Immunosuppression Flashcards
why is immunosuppression increasing?
-increase in the number of organ transplants
-disease may lead to decreased immunity
-increasing number of patients on immune suppressants
what is immunodeficient?
any state where the immune system is below the optimum level
what is immunosuppression?
act of artificially depressing the immune system
what is immunocompromised?
those at risk due to reduced function of the immune system
what does the immune system comprise?
divided two sections
innate - immediate, non-specific, no memory
1. recognition of pathogens (cytokines, complement and phagocytosis)
2. acute inflammatory response (contains infection)
adaptive - delayed, specific with memory
1. antigen presentation (activation of T helper cells)
2. targeted response (antibody, cytotoxic t-cells, memory cells)
give examples of common acquired diseases that lead to immunodeficiency.
-infectious disease - HIV
-malignancies - Hogkins disease: leukaemia
-autoimmune disease - rheumatoid disease, SLE
-nutritional deficiencies - iron/vitamin deficiencies
-other conditions - sickle cell disease
-iatrogenic suppression - anti-rejection drug therapy
-obesity
-diabetes
what drugs lead to immunosuppression?
- steroids: prednisolone (affects interleukin-1 signalling), dexamethasone and hydrocortisone
- monoclonal antibodies: infliximab, rituximab
-chemotherapy agents: azathioprin, cyclosporin (acts on IL2)
-biologics
how do steroids lead to immunosuppression?
-non-specific
-inhibits multiple steps in immune activation (IL-1, IL-2, IL-6, TNF, prostaglandins, chemokines, MHCII)
multiple side effects - osteoporosis so patients may be on bisphosphonates for bone protection this drug can have an impact on the jaw.
what is an issue with steroid administration?
for example the patient is taking prednisolone this will lead to the adrenal gland producing less steriods.
this can lead to an Addisonian crisis and will not be able to respond to stress, normally.
what are the specific oral side effects of immunosuppression?
Gingival hyperplasia due to cyclosporin and tacrolimus. These drugs cause an increase in collagen synthesis and decrease collagen breakdown.
Overcome this by surgical reduction, improved oral hygiene and modification of drug treatment.
what are the general oral side effects of immunosuppression?
-delayed healing
-infection
-candida (widespread)
-herpes simplex
-accelerated periodontal disease
-leukoplakia (EBV)
-malignancy
what malignancies do transplant patients develop?
3-31% of transplant patients will develop a malignancy.
-lip squamous cell carcinoma (SCC) most common
-oral scc
-basal cell carcinoma
-Kaposi sarcoma
