Immunotherapy Flashcards
What are the established types of immunosuppression?
Corticosteroids
Azathioprine
Cyclophosphamide
How do corticosteroids cause immune suppression?
Alters B and T cell function
Bind to cytoplasmic receptors and are transported to nucleus, where expression of various genes is modified
What do corticosteroids majorly affect?
Cytokine networks
Inflammation
T cell and monocyte function
Transit and circulation of immunologically active cells
What is azathioprine?
Purine analogue that inhibits DNA synthesis
What are the functions of azathioprine?
Inhibit T and NK cell functions
Anti-inflammatory
How is azathioprine normally used?
In combo with steroids
What is cyclophosphamide?
Alkylating agent that interferes with DNA synthesis
What does cyclophosphamide interfere with?
Supresses B cell activity and antibody production
What are the newer immune suppressants?
Cyclosporin and tacrolimus
Sirolimus
Mycophenolic acid
What do cyclosporin and tacrolimus affect?
T cells and NK cells
How do cyclosporin and tacrolimus act?
Modulate and down regulate varoius genes, esp IL2 gene
How does sirolimus act?
Decrease IL2 production by T helper cells
What are the main uses of mycophenolic acid?
Transplant rejection
Crohn’s disease
How does mycophenolic acid act?
Prevents T cell proliferation, antibody production and leucocyte migration by inhibiting purine synthesis
What are the effects of cytokine therapy?
Affect proliferation, differentiation and growth
Activate anti-tumour immunity
What are the types of cytokine therapy?
IL-1 and TNF
IL-2
IFN alpha
IFN gamma
What are the actions of IL-1 and TNF?
Decrease activity of pro-inflammatory cytokines
What are IL-1 and TNF used in?
Rheumatoid arthritis
Septic shock
What is the action of IL-2?
Affects activity of T cell activated cytokines
What is IL-2 used in?
Autoimmune disease
Transplant rejection
Some immune deficiency disorders
Tumour therapy
What are the actions and used of IFN alpha?
Anti viral- used in hep C
Anti-neoplastic- used in hairy cell leukaemia
What is th action of IFN gamma?
Increase phagocyte intracellular killing activity
What is IFN gamma used in?
Chronic granulomatous disease
What is plasma exchange?
Patients plasma is filtered off ex vivo in centrifuge and donor plasma given back to patient
What is plasmapheresis?
Albumin solutions used to replace plasma
What is plasma exchange and plasmapheresis used in?
Autoimmune disorders that involve formation of autoantibodies of immune complexes ir Myasthenia gravis, Goodpastures, systemic vasculitis
What is immunoglobulin therapy used as?
Replacement therapy in patients with primary or secondary antibody deficiency
Immune modulating therapy in certain inflammatory and autoimmune conditions
What are some inflammatory/autoimmuen conditions in which Igs can be used?
Kawasaki's ITP Allergic disorders vasculitis Neuropathies SLE Myasthenia
What are the issues with Ig therapy?
Adverse reactions during infusions
Transmission of infection, esp Hep C