Immunotherapy

Question 1

Types of adaptive immunity

Answer 1

Active:

• infection or exposure
• immunisation vaccines

Passive:

• placental transfer of IgG
• Colostral transfer of IgA
• immunoglobulin therapy or immune cells

Question 2

Difference between active and passive immunity

Answer 2

Active immunity results in memory formation

Question 3

Examples of passive immunity

Answer 3

Bites and stings
-passive infusion of antibody specific for the toxin

Hypogammaglobulinaemia
-primary or secondary infusion of y-globulins to reduce infection

Rabies immunoglobulin
-“post-exposure prophylaxis” together with vaccination

Question 4

Differnent types of immunoglobluin for post exposure prophylaxis

Answer 4

Human normal immunoglobulin:

• Prepared from pools of at least 1000 donations of human plasma
• Contains immunoglobulin G (IgG) and antibodies to hepatitis A, measles, polio, rubella

Specific Immunoglobulins:

• Prepared from the plasma of individuals with have high antibody levels against a specific infection
• Can be used for hepatitis B, rabies, tetanus, varicella-zoster virus

Question 5

Examples of intravenous immunoglobulin licensed indications

Answer 5

IgG key biologic replacement therapy in primary and secondary immunodeficiency disorders

Primary immunodeficincy,
Idiopathic Thrombocytopenic Purpura,
Children with HIV,
Guillain-Barre syndrome

Question 6

Different types of immunotherapy

Answer 6

Direct:
-antibodies or antibody related fragments that detect antigen on tumour cell

Indirect:
-activated rendering it able to seek and destroy tumour cells

Question 7

Direct Immunotherapy examples

Answer 7

Monoclonal antibodies,
Chimeric antigen receptors (CAR)
Bi-specific antibodies

Question 8

Indirect immunotherapy examples

Answer 8

Tumour vaccines, 
Dedritic cell vaccines, 
Adoptive cell transfer, 
Cytokine therapies, 
Checkpoint inhibitor therapies,
Stimulatory antibodies

Question 9

what are cytokine therapies

Answer 9

Immunomodulatory cytokines to activate anti-tumour immunity

pegylated IFN-a, IL-2, GM-CSF

Used in specific cancers

Pegylated is an effective anti-viral IFN-a therapy and used in melanoma

Question 10

Difference between polyclonal and monoclonal antibodies

Answer 10

Polyclonal:
-made using several different immune cells
-will have the affinity for the same antigen but different epitopes,
Monoclonal:
-Antibodies are made using identical B cells that are all clones of a specific parent cell
-only recognize the same epitope of an antigen

Question 11

What kind of drug is rituximab and how does it work?

Answer 11

Monoclonal antibody
Specific for the CD20 molecule on the cell surface of B cells

Works as a chimeric antibody that blocks the function of TNF (a pro-inflammatory cytokine that stimulates an acute phase reaction)

Question 12

How does herceptin work

Answer 12

Antibody binds on HER2 on cancer cels and marks them for destruction

*new anti-HER2 antibodies- Pertuzumab

Question 13

How do ipilimumab work

Answer 13

Checkpoint inhibitor

Question 14

How do Dc vaccines work

Answer 14

Take a blood sample from patient
Culture cells in vitro
With cytokines that promote APC function
Transfuse patients with APC after uptake of tumour antigen

Question 15

CAR T cell therapy work

Answer 15

Chimeric antigen receptors

CAR T cell are engineered to express antigen-targeted receptors specific for tumour antigens.

CAR includes an antigen-binding domain fused to a transmembrane domain followed by T-cell activation domains associated with the T-cell receptor (TCR).

A T cell modified with a CAR is endowed with a new antigen specificity, and binding its antigen supports T-cell activation and killing of the target cell.

Question 16

How is CAR T cell therapy conducted

Answer 16

Patients leukocytes are collected by apheresis

Patient receieves lymphocyte-depleting chemotherapy prior to T-cell infusion

Patient receives CAR T-cell infusion