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Clinical pathology > Immunomodulation and immunosuppression > Flashcards

Immunomodulation and immunosuppression Flashcards

1
Q

What is immunomodulation

A

The act of manipulating the immune system using immunomodulatory drugs to achieve a desired immune response

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2
Q

What are immunomodulators

A

Medicinal products produced using molecular biology techniques including recombinant DNA

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3
Q

Main classes of immunomodulators

A
  • Monoclonal antibodies
  • Fusion proteins
  • Substances nearly identical to body proteins
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4
Q

What is immunopotentiation

A

Strengthening of the immune system:

  • Immunisation
  • Replacement therapies
  • Immune stimulants
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5
Q

Passive immunisation

A
  • Transfer of specific antibodies

- Risk of transmission of virus

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6
Q

Types of passive immunisation

A
  • Convalescent plasma
  • Pooled specific human immunoglobulin
  • Animal sera
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7
Q

Active immunisation

A

To stimulate the development of a protective immune response and immunological memory

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8
Q

What is immunogenic material

A
  • Weakened forms of pathogens
  • Killed/inactivated pathogens
  • Purified materials
  • Adjuvants
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9
Q

Problems with secondary immunisation

A
  • Allergy to vaccine
  • no useful if immunocompromised
  • Delay in achieving protection
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10
Q

Replacement therapies and immune stimulants for immunocompromised

A
  • Pooled human immunoglobulin used in treatment of antibody deficiency states
  • G-CSF/GM-CSF - increase production of mature neutrophils
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11
Q

Cytokines - immune stimulants

A
  • IL-2 - stimulates T cell activation
  • α-interferon - Hep C
  • β-interferon - therapy of MS
  • γ-interferon - chronic granulomatous disease
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12
Q

Immunosuppression methods

A
  • Corticosteroids
  • Cytotoxic agents
  • DMARD’s
  • Anti-proliferative/activation agents
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13
Q

Corticosteroids action

A
  • Decreased neutrophil margination
  • Reduced production of inflammatory cytokines
  • Decrease T cell proliferation
  • Inhibition phospholipase A2 released
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14
Q

Corticosteroids side effects

A
  • Carbohydrate and lipid metabolism - Diabetes
  • Reduced protein synthesis = poor wound healing
  • Osteoporosis
  • Glaucoma + cataracts
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15
Q

Corticosteroid uses

A
  • Autoimmune disease
  • Inflammatory diseases
  • Malignancies
  • Allograft rejection
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16
Q

Drugs targeting lymphocytes and the immune response

A
  • Antimetabolites
  • Calcineurin inhibitors
  • M-TOR inhibitors
  • IL-2 receptor mAB’s
17
Q

Calcineurin inhibitors

A
  • CyA - binds to intracellular protein cyclophilin
  • Tacrolimus - binds to intracellular protein
  • Prevents action of NFAT, less cytokine stimulation
18
Q

Sirolimus (rapamycin) - M-TOR inhibitor

A
  • A macrolide antibiotic
  • Inhibits mammalian target of rapamycin
  • Inhibits response to IL-2
  • T cell cycle stops at G1-s phase
19
Q

Calcineurin/mTOR side effects

A
  • Hypertension
  • Nephrotoxicity
  • Hepatotoxicity
  • Lymphomas
  • Neurotoxicity
20
Q

Antimetabolites

A

Inhibit purine synthesis

  • Azathioprine - guanine metabolite
  • Mycophenolate mofetil - prevents production of guanosine triphosphate
21
Q

Cytotoxic drug effects

A
  • Bone marrow suppression
  • Gastric upset
  • Hepatitis
  • Susceptible to infections
22
Q

AZA/MMF clinical uses

A

Autoimmune diseases - SLE, vasculitis

23
Q

MTX clinical uses

A

RA, vasculitis, Polymyositis

24
Q

Anti-cytokines

A
  • Anti-TNF - used in therapy of RA - other inflammatory conditions
  • Anti Il6 - blocks IL6 receptor
  • Anti Il1 - used for autoinflammatory syndromes
25
Q

Rituximab

A

Monoclonal antibody that acts on protein in B cell surface - used for lymphomas and transplant rejection

26
Q

Adoptive immunotherapy

A
  • Bone marrow transplant

- Stem cell transplant

27
Q

Immunomodulators: Allergy

A
  • Immune suppressants
  • Allergen specific immunotherapy
  • Anti-IgE monoclonal therapy
  • Anti IL5 monoclonal treatments
28
Q

Mechanism of allergen specific immunotherapy

A

Switching of immune response from TH2 (allergic) to TH1 (non-allergic)

29
Q

Routes of allergen immunotherapy

A

sublingual

aero-allergens

30
Q

Omalizumab

A

Antibody against IgE

  • Used in reaction of asthma
  • can cause severe systemic anaphylaxis
31
Q

Mepolizumab

A

Antibody against IL-5

- Prevents eosinophil recruitment and activation

Clinical pathology (69 decks)

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