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Immunology > MHC > Flashcards

MHC Flashcards

0
Q

Function of MHC 1

A

Target of immune response in transplant
All cells have mhc which are used to present antigen eg virus to cytotoxic cells
Donor cells have different mhc1

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1
Q

Role MHC2

A

Found on APCS only
Present to CD4 (mostly helper not killer)
Direct recognition of a foreign mhc2 does not lead to death because majority of cd4 are HRLPER NOT KILLER. What actually happens is increase in IFNg which increases macro activation and secretion TNF alpha which kills donor cells
Emhances B cell response by activation CD4

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2
Q

What is the major way the anti transplant response is activated?

A

INDIRECT presentation
Re perfusion injury to the donor - dead cells taken up as APCs
Dendritic cells can present on class 1 and 2
Other APCs can only present on 2

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3
Q

HLA CLASS 1

A

A b c

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4
Q

HLA class 2

A

Dr dp dq

The patient has a donor selected with the most B AND DR in common

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5
Q

Strongest association with a HLA

A

HLA B27 and Ank spond

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6
Q

ANK SPOND

A

HLAB27- this is a class I

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7
Q

RA

A

HLA DR4

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8
Q

Dermatitis herpeteformis which HLA association?

A

HLA DR3

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9
Q

DM type 1

A

HLA DR4
(also 3)

DR3,4- DQ 2,8 –>1/25 sporadic

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10
Q

What are the islet cell auto Ab?

A

Anti GAD- sens 72% spec 99%- involved in glutamate metabolism (more in older patients- teens onwards)
Anti-insulin - sens 40% spec 90% the only Beta cell spec. More in younger patients, not really seen in adults
Anti IA-2 (tyrosine phosphatase) SEns 62% spec 96%
Zinc transporter 40-60%

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11
Q

AutoAb in stiff man syndrome?

A

Anti GAD ab

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12
Q

Auto Ab in MG?

A

Anti ACh receptor

Anti-MUSK

  • more likely bulbar disease
  • more resp crises
  • less occular
  • less thymoma
  • good steroid response
  • ACH response poor
  • NOT for thymectomy- do not improve
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13
Q

AutoAb in Graves?

A 
Anti TSH receptor (90%)
Anti TPO (50%)
Anti thyroglobulin (30%)
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14
Q

Auto Ab in hashi?

A

TPO - 90%

thyroglobulin - 90%

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15
Q

AutoAb in Addisons disease?

A

Anti hydroxylase Ab in 80%

16
Q

What’s the deal with autoimmune diabetes in adults? (LADA)

A

One in 12 adults with presumed type 2 actually have type 1 /autoimmune.
Usually Anti GAD positive, IA2 and insulin Ab less common

GAD Ab is a good predictor of insulin requirement!

FAT/thin/young/old/ketoacidosis- doesn’t really matter!

17
Q

What is the “thyrogastric cluster?”

A

autoimmune gastritis
autoimmune thyroiditis
Type 1 DM

IF find one Ab, can look for others in Juvenille onset

18
Q

HLA in coeliac disease

A

HLA DQ 2 DQ 8- ESSENTIAL

99.6% all patients with coeliac but only 20-30% population- so if Ab negative and then DQ2/8 positive, strong grounds for recommending gastroscopy

19
Q

What are the three auto Ab in coeliac?

A

Anti tissue transglutaminase antibody (IgA)
Anti endomysial Ab (IgA)
Anti gliadin antibodies (IgA, IgG)

tTg and AGA are epiphenomemon - not actually pathogenic

PLUS total IgA to exclude the three percent of the population with selective IgA hypogammaglobulinaemia

Usually check first or second one

Increased risk if gluten given to baby too soon or too much, rotavirus infection. Breast feeding protective.

20
Q

Explain the role of Ab in pernicious anaemia?

A

Anti parietal cell Ab are present in 90%- against H/K ATP-ase- but also in 15% reg population
Anti-intrinsic factor Ab 60% sens but highly specific

Atrophic gastritis classically affects the body and spares the antrum.

AUTOIMMUNE GASTRITIS CAUSES IRON DEF ANAEMIA 4-6 times as much as coeliac disease.

Once get to the end stage- atrophic gastritis- with neuroendocrine G cell hyperplasia, gastrin Ab sens 90%, 100% specific

21
Q

Features of Autoimmmune Polyglandular Syndromes -type 1 2 3

A

1- kids, AR
all have adrenal insufficiency
Vitiligo, alopecia, mucocutaneous candidiasis
Hypoparathyroid

2. Adults assoc HLA DR3/4
Adrenal insuff in all
Thyroiditis 70%
DM 1 in 50%
Hypogonadism
  1. Heterogenous - thyroiditis + another autoimmune
22
Q

Haemochromatosis HLA association?

A

HLA-A3

23
Q

Becet’s HLA association?

A

HLA-B5

24
Q

HLA DR2 two associations

A

narcolepsy

goodpastures

25
Q

Sjogren’s HLA associations

A

HLA-DR3

26
Q

PBC HLA association?

A

HLA-DR3

27
Q

Explain how many copies of each HLA we get-

A

HLA class I- get a single chain for each molecule A,B,C, and each person gets one from mum and mum from dad

HLA class 2 has 2 chains for each DP,DQ,DR
DR- alpha is invariant but beta is highly polymorphic and may have either 1 or 2 copies of HLA DR beta on each chromosome so 2-4 possible molecules
DP- alpha and beta both plymorphic and four possible molecules (alpha and beta each chrom)
DQ- alpha and beta both polymorphic and four possible molecules (alpha and beta on each chrom)

28
Q

What is the Mixed Lymphocyte Reaction test?

A

T cells from one person mixed with irradiated T cells from another person (irradiation prevents division)
Rate of cell division is measured and reflects recognition by T cells of MHC molecules

Way to check allogeneic recognition

29
Q

DQ and DR are…

A

always inherited together

30
Q

HLA in SLE?

A

DR3

31
Q

Grave’s HLA?

A

DR3

32
Q

Hashimoto’s HLA?

A

DR11

33
Q

MOST polymorphic HLA?

A

B

34
Q

HLA in MS?

A

DR2

Immunology (16 decks)

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