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Immuno Exam 3 > Tolerance and Immunology > Flashcards

Tolerance and Immunology Flashcards

1
Q

Tolerance

A

process by which the body ensures that immune responses are directed against foreign antigens and altered self and not against normal self tissues

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2
Q

Tolerance definition

A

SPECIFIC unresponsiveness of an individual to an antigen

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3
Q

Which cells are capable of tolerance

A

only cells with antigen-specific receptors can be tolerant… B and T cells

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4
Q

Tolerance mechanism involves

A

the selective destrcution of lymphocytes that react to self antigens (positive and negative selection)

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5
Q

Central tolerance

A

occurs early in lymphocyte development

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6
Q

Peripheral tolerance

A

regulation of “escapees” of central tolerance in the periphery

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7
Q

Central B tolerance

A

if an immature B cell possesses an IgM that is self-reactive it will undergo anergy (tolerant signals) ro deletion (apoptotic signals)

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8
Q

Peripheral B cell Tolerance

A

BCR is constantly stimulated, chronic stimulation in the absence of other secondary signals = anergy

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9
Q

Central T cell Tolerance

A

if an immature T cell possesses a TCR that is strongly self-reactive, apoptosis is induced

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10
Q

Peripheral T cell Tolerance

A

Primary stimulation of Tcells (antigen recognition) without secondary stimulation results in an inactive T cells

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11
Q

Primary stimulation of peripheral T cells

A

antigen recognition via MHC/peptide-TCR

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12
Q

Secondary stimulation of peripheral T cells

A

B7-CD28 stabilizes IL-2 mRNA that is otherwise rapdily degraded

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13
Q

Antigen recognition without _____________ results in

A

IL-2 present results in peripheral T cell anergy

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14
Q

Repeated stimulation of activated T cells results in

A

apoptosis (clonal deletion)

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15
Q

Regulatory T cells

A

inhibits the activation of T cells by self peptide/MHC

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16
Q

Peripheral Tolerance via regulatory B cells

A

produce IL-10 that negatively regulates the activation of both Th1 CD4+ T cell and CD8+ T cells

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17
Q

Peripheral Tolerance via regulatory T cells

A

CD4+ usually (may be CD8+), express FoxP3, secrete inhibitory cytokines (TGF-beta, IL-10 for Th1 inhibition) and CTL lysis

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18
Q

FoxP3

A

transcriptional repressor expressed by T reg and B reg cells

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19
Q

relapsing MS patients show

A

decreased numbers of IL-10 producing B cells and decreased ability of existing cells to produce IL-10

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20
Q

What age groups are consider immunosuppressed

A

very young and elderly

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21
Q

malnutrition may

A

play a profound effect on the immune system

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22
Q

Disease

A

some diseases may induce a state of nonresponsiveness to antigens

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23
Q

Stress

A

profoundly affects the immune system

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24
Q

HLA sequence

A

determines whether a individual will be capable of responding to an antigen sequence

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25
Q

HLA-B27

A

HLA sequence that causes autoreactivity producing ankylosing spondylitis and reactive arthritis

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26
Q

Doasge and tolerance

A

small doses over long periods induce tolerance

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27
Q

If self molecules are located in immunologically privileged sites and trauma occurs

A

the immune system may gain access to “new” antigens evoking a response

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28
Q

Sympathetic opthalmia

A

retinal or uvealproteins exposed after trauma to eye

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29
Q

Genetic predisposition to autoimmunity

A

HLA type inheritance

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30
Q

Preceding infectious processes in autoimmunity

A

molecular mimicry from a pathogens antigens causes cross-reacting immune-responses

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31
Q

Streptococcal pharyngitis –> which autoimmune disease?

A

rheumatic fever and heart valve destruction

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32
Q

Helicobacter pylori –> which autoimmune disease?

A

gastric carcinoma

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33
Q

Campylobacter jejuni –> which autoimmune disease?

A

Guillian-Barre syndrome

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34
Q

What is Guillian-Barre syndrome

A

immune response against the pathogens LPS that cross-reacts with motor nerves, resulting in severe paralysis and polyneuritis

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35
Q

Klebsiella –> which autoimmune disease?

A

ankylosing spondylitis (chronic inflammation, fibrosis, and ossification of the articulations)

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36
Q

Diseases that elicit polyclonal activation of lymphocytes act via

A

activation of previously anergic self-reactive lymphocytes

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37
Q

What factors are linked to autoimmune diseases?

A

genetics, previous infection, environmental trigger,impaired immunoregulatory mechanisms, hormones/gender

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38
Q

Environmental triggers linked to autoimmune diseases?

A

exposure to environmental triggers (ie. gluten)

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39
Q

Exposure to gluten may lead to

A

Celiac Disease

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40
Q

What is Celiac Disease

A

exposure to gluten causes autoimmune attack on villi in the small bowel (villi atrophy and T cell infiltration)

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41
Q

Celiac Disease is mediated by

A

T cells

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42
Q

95% of individuals with Celiac Disease have

A

autoantibodies against tissue transglutaminase (anti-TG)

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43
Q

90% of individuals with Celiac Disease have

A

HLA-DQ2 and remaining have HLA-DQ8

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44
Q

Celiac Disease is associated with

A

IgA deficiency

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45
Q

Impaired immunoregulatory mechanisms that lead to autoimmune diseases

A

deficient or defective T cells may alter normal immune control, defective antibody production of one class may lead to inhibition of another class

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46
Q

Example of defective antibody production of one class may lead to inhibition of another class

A

elevated IgE in selective IgA deficiency

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47
Q

Which gender is more likely to have an autoimmune disease and why

A

women, possibly due to ER on immune cells

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48
Q

Myasthenia Gravis is a result of

A

antibodies produced against the ACh receptors at neuromuscular junctions (ORGAN-SPECIFIC)

49
Q

Myasthenia Gravis manifestations

A

severe muscle weakness, drooping eyelids, difficulty chewing, swallowing, breathing

50
Q

Myasthenia Gravis genetic component

A

associated with HLA-DR3

51
Q

Myasthenia Gravis

A

Organ-specific, antibody-mediated

52
Q

Autoimmune hemolytic anemia is the result of

A

antibodies produced against either Rh antigen or I antigens on RBCs, targetting them for destruction

53
Q

RBCs in Autoimmune hemolytic anemia

A

complement-mediated lysis or macrophage phagocytosis

54
Q

Autoimmune hemolytic anemia effects which body system

A

spleen (organ-specific)

55
Q

Autoimmune hemolytic anemia manifestations

A

anemia, haemolysis, low haptoglobin, increased lactate DH, elevated direct bilirubin

56
Q

Myasthenia gravis is a Type ____ hypersensitivity

A

Type II

57
Q

Direct antiglobin would test positive in which disease

A

Autoimmune hemolytic anemia

58
Q

Autoimmune hemolytic anemia is caused by

A

warm hemagluttinins or cold hemagluttinins

59
Q

Warm hemagluttinins

A

IgG that can bind RBCs at 37C specific for Rh (Kupffer phagocytosis)

60
Q

Cold hemagluttinins

A

IgM binds RBCs at less than 37C specific for I antigens (complement/MAC)

61
Q

Systemic Lupus Erythematosus

A

antibodies against double-stranded DNA (and other nuclear/cytoplasmic components) form IC and deposit in kidneys, arteriole walls, synovium

62
Q

Systemic Lupus Erythematosus IC’s activate

A

complement, PMNs, granulocytes

63
Q

Systemic Lupus Erythematosus manifestations

A

fever, joint pain, malar, CNS damage, damage to heart and kidneys

64
Q

genetic component of SLE

A

C1, C4, or C2 deficiency resulting in lack of C3b for IC phagocytosis

65
Q

Systemic Lupus Erythematosus is more common in what patient population

A

women 15-45

66
Q

is linked to what HLA type

A

HLA-DR3 or DR2

67
Q

Tests for Systemic Lupus Erythematosus

A

indirect fluorescent antibody stain

68
Q

Scleroderma

A

antibody production against nuclear enzymes (topoisomerase and RNA pol)

69
Q

Scleroderma manifests as

A

skin thickening, arthritis, hair loss, arteritis, Reynaud’s, overproduction of EC matrix proteins

70
Q

Scleroderma is most common in what patient population

A

women 30-50

71
Q

Sjogren’s Syndrome

A

antibodies against cytoplasmic protein-RNA complexes called SS-A (Ro) and SS-B (La)

72
Q

Detection of Scleroderma

A

indirect fluorescent antibody stain (same as SLE) but different pattern

73
Q

Sjogren’s Syndrome manifestation

A

systemic inflammation and destruction of exocrine glands, esp salivary and lacrimal - dry mouth and eyes

74
Q

Sjogren’s Syndrome detection

A

ELISA or western

75
Q

SLE is a Type _____ hypersensitivity

A

Type III

76
Q

Graves’ Disease

A

antibodies (TSI) against TSH receptors, bind and cause expression of TSH receptor = hyperthyroidism

77
Q

Graves’ Disease Manifestations

A

low TSH, high T4 and T3

78
Q

TBIIs

A

antibodies aginst TSH receptors, bind and cause repression og TSH receptor = hypothyroidism

79
Q

Graves’ Diseaseeffects primarily

A

women (4:1)

80
Q

Goodpasture’s Disease

A

antibody production against alpha-3 chain of basement membrane collagen, Fc binds Fc-gamma receptors on immune cells for activation

81
Q

Goodpasture’s Disease manifestations

A

binding to renal glomeruli, pulmonary alveoli causing disease and tissue injury

82
Q

Goodpasture’s Disease is a Type _____ hypersensitivity

A

Type II

83
Q

Multiple Sclerosis

A

T-cell mediated (CD4 and CD8) response to CNS myelin

84
Q

MS may be linked to

A

EBV, ADV-2, Hep-B infections, and associated with HLA-DR2

85
Q

Type I DM

A

T-cell mediated- CD8 CTLs destroy insulin-producing beta cells of the pancreas

86
Q

Genetic component to Type I DM

A

HLA-A2

87
Q

Rheumatoid Arthritis

A

T-cell mediated and antiboy mediated

88
Q

Inflammation in RA in initiaed by

A

deposition of IC’s and inflammaotry infiltration of the synovial membrane

89
Q

What immune cells are present in RA synvoial membranes

A

macrophages, T cells, and plasma cells

90
Q

RA manifestations

A

chronic inflammation of the synovium, fever, fatigue, joint pain and swelling

91
Q

Pannus

A

destruction of neighborign cartilage to expose chondrocytes and compromise synvoial integrity

92
Q

2 diagnostic markers for RA

A

anti-citrullinated peptide antibodies (ACPAs) and rheumatoid factor (RF)

93
Q

RF

A

IgM against IgG Fc portions, form IC’s that are deposited in the synovium –> complement

94
Q

RF titers

A

20-30% of the time, no RF in RA patients, but generally RF levels coincide with RA severity

95
Q

presence of RF and arthritis

A

not always due to RA, RF may be elevated in SLE

96
Q

ACPA titers

A

90-95% indication of RA

97
Q

Hashimoto’s thyroiditis

A

T cell-mediated, but have antibodies against thyroid peroxidase and thyroglobulin

98
Q

What type of hypersensitivity is Hasimoto’s?

A

Delayed Type IV

99
Q

Hashimoto’s thyroiditis manifestations

A

puffy round face, dry skin, cold, brittle hair and nails

100
Q

Hashimoto’s thyroiditisis associated with

A

HLA-DR5, -Dr3 and B8

101
Q

Treatment for hypothyroidism

A

administration of thyroxine

102
Q

Myasthenia Gravis treatment

A

cholinesterase inhibitors

103
Q

immunosuppressive therapy for autoimmune disease

A

anti-mitotic drugs, anti-inflammatory, cyclosporine

104
Q

advantages and disadvantages of using immunosuppressive therapy for autoimmune disease

A

dampen immune response, adverse side effects (susceptibility of disease), NSAIDS

105
Q

Cytokine treatment of MS

A

IFN-beta.1a (avonex, rebif)

106
Q

TNF-alpha blockades (infliximab, etanercept, adalimumab, golimumab, certolizumab

A

treatment for RA and akylosing spondylitis

107
Q

SLE and scleroderma treatments

A

bone marrow ablation and transplant

108
Q

glatiramer acetate

A

induces production of Treg cells for treatment of MS

109
Q

tocilizumab

A

tocilizumab for RA Anti-IL-6R

110
Q

rituximab

A

anti-CD20 for B cell targeting

111
Q

abatacept

A

T cell activator for RA

112
Q

natalizumab

A

anti-alpha-4 integrins for MS

113
Q

Anti-BAFF

A

SLE

114
Q

Low dose - Oral tolerance

A

oral low dose Ag causes induction of Th3 cells and the release of TGF-beta which inhibits Th1 and Th2

115
Q

Low dose - Oral tolerance results

A

ag-specific Th3 and IgA isotype switch (inhibits Th1 and Th2 and cytokine production)

116
Q

High dose - Oral tolerance

A

clonal exhaustion and anergy of CD4 T cells

117
Q

Oral tolerance for MS

A

bovine myelin

118
Q

Oral tolerance for RA

A

Type II collagen

119
Q

Oral tolerance for graft rejection

A

HLA molecules

Immuno Exam 3 (6 decks)

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