections
41
Q

what is the clinical uses of calcineruin and MTORi

A

transplantation and allograft rejection AI disease

42
Q

what are biologic DMARDs mainly used for

A

inflammatory conditions

43
Q

what is anti-TNF used for and what is a side effect

A

RA inflammatory conditions e.g crohns psoriasis ank. spond.

risk of TB

44
Q

what is anti-IL6 used for

A

RA and AOSD

problem = control of serum lipids

45
Q

what is anti-IL1 used for

A

AOSD and autoinflammatory conditions

Autoimmune disease (1 decks)

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