T Cell-Mediated Immunity Flashcards

1
Q

Activation of dendritic cells

A
  • Activated peripheral DCs: Lose adhesive markers and up-regulate CCR7 expression (lymphatic endothelium)
  • Mature as they migrate: Increase expression of MHC/HLA, CD80 (B7) and LFA-1
  • Travel to regional secondary lymphoid tissue,
  • Home by chemokines
  • Present Ag to mature, naïve T cells circulating through lymphoid tissues.
  • Secret cytokines to promote T cell subset differentiation

DC cytokines

IL-12 : Th1

IL-23 : Th17

IL-10 : Tregs

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2
Q

CD4+ vs CD8+

A
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3
Q

mature naive t cells

A

T Cytotoxic Cells

TCR/CD3 signaling complex including z

CD8+

MHC/HLA Class 1

CD28+

LFA-1

CCR7

L- selectin

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4
Q

mature naive T Helper Cytokine Secreting Cells

A

T Helper Cytokine Secreting Cells

TCR/CD3 signaling complex including z

CD4+

MHC/HLA Class 1

CD28+

LFA-1

CCR7

L- selectin

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5
Q

Naïve t cell migration in the peripheral lymphoid organs

A
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6
Q

Naïve Lymphocyte trafficking

A

•Naïve T cells enter the lymph nodes across the high endothelium venules (HEV) in the cortex

  • Slow down – L-selection, CCR7
  • Stable arrest - LFA
  • T cells sample the antigen presented by APCs.
  • T cells that do not encounter specific Ag leave the node through the lymphatics and travel down the chain to the next lymph node
  • T cells that encounter Ag proliferate and differentiate into effector cells:
  • CD4+ T cells increase 100X to 1000X
  • CD8+ T cells increase 100,000X
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7
Q

immunological synapse

A

All the same molecular players for CD8 positive T cells with the exception of HLA Class I instead of Class II for CD8 binding.

CTLA-4 : Cytotoxic T lymphocyte associated protein - 4
PD-1 : Programmed cell death protein 1

Formation of the immune synapse initiates the intracellular signaling leading to complete T cell activation.

Occurs through activation of immunoreceptor tyrosine-based activation motifs (ITAMs).

Kinase associated with co-receptors CD4 and CD8, phosphorylates and activates the tyrosine kinase ZAP-70 associated with the ζ chain

Activation of ZAP-70 on the ζ chain is necessary for all downstream signaling

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8
Q

T Cell Activation: First Signal

A

FIRST SIGNAL is binding of MHC/peptide complex displayed by DC to TCR on T cell

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9
Q

Upon binding of TCR to MHC/HLA peptide complex:

A

T Cell

  • CD40L expression increased
  • CD 40 constitutive

Dendritic Cell

  • CD28 constitutive
  • B7 (CD80) expression increased
  • Cytokine secretion increased
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10
Q
A
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11
Q

other celluar changes in t cell activation

A
  • TCR/HLA antigen recognition changes integrin conformation on T cells from low affinity to high affinity.
  • Integrin advidity Increases upon antigen recognition by T cells : LFA-1
  • Allows for clustering of adhesion molecules and firm adhesion for immune synapse.
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12
Q

Why Two Pronged Approach : Clonal Selection

A

First signal : Recognition of antigenic epitope by TCR

Second signals: Maintains the specificity of the response to the specific epitope

This results in a large number of antigen-specific effector cells from rare antigen-specific naïve T cell.

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13
Q

Induction of anergy

A

T cells recognizing antigen without binding of co-stimulatory ligands or cytokine support will not become activated.

These cells become unresponsive to additional stimulus

  • anergic
  • tolerant
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14
Q

Promoting Proliferation:
Self-Stimulation by IL-2

A
  • IL-2 is an autocrine survival signal for newly activated T cells. It is not produced until activation.
  • IL-2Rbgc is constitutively expressed on mature, naïve T cells as a low affinity receptor minimizing proliferation
  • Upon activation, upregulation of additional high affinity chain in IL-2R, the a chain (CD25)

-IL-2R abgc

  • Binding of IL-2 to high affinity IL-2R promotes T-cell proliferation and differentiation
  • IL-2a chain = CD25

Clinical application

Inhibition of IL-2 used to prevent the rejection of organ transplant by suppressing the activation and differentiation of naïve T cells and all immune responses that require activated

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15
Q

Activation of T Cells Triggers a Cascade of Protein Production

A

Substantial proliferation of activated clone to expand population of Ag specific lymphocytes

Activated CD4+ Th cells start expressing CTLA-4 and PD-1 for immune regulation.

Activated CD8+ T cells start expressing PD-1 for immune regulation

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16
Q

Trapping and Activation of Naïve T cells

A
  • Within two days of an antigen appearing in a lymph node, it has been bound by its naïve antigen specific T cell.
  • Five days after the arrival of the antigen, activated effector cells emigrate from the lymph node into the periphery
  • Transient expression of CD69

-Binds to S1PR and impairs migration

Naïve T cells entering the lymph node encounter many antigen-presenting dendritic cells. Most T cells will not recognize their specific antigen and re-circulate. T cells that recognize their specific antigen are activated by the dendritic cells resulting in effector T cells. The circulation of lymphocytes allows for all antigen-specific, naïve T cell in the periphery to be ‘trapped’ by antigen within a node after 2 days. By five days after the arrival of the antigen, activated effector cells emigrate from the lymph node to the periphery.

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17
Q

Role of CD69 in sequestering

A
  • S1P in high quantity in the blood and lymphatics.
  • Naïve T cells express receptor for S1P (S1PR) that directs their migration through circulation.
  • Newly activated T cells will transiently express CD69.
  • CD69 binds to S1pR on T cell surface and sequesters it
  • Leaves the T cell unable to respond to S1P migration signals.
  • Ensures activated T cell has time to provide “help” to other lymphocytes
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18
Q

CD4+ T helper cells differentiation

A
  • All start at CD4+ Th0
  • Differentiation of each subset is induced by the types of microbes it is best able to combat.
  • Antigen drives the response
  • Contributing cytokine microenvironment during activation.

•Each subset of T helper cells produces cytokines that support its own development and suppress other subset development.

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19
Q

CD4+ T help for CD8+ T cell Activation

A
  • Cytokine support of activation and proliferation of CTLs
  • Induction of cytotoxic protein synthesis
  • Cross presentation is often necessary for CD8+ T cell activation
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20
Q

Cross-Presentation of antigen by Dendritic cells

A
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21
Q

CD4+ T regulatory cells

A
  • Tregs / Th3
  • Influenced by IL-2, IL-10 and TGF-β
  • Constitutively express CTLA-4 and CD25 (a chain)
  • Novel transcription factor FOXp3
  • Secrete IL-10 and TGF-β
  • Peripheral tolerance
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22
Q

Gamma Delta T cells

A
  • TCR composed of g/d chains instead of a/b
  • Less than 5% of Ts
  • Found in higher numbers at epithelial boundaries especially the gut mucosa.
  • Ag restricted
  • Limited diversity of peptides recognized
  • Can recognize non-protein Ag
  • Not restricted to MHC/HLA presentation.
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23
Q

effector t cell: t cytotoxic cells

A

T Cytotoxic Cells

TCR/CD3 signaling complex including z

CD8+

MHC/HLA Class 1

CD28+

CD25+

FasL

PD-1

LFA-1/VLA-4

CXCR3

E- and P- selectin ligand

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24
Q

effector t cells: t helper cells

A

T Helper Cells

TCR/CD3 signaling complex including z

CD4+

MHC/HLA Class 1

CD28+

CD25+

CTLA-4

PD-1

LFA-1/VLA-4

CXCR3

E- and P- selectin ligand

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25
Q

The Major Difference Between
Effector T cells and Resting Naïve T cells is. . .

A

An effector T cell is able to respond to specific antigen WITHOUT need for co-stimulation via B7 (CD80)-CD28 interaction!

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26
Q

Cell mediated immunity

A
  • Can transfer immunity to intracellular microbes to non-immune individuals by transferring “immune” T cells.
  • Intracellular microbes are killed by either CD8+ CTLs or activated macrophages or “cells”.
  • Immune serum (antibodies) does not protect against intracellular microbes.
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27
Q

Effector t cell migration site of infection

A

Effector Ts enter the peripheral tissues by interacting with cytokines, chemokines and adhesion molecules on the endothelium at the site of infection.

The adhesion molecules and chemokines for effector Ts are different than the molecules on the HEVs naïve T cells interact with.

  • Slow down: E and P selectin ligand, CXCR3
  • Stable arrest: LFA-1 & VLA-4

Not every effector T cell that enters the area will be specific for that antigen. Why?

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28
Q

Overview of T helper subsets

A

Th1: IFN-gamma

Role : Macrophage activation

Defense : Intracellular pathogens

Pathology : Chronic inflammation, autoimmunity

Th2 : IL-4, IL-5, IL-13

Role: Eosinophil, mast cell and alternative macrophage activation

Defense : Helminths

Pathology: Allergy

Th17: IL-17, IL-22

Role: Neutrophil activation

Defense: Extracellular bacteria & fungi

Pathology: Autoimmunity, inflammation

Treg: IL-10, TGF-b

Role: Peripheral tolerance

Defense: Regulation of T cell responses

Pathology: Autoimmunity

Tfh: IL-21, IL-4

Role: support of B cells in germinal center

Defense: Extracellular pathogens

Pathology : Antibody mediated autoimmunity?

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29
Q

Migration of CD4+ T helper cells

A
  • Effector Th cells leave the lymphatics and re-enter circulation.
  • They circulate until they are exposed to inflammatory molecules that allow them to migrate into the peripheral tissues at the sight of infection.
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30
Q

CD4+ T helper 1 overview

A

Th1

Proliferate in response to IL-12 and IFN-γ secreted by Macrophages, NK cells and DCs

Unique transcription factor: T-bet

Secrete : IFN-γ and TNF-a

Role : Classical macrophage activation

Defense : Intracellular pathogens

Pathology : Chronic inflammation, autoimmunity

Don’t forget – these cells are also secreting IL-2 upon activation as well. It’s an autocrine survival signal.

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31
Q

T helper 1 cytokine activities

A

IFN-γ

  • Increases microbicidal activity by macrophages against intracellular microbes
  • Classical activation
  • Stimulates B cells to class switch to IgG during activation (opsonization)
  • Stimulates class II HLA antigen presentation and B7 (CD80) expression
  • Inhibits Th2 and Th17 production

Don’t forget – these cells are also secreting IL-2 upon activation as well. It’s an autocrine survival signal.

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32
Q

Th1 phagocyte activation

A
  • Effector T helpers leave the nodes and migrate to the area of infection.
  • Following chemokines and other markers of inflammation and migrate into the tissues.
  • They “sample” antigen presented to them by macrophages.

-Looking for the same epitope they are effector clone for.

•Immune synapse between T helper cells the macrophage fully activates the macrophage to become a better killer.

Immune synapse ligand interactions and binding the same as for the synapse between DC and T cell. The macrophage has become the APC. Remember – macrophages and B cells can present antigen to effector (activated) and memory T cells.

CD40, B7, Class II HLA/MHC/peptide complex/ICAM – macrophage

CD40L, CD28, CD3 TCR complex/LFA-1 – T cell

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33
Q

CD4+ T helper 2 OVerview

A

Th2

Proliferates in response to IL-4 secreted by mast cells, basophils and Th2 cells in immediate surroundings

Unique transcription factor: GATA-3

Secretes : IL-4, IL-5, IL-13

Role: Eosinophil, mast cell and alternative macrophage activation

Defense : Helminths

Pathology: Allergy

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34
Q

T helper 2 Cytokine activities

A
  • IL-4, IL-5 and IL-13
  • Stimulates B cells to class switch to IgE during activation
  • FcR for IgE on cell membranes and cross-linking of bound IgE leads to physiological responses
  • Increased production of mucus in epithelial cells (gut and airway, IL-13)
  • Increased eosinophil migration and activation (IL-5)
  • Support alternative macrophage development.
  • Inhibits Th1 development and effector responses
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35
Q

T helper 2 Immunity

A

Functions as protection against helminths (large worms

  • Mast cell activation
  • Mucus production
  • Peristalsis
  • IgA production
  • Eosinophil activation

Alternative Macrophage activation

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36
Q

Th1 versus Th2 activation of Macrophages

A

An example of the dichotomous development of Th1 versus Th2 immune responses by suppression of other subset. Directly influences immune responses to antigens and can impact pathological processes.

37
Q

Th1/Th2 Cytokine influence on disease

A

Th1 effector T cells are necessary to combat intracellular microbes.

A predominant Th2 response to an intracellular microbe can lead to poor disease outcomes.

38
Q

T helper 17 overview

A

Th17 / Th17

Proliferates in response to IL-1 and IL-6 secreted from DCs during activation.

Secretes : IL-17, IL-22

Unique transcription factor: RORγt

Role: Neutrophil activation

Defense: Extracellular bacteria & fungi

Pathology: Autoimmunity, inflammation

39
Q

T helper 17 cytokine activity

A

IL-17 : Inflammatory

Recruitment of pro-inflammatory leukocytes

  • Increases pro-inflammatory cytokine and chemokine production
  • Stimulates anti-microbial peptide (defensins) production

IL-22 : Protective

Promotes regenerative responses within epithelial barrier

•Stimulates anti-microbial peptide (defensins) production

40
Q

T helper 17 immunity

A

Destruction of extracellular bacteria and fungi by inducing neutrophilic inflammation

  • Important in barrier function integrity
  • Role in inflammatory autoimmune diseases including multiple sclerosis, inflammatory bowel disease, and rheumatoid arthritis
  • Role in integument pathology
  • Role in cancers such as breast/lung?
41
Q

CD4+ T helper cells effector functions in the periphery

A
  • Effector Th cells leave the circulation and migrate into the peripheral tissues at the site(s) of inflammation.
  • They perform their specific effector functions in the periphery, not in the lymphoid tissues where activated.
42
Q

CD8+ Cytotoxic T Lymphocytes

A
  • Tc / CTL / Cytotoxic T
  • TCR recognizes MHC/HLA Class I plus altered-self peptides
  • Effector function is killing of cells infected with intracellular pathogens or tumor-transformed cells by release of lytic enzymes or Fas/FasL induced cell death.
  • Th1 effector cells enhance proliferation, differentiation and clonal expansion of activated CD8+ T cells by providing additional IL-2

What is not needed with CD8+ cells are the CD40/CD40L and CD28/B7 ligand interactions that are seen with effector Th1s and macrophages. Why? Because the CD8+ need to be able to kill any infected cell in the body, not just antigen presenting cells. CD8+ Ts and NK cells are tumor surveillance cells. NKs are able to respond non-specifically while effector CD8+ Ts respond very specifically, these CD8+ are sometimes referred to as tumor infiltrating lymphocytes (TIL). This is a very large area of clinical research for many types of cancer.

43
Q

Overview of CD8+ Cytotoxic
T Lymphocyte Function

A

MHC I restricted cytotoxicity for non-self or altered self peptides

Involved in the killing of intracellular pathogens

•Host cell must be killed to eliminate the pathogen

Two killing mechanisms:

  1. Cytotoxins: preformed granules contain lytic cytotoxins

•Granular proteins

–Perforin- necessary for delivery of granzymes through endocytic vesicle membrane

–Granzymes- activate caspases, induce apoptosis

Cytotoxins are delivered directly onto the surface of the infected target cell by cell exocytosis upon recognition of altered peptide displayed within MHC/HLA Class I

  1. FasL and Fas (CD95) induction of apoptotic pathways in target cell.
44
Q

Migration of CD8+ Effector Cells

A

Effector Th cells leave the lymphatics and re-enter circulation.

They circulate until they are exposed to inflammatory molecules that allow them to migrate into the peripheral tissues at the sight of infection.

45
Q

CTL Killing: Cytotoxic enzymes

A
  • Antigen recognition and immune synapse formation
  • Directional release of enzymes and targeted killing of infected/altered cells
  • Endocytosis of Perforin and granzymes
  • Perforin “pokes holes” in endocytic vesicle membrane allowing granzymes to enter cytosol to induce apoptosis
46
Q

CTL Killing: Fas/FasL induction

A

Effector CTLs express Fas ligand (FasL)

•binds to the death receptor Fas expressed on many cell types

Activation of caspases and apoptosis of Fas-expressing altered target cells

47
Q

CTLS Are Serial Killers

A

There is a definite pattern in killing

  • Antigen specific recognition of infected/transformed cells
  • Induction of apoptosis to prevent pathogen replication and release of infectious material
  • Move to the next target cell

In vitro studies suggest that effector CTL can kill hundreds of cells a day. In vivo modeling suggests many less cells a day do to limitations of extracellular matrix, trafficking, etc.

48
Q

Cooperation Exists Between CD4+ and CD8+ T Cell Subsets

A
  • Immunity to intracellular bacteria.
  • Phagocytozed microbe is processed and presented with MCH/HLA Class II by macrophage to effector Th cells.
  • Phagocytosed microbe escapes phagolysosome.
  • Microbe in cytosol.
  • Cytosolic microbe is processed and presented with MCH/HLA Class I by macrophage to effector CTLs cells.
  • Need both populations of effector cells for the eradication of some intracellular pathogens.
49
Q

Cooperation between NK Cell and CTL Killing

A

Both kill tumor cells and virus-infected cells

Both kill by granzymes, perforin or Fas/FasL induction of apoptosis

CD8+ killing activated by altered peptide MHC/HLA Class I

NK killing activated by decreased display of MCH/HLA Class I (inhibitory receptor).

Why is two different recognition systems necessary for transformed/infected cells?

Some intracellular pathogens and cancers downregulate expression of MHC/HLA Class I

50
Q

Antibody-Dependent
Cell-Mediated Cytotoxicity (ADCC)

A
  • NK cells
  • Macrophages
  • Neutrophils
  • Eosinophils
  • Targeted recognition through IgG or IgE binding.
  • Killing by lytic enzymes, TNF and Perforin/ granzyme by specific cell types

basic premise – antibody binds to target, target killed by cells binding to Fc region of antibody.

51
Q

Migration of CD8+ Effector Cells

A

Effector CD8+ CTLs leave the lymphatics and re-enter circulation.

They perform their specific effector functions in the periphery, not in the lymphoid tissues where activated.

52
Q

Contraction of Immune Responses

A
  • Number of specific clones decrease as antigenic stimulus is removed
  • The majority of effector T lymphocytes will undergo apoptosis.
  • A small percentage of clones will become memory cells

-Express increased levels of anti-apoptotic protein, Bcl-2

53
Q

CD4+ T Regulatory Cells

A
  • Tregs/ Th3
  • Constitutively express CTLA-4 & CD25
  • FOXp3 transcription factor
  • CTLA-4 binds to B7 co-stimulatory ligand on APC and competitively blocks APC signaling.

-Binds more avidly than CD28

54
Q

Regulatory Receptors for contraction of response

A

•CTLA-4 inducible on activated Th cells

  • Competitive binding to B7/CD80 for downregulation of presentation
  • Binds with higher affinity than CD28

•PD-1 inducible on Ts, Bs and myeloid cells after activation

-Contains ITIM signaling domain

ITIM: Immunoreceptor tyrosine-based inhibition motifs

55
Q

Effector T cell exhaustion

A
  • Regulatory ligand expression can also lead to inability of T effectors respond effectively to chronic infections.
  • Effector cells become “exhausted” as they express increasing amounts of PD-1 and CTLA-4 on cell membrane.
56
Q

Induction of anergy

A

T cells recognizing antigen without binding of co-stimulatory ligands or cytokine support will not become activated.

These cells become unresponsive to additional stimulus

  • anergic
  • tolerant
57
Q

Memory T cells

A
  • Activated T cell clones differentiate into effector cells and memory cells
  • Most become effector T cell clones which are short-lived
  • A small population will become memory cells specific for their antigenic epitope
  • Memory CD4+ and CD8+ T cells require reactivation to regain their effector function
  • Respond more rapidly than naïve
  • Can respond in peripheral tissues
  • Require IL-7 and IL-15 for survival
58
Q

Evasion Mechanisms

A
  • Pathogens have adapted to escape our immune processes.
  • Viruses and intracellular pathogens can downregulate the cell mediated immune responses by several different mechanisms.
  • Some are overlapping mechanisms, others are pathogen specific.
  • Most are related to antigen processing or cytokine driven.

Do not memorize table for specific pathogens. Understand the basic premise of how pathogens evade cellular response mechanisms. You will be coming back to the individual pathogenic mechanisms in MOD and systems based pathology content.

59
Q

Reference reading for T Cell-Mediated Immunity

A

Referenced Reading : A.K. Abbas, A.H. Lichtman and S. Pillai, Basic Immunology: Functions and Disorders of the Immune System, 6th Edition, Chapter 5 & 6, 96 ‐136.

60
Q

List and describe the function of receptors and their ligands on surface of mature T cells. a. TCR

A

reference reading

61
Q

List and describe the function of receptors and their ligands on surface of mature T cells. b. CD4/CD8

A

reference reading

62
Q

List and describe the function of receptors and their ligands on surface of mature T cells. c. CD3

A

reference reading

63
Q

List and describe the function of receptors and their ligands on surface of mature T cells. d. CD25

A

reference reading

64
Q

List and describe the function of receptors and their ligands on surface of mature T cells. e. CD28

A

reference reading

65
Q

List and describe the function of receptors and their ligands on surface of mature T cells. f. CTLA-4

A

reference reading

66
Q

Diagram the migration of mature, naïve T lymphocytes in lymphoid tissues: a. Role of L selectin, ICAM‐1 and chemokines in homing of mature, naive T cells

A
  • Innate immune response aids in initiation of T cell activation through the generation of acute inflammation.
  • Activated T cells perform effector functions:
  1. CD4+ T cells “help” activate B cells and macrophages
  2. CD8+ T cells initiate cell death of infected or transformed cells

•DCs alone are capable of activating mature naïve T cells

-B cells and macrophages can activate memory T cells

reference reading

67
Q

Diagram the immune synapse between an antigen presenting cell and a T cell. Describe how each ligand interaction contributes to antigen recognition (first signal) and co-stimulation (second signal) leading to activation.

A

reference reading

68
Q
  1. Describe the additional stimuli that may be necessary for activation of CD8 + T cells.
A

reference reading

69
Q

Describe the functional responses of activation of T lymphocytes. a. Secretion of cytokines and expression of cytokine receptors

A

reference reading

70
Q

Describe the functional responses of activation of T lymphocytes. b. Clonal expansion

A

reference reading

71
Q

Describe the functional responses of activation of T lymphocytes. c. Differentiation of naive T cells into effector cells

A

reference reading

72
Q

Describe the functional responses of activation of T lymphocytes. d. Development of memory T lymphocytes

A

reference reading

73
Q

Diagram the migration of effector T lymphocytes in cell‐mediated immune reactions: a. Role of sphingosine 1‐phosphate (S1P) in in the egress of T cells from lymph nodes

A

reference reading

74
Q

Diagram the migration of effector T lymphocytes in cell‐mediated immune reactions: b. Role of E and P selectins, ICAM‐1 and VCAM‐1, and chemokines in homing of effector T cells

A

reference reading

75
Q

Compare and contrast the functional responses of CD4+ Effector T Lymphocytes: a. Th1 Cells

A

reference reading

76
Q

Compare and contrast the functional responses of CD4+ Effector T Lymphocytes: b. Th2 cells

A

reference reading

77
Q

Compare and contrast the functional responses of CD4+ Effector T Lymphocytes: c. Th17 cells

A

reference reading

78
Q

Compare and contrast the functional responses of CD4+ Effector T Lymphocytes: d. T regulatory cells (Tregs)

A

reference reading

79
Q

Describe the development and functions of CD8+ cytotoxic T Lymphocytes: a. Role of Ag cross‐presentation

A

reference reading

80
Q

Describe the development and functions of CD8+ cytotoxic T Lymphocytes: b. Role of Perforin and Granzymes in CTL killing of target cells

A

reference reading

81
Q

Describe the development and functions of CD8+ cytotoxic T Lymphocytes: c. Fas‐FasL‐mediated killing of target cells

A

reference reading

82
Q

Describe the necessary cooperation between CD4+ and CD8+ T cells in eradication of intracellular infections.

A

reference reading

83
Q

Describe the mechanisms of contraction of a T cell mediated immune response to homeostasis. a. CD4+ Tregs

A

reference reading

84
Q

Describe the mechanisms of contraction of a T cell mediated immune response to homeostasis. b. CTLA-4

A

reference reading

85
Q

Describe the mechanisms of contraction of a T cell mediated immune response to homeostasis. c. PD-1

A

reference reading

86
Q

Describe the mechanisms of contraction of a T cell mediated immune response to homeostasis. d. Anergy

A

reference reading

87
Q

Describe the mechanisms of contraction of a T cell mediated immune response to homeostasis. e. Tolerance

A

reference reading

88
Q
  1. Describe mechanisms of resistance of pathogenic microbes to cell‐mediated immunity.
A

reference reading

89
Q

Lymphocyte activation

A