Immunotherapy

Question 1

What are the established types of immunosuppression?

Answer 1

Corticosteroids
Azathioprine
Cyclophosphamide

Question 2

How do corticosteroids cause immune suppression?

Answer 2

Alters B and T cell function

Bind to cytoplasmic receptors and are transported to nucleus, where expression of various genes is modified

Question 3

What do corticosteroids majorly affect?

Answer 3

Cytokine networks
Inflammation
T cell and monocyte function
Transit and circulation of immunologically active cells

Question 4

What is azathioprine?

Answer 4

Purine analogue that inhibits DNA synthesis

Question 5

What are the functions of azathioprine?

Answer 5

Inhibit T and NK cell functions

Anti-inflammatory

Question 6

How is azathioprine normally used?

Answer 6

In combo with steroids

Question 7

What is cyclophosphamide?

Answer 7

Alkylating agent that interferes with DNA synthesis

Question 8

What does cyclophosphamide interfere with?

Answer 8

Supresses B cell activity and antibody production

Question 9

What are the newer immune suppressants?

Answer 9

Cyclosporin and tacrolimus
Sirolimus
Mycophenolic acid

Question 10

What do cyclosporin and tacrolimus affect?

Answer 10

T cells and NK cells

Question 11

How do cyclosporin and tacrolimus act?

Answer 11

Modulate and down regulate varoius genes, esp IL2 gene

Question 12

How does sirolimus act?

Answer 12

Decrease IL2 production by T helper cells

Question 13

What are the main uses of mycophenolic acid?

Answer 13

Transplant rejection

Crohn’s disease

Question 14

How does mycophenolic acid act?

Answer 14

Prevents T cell proliferation, antibody production and leucocyte migration by inhibiting purine synthesis

Question 15

What are the effects of cytokine therapy?

Answer 15

Affect proliferation, differentiation and growth

Activate anti-tumour immunity

Question 16

What are the types of cytokine therapy?

Answer 16

IL-1 and TNF
IL-2
IFN alpha
IFN gamma

Question 17

What are the actions of IL-1 and TNF?

Answer 17

Decrease activity of pro-inflammatory cytokines

Question 18

What are IL-1 and TNF used in?

Answer 18

Rheumatoid arthritis

Septic shock

Question 19

What is the action of IL-2?

Answer 19

Affects activity of T cell activated cytokines

Question 20

What is IL-2 used in?

Answer 20

Autoimmune disease
Transplant rejection
Some immune deficiency disorders
Tumour therapy

Question 21

What are the actions and used of IFN alpha?

Answer 21

Anti viral- used in hep C

Anti-neoplastic- used in hairy cell leukaemia

Question 22

What is th action of IFN gamma?

Answer 22

Increase phagocyte intracellular killing activity

Question 23

What is IFN gamma used in?

Answer 23

Chronic granulomatous disease

Question 24

What is plasma exchange?

Answer 24

Patients plasma is filtered off ex vivo in centrifuge and donor plasma given back to patient

Question 25

What is plasmapheresis?

Answer 25

Albumin solutions used to replace plasma

Question 26

What is plasma exchange and plasmapheresis used in?

Answer 26

Autoimmune disorders that involve formation of autoantibodies of immune complexes ir Myasthenia gravis, Goodpastures, systemic vasculitis

Question 27

What is immunoglobulin therapy used as?

Answer 27

Replacement therapy in patients with primary or secondary antibody deficiency Immune modulating therapy in certain inflammatory and autoimmune conditions

Question 28

What are some inflammatory/autoimmuen conditions in which Igs can be used?

Answer 28

``` Kawasaki's ITP Allergic disorders vasculitis Neuropathies SLE Myasthenia ```

Question 29

What are the issues with Ig therapy?

Answer 29

Adverse reactions during infusions | Transmission of infection, esp Hep C