Thrush - Immunological Tolerance and Autoimmunity

Question 1

____ is when the immune system is silenced to a particular antigen and can be induced.

Answer 1

Tolerance

Question 2

what are the ways tolerance can be induced

Answer 2

1. introducing ag to pt via multiple blood transfusions prior to grafting inc survial of human kidney transplants by inc. stimulation of T cells.
2. In mice, can transfer tolerance from one animal to another

Question 3

____ tolerance is destruction of self reactive cells in the primary lymphoid organs (bone marrow and thymus). Self reactive cells killed via central tolerance is induced to undergo apoptosis.

Answer 3

Central

Question 4

____ tolerance is where self reactive cells are suppressed. They should have tolerance (anergic) to these self molecules. Peripheral tolerance can be through the lack of proper second signals or interaction of _____ with B7.

Answer 4

Peripheral; CTLA-4

Question 5

failure of self vs non self develops into :

Answer 5

autoimmunity

Question 6

How is tolerance established

Answer 6

Depends on how the antigen is presented to immune system:

1. tolerogen
2. immunogen

Question 7

Tolerance is ____ specific

Answer 7

antigen

Question 8

What are the tolerance inducers

Answer 8

1. high doses of Ag
2. Pesistence of Ag in host
3. IV or oral introduction
4. absence of adjuvants
5. low levels of co stimulator molecules

Question 9

_____ and CD____ T regs have been shown to play a role in suppressing the immune response to self tissues. The signaling molecules in these cells is ____. Loss/mutations in the gene for this molecule is associated with autoimmune dissease

Answer 9

CD4+ ; CD25+; Foxp3

Question 10

Tregs are _____ tolerance

Answer 10

peripheral

Question 11

Autoimmunity can be caused by ___ cells, ___ cells or a combination of the two. It is usually do to failure of ____ process (central tolerance), _____ (peripheral tolerance), and apoptosis via lack of Fas mediated killing of self reactive cells. Autoimmunity can be organ specific such as in ____ diabetes, or organ non specific such as in ______. But there are many genetic predispositions as well due to ____ association.

Answer 11

B; T; selection; anergy; type 1; lupus;

Question 12

HLA ____ has a strong association with ankolysing spondylitis and insulin dependent diabetes has an association with HLA-______ and HLA-____

Answer 12

B27; DQ8; DQ2

Question 13

What are the factors that can cause an autoimmune disease?

Answer 13

1. release of sequestered antigens; due to infection or aging
2. loss of suppression due to inactivation of Tregs
3. cross reaction with self tissues
4. chemical/viral infection alter self proteins which could be recognized as foreign Ag
5. combination of the above

Question 14

____ play an important role in autoimmune diseases and women are more susceptible to them. They produce more Ab than men and have higher CD4 cell counts. They also have a different proportion of Th1/Th2 cells than men. During pregnancy the mothers immune response factors a _____ type response. The fetus is a “graft”

Answer 14

hormones; Th2

Question 15

What are the effect of hormones?

Answer 15

1. In mice, can switch female Th1 response to Th2 by injection of testosterone.
2. glucocorticoids are immunosuppressive

Question 16

______ thyroiditis occurs primarily in middle aged Japenase women (genetics and environmental). You get autoantibodies and Th1 cells that damage thyroid cells…lack of iodine uptake =_____

Answer 16

hashimitos; hypothyroidism

Question 17

Autoimmune anemia or ____ anemia is due to an autoimmune reaction against ____ factor or against the parietal cells that produce this factor which leads to vitamin ____ deficiency

Answer 17

pernicous; intrinsic; B12

Question 18

Insulin dependent diabetes millitius occurs when _____ attack the pancreatic islet beta cells. Abs can play a role as well.

Answer 18

CTL’s

Question 19

what are the diseases due to to direct cellular damage

Answer 19

1. hashimitos thryoiditis
2. autoimmune anemia
3. insulin dependent diabetes mellitis

Question 20

what is an auto immune diseases due to stimulating or blockning auto antibodies

Answer 20

1. myasthenia gravis; blocking Ab to acetylcholine receptors on muscles; progressive skeletal muscle weakness; if one removes the auto ab or suppresses the immune response, individuals diagnosed before permanent damage has occurred can have a normal life

Question 21

what are systemic auto immune diseases

Answer 21

1. systemic lupus erythematosis
2. multiple sclerosis
3. rhematoid arthiritis

Question 22

____ is primarily found in women and is due to the production of autoantibodies against _____, histones, ____, platelets, _____ factors, etc. These autoantibodies are often analyzed in the lab when looking for ____ nuclear _____. ANA forms immune complexes with antigens after these molecules are released from a dead cell and can damage bystander cells especially blood vessels of the ____. One of the classic symptoms of a lupus pt is the presence of a butterfly rash on the face.

Answer 22

SLE; DNA; RBCs; clotting; anti antibodies; kidney

Question 23

_____ is where auto reactive T cells target the myelin sheath proteins and cause decreased function of the ____.

Answer 23

multiple sclerosis; neurons

Question 24

______ is primarily in women between 40-60 due to production of auto reactive antibodies including an ____ isotope that reacts with the Fc region of IgG or ANAs. The auto antibodies are called ____ ____ and bind ____ and immune complex formation can occur and can cause inflammation. You have chronic inflammation of the points.

Answer 24

rheumatoid arthritis; IgM; rheumatoid factor; IgG