Week 5 Flashcards

1
Q

pro-B cell

A
  • earliest identifiable cell of B cell lineage

- CD34 is found on undifferentiated precuros cells of hematopoetic origin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Pro-B cell rearrangement

A
  • rearrangement of heavy chain only uses one chromosome

- if non-productive rearrangements are made with both chromosomes then the B cell will go through apoptosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Pre-B cell and Ig heavy chains

A
  • pre-B cell assess quality of the Ig heavy chain
  • VpreB and gamma 5 proteins make up a surrogate light chains that binds to mu heavy chains to mimic the light chain and test out whether it is functional
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

re-arrangement of light chain

A
  • uses VDJ recombinase

- reaarangement success rate is increased because there are two genes that can be used; kappa and lambda

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

kappa vs lamba

A
  • the body always uses kappa genes first but if it cannot rearrange those then it will move on to lambda
  • because kappa is used first they are used more than lambda
  • the only Ig that predominately uses lambda chains is IgD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Checkpoints of B cells

A
  • Checkpoint 1: occurs at the late pro-B-cell stage with formation of a functional pre-B-cell receptor; involves whether cell is able to make mu chains that can assemble a functions pre-B cell receptor
  • Checkpoint 2: at the stage of the small pre-B cell, is dependent on whether the cell is able to make a function light chain that can bind to the heavy chain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

t-cells and the thymus

A

T cells have to migrate to the thymus to mature and once matured they move to the lymphnode

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

two lineages of b cells

A
  • α:β T cells and γ:δ T cells.

- these cells will begin to express CD4 and/or CD8 during their development

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

thymus

  • made of
  • later in life
A
  • made of epithelial that is colonized by bone marrow progenitor cells which give rise to thymocytes and dendritic cells
  • involution: fat cells claim area that were once packed with thymocytes and thymus is no longer able to produce as many T-cells; this does not effect t-cell immunity because T cells are long lived
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

DiGeorge Syndrome

A

genetic disease where the thymus fails to develop so T cells are absent but B cells are present. This leaves patient open to opportunistic infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Thymocytes commit to T-cell lineage

A
  • lymphoid progenitor cells express CD34 but with interaction of thymic stromal cells the progenitor cells will divide and differentiate
  • the cell will begin to express CD2 and CD5 showing that they have committed to T4 lineage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Double negative thymocytes

A

-the t cell does not have CD4 or CD8 yet on cell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Double positive thymocytes

A
  • the t cells have both CD4 and C8 on cell surface

- need to

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Notch 1

A

-transcription factor that binds to the nucleus and initiates transcription of T cell genes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

thymocyte lineage

A
  • commitment to α:β or a γ:δ is a race; whichever gene can rearrange and make a functional receptor first will be the lineage that the receptor will go down
  • if beta chain is made before a γ:δ receptor is made then it becomes a pre-T cell receptor
  • Pre-T cell receptor will express CD4 and CD8 then alpha chain will be allowed to rearrange while still competing with γ:δ to make a successful receptor
  • if γ:δ make a succeessful receptor before the cell can make a beta chain then the cell is committed to γ:δ lineage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

pre-TCR complex

A
  • tests for ability of beta chain to bind surrogate alpha chain whcih will bind with CD3 complex forming the pre-T cell recptor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Thymocytes attempts at rearrangement

A
  • thymocytes have four attempts to re-arrange beta cell before it goes through apoptosis
  • thymocytes have multiple attempts at re-arragning alpha chain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

why do we favor α:β lineage over γ:δ lineage

A

commitment to α:β lineage requires only one productive gene rearrangement, whereas commitment to the γ:δ lineage requires a minimum of two productive rearrangements.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

alpha chain rearrangement and delta locus

A
  • When an α-chain gene is rearranged, the δ locus situated within the α locus will be automatically deleted
  • greatly reduces the probability that a T cell committed to the α:β lineage will end up expressing a γ:δ receptor as well as an α:β receptor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

positive selection

A
  • mediated by the complexes of self peptides and self-MHC molecules present on the surface of the cortical epithelial cells
  • If a peptide:MHC complex is bound within 3–4 days after the thymocyte first expresses a functional receptor, then a positive signal is delivered to the thymocyte, which permits its maturation to continue.
  • double-positive CD4 CD8 T cell interacts through its α:β receptor with a particular peptide:MHC complex. When the interacting MHC molecule is class I, CD8 molecules are recruited into the interaction, whereas CD4 molecules are excluded. Conversely, when the selecting MHC molecule is class II, CD4 is recruited and CD8 excluded
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

negative selection

A

-deletes T cells whose antigen receptors bind too strongly to the complexes of self peptides and self-MHC molecules presented by cells in the thymus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How negative selection occurs

A
  • development of central tolerance: AIRE transcription factor will induce transcription of tissue specific genes in the thymus and if developing B cell binds too tightly to self antigen it will induce apoptosis
  • development of peripheral tolerance: after development if a t-cell binds to self antigen too tightly it will become anergic and eventually die
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

autoimmune disease

  • CTLA-4
  • defecive AIRE alleles
  • FOXP3
A
  • arises when tolerance to self antigens in lost
  • CTLA-4 will compete with CD28 for binding with B7; when 28 is bound the T cell is activated when 4 is bound the T cell is inactivated; if CTLA4 is inhibited then the T cell will always be activated (Ipilimumab)
  • common in Finns, Sardiniansm and Iranian jews; will have incomplete deletion of sef–reactive T-cells
  • FOXP53 only used by T-reg cells to cause annergy to t-cells activated by self antigen after maturation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Endocrine glands and autoimmunity

A
  • contains tissue specific proteins not expressed in other tissues and are well vascularized
  • Thyroid gland, islets of langerhans and adrenal gland
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Autoimmunity and infections

A
  • some antibodies made in infection can react with epitopes present in human tissue (molecular mimicry)
  • ex: rheumatic fever; antibodies specific for cell-wall components of S. pyogenes are made and react with epitopes present on human heart, joint, and kidney tissue causing inflammation in those tissues
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

autoimmunity being caused by environmental factors

A
  • smoking: Alveoli in the lungs of smokers are chronically damaged from their daily exposure to cigarette smoke. This lack of integrity gives circulating antibodies access to the basement membranes, where deposition of immune complexes activates complement, causing blood vessels to burst and hemorrhage.
  • punched in the eye: proteins unique to the eye drain from the anterior chamber to the local lymph node and there induce an autoimmune response which can cause blindenss to both eye unless treated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Immunogen

A

elicits an immune response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Toleragen

A

Does not ellicit an immune response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is self-tolerance

A

body’s non-response to antigens that are normally seen in the body where as a failure of that would be an autoimmune disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Mechanisms of by which the immune system develops tolerance to self during development

A

○ T-cells: May undergo apoptosis OR CD4 cells may differentiate to Treg cells (which will have an effect in regulating peripheral responses to self antigens)
○ B-cell: engages with self antigen while being developed the BCR undergo receptor editing (gene rearrangements) OR undergo apoptosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Mechanisms of by which the immune system develops tolerance to self in periphery

A
  • T-cell may undergo apoptosis OR it may just become anergic by the co-engagement w/ the Treg cells that we’re developed after self antigen exposure in the thymus
  • B cells may undergo apoptosis OR just have an anergic response
32
Q

How does self-tolerance arise

A
  • Presentation of self antigens during lymphocyte development leading to negative selection of T-cells and B-cells if they bind too strongly to self-antigen
  • Receptor editing: Editing the receptor to make it less reactive towards that self antigen
  • Peripheral tolerance: B cells that are in the periphery, when they recognize self antigen become anergic
  • Immune privilege: Exclusion of lymphocytes from certain peripheral tissues (specifically the brain, eye, & testis)
33
Q

Autoimmunity and hypersensitivity

A
  • Type II: mediated by antibodies (most often IgG sometime IgM) that are directed against a tissue surface (could be a cell or ECM); Sometimes the antibodies are directed against receptors, w/ those particular kind of autoimmune diseases:
  • Type III: in solution, its not directed against tissue surface; you form immune complexes that get all over body and cause destruction in many different places
  • Type IV: T cells are mediating the destruction
34
Q

3 pathways that cause the destruction of the RBCs

A
  • destruction through binding of the Fc region by the Fc gamma receptors usually, then those are taken up by phagocytes utilizing the Fc gamma receptors that they have
  • antibodies binding which fix complement which causes complement mediated phagocytosis through binding via the receptor CR1 receptor that will bind to C3b
    ○ complement could also proceed all the way down to the terminal complement protein and cause formation of MAC
35
Q

greatest factor that determines autoimmune disease development

A
  • HLA: Some of the HLA types actually confer resistance
  • ex: Type 1 Diabetes, you have less chance of developing type 1 diabetes if you have a DQ6 in your haplotypes; even if you are carrying the one that confers susceptibility like DQ2 or DQ8, if you have DQ6 in your other chromosome then you are still able to override the susceptibility
36
Q

Are all autoimmune diseases evenly spread equally spread across all demographics

A

No, more common in women except for ankylosing spondylitis

37
Q

auto-immunity and time of susceptibility

A
  • relates to genetic pre-disposition to immune disease related strongly to HLA haplotype
  • results in resultant loss of self tolerance
38
Q

Phases of auto-immunity

A
  • initiation phase: occurs to induce/insight the inflammation and then persistent disease
  • propagation phase
39
Q

What are some of the inciting events or additional environmental factors that may contribute to the development of autoimmune disease in general?

A
  • UV radiation
  • Dysbiosis
  • Infection
40
Q

UV radiation and autoimmunity

A

Damage to DNA can cause the cell to lyse (cellular apoptosis) releasing intracellular pieces that the body may not recognize outside of cell which causes loss of self tolerance to those specific pieces and they get presented and cause disease process.

41
Q

Dysbiosis and autoimmunity

A
  • Displacement of normal microbiota can make way for other pathogens that can cause infection
  • Role of microbiota in the gut or on surface of skin has a role in process of disease and is currently being research.
  • Perturbation of gut flora can lead to some autoimmune diseases.
42
Q

Molecular mimicry

A
  • Recognition of self by immune system; immune system exposed to a bug(ex chlamydia) now with exposure the cells that are propagating and producing antibodies because of that exposure may now respond to a self antigen that may mimic the bacteria
  • Chlamydia is particular pathogen that is thought to contribute to development of HLA-v27 associated autoimmune disease
43
Q

Bystander activation

A
  • T-cells being activated
  • If immune sys is responding to a antigen, that infectious process is going to lead to the proliferation of proinflammatory cytokines and various mediators that are not only gonna stimulate the cells that are going to fight against pathogens, but the proinflammatory mediators will also excite autoreactive lymphocytes and other cells that may injurious–viral syndrome may induce systemic lupus even though that virus may not be pre-disposing pathogen to lupus but infection itself contributed to development of disease.
44
Q

a genetic deficiency of complement proteins C1q and C4 leads to autoimmunity

A
  • cells are apoptosing or they have just been injured by the immune system and persistence of those self-proteins to various other antigens can contribute to development of auto-immunity and the fact that complement proteins are not there to participate in clearance of self antigens is thought to lead to development of systemic lupus specifically
  • As the disease process continues with flare ups, we see the complement levels go down even further because complement markers are being consumed and may be injuring the kidneys or other tissues leading to the manifestations of the disease
45
Q

HLAs role in autoimmunity

A

plays a role in antigen presentation and if it is a particular haplotype, it’s interaction with the immune system may induce this idiosyncratic autoimmune response

46
Q

TLR7 and TLR9 role in autoimmunity

A

if self-cells are apoptosing or being cleared physiologically by the immune system, our nucleic acid is going to be engulfed by APC, and if you have a particular TLR variant, that may contribute to auto-immune disease if the TLR engages with self nucleic acids.

47
Q

What phenomenon most likely explains the relentless progression of SLE?

A

epitope spreading: constituents of cell surfaces, cytoplasm, and nucleus, become antigenic

48
Q

Goodpasture’s syndrome

A
  • autoantibody is specific for the α3 chain of type IV collagen, the collagen of basement membranes throughout the bod
  • IgG is deposited along the basement membranes of renal glomeruli and renal tubules which created inflammatory response
  • Treatment involves plasma exchange with immunosuppressive drugs
49
Q

Sjögren syndrome

A
  • chronic disease characterized by dry eyes (keratoconjunctivitis sicca) and dry mouth (xerostomia) resulting from immunologically mediated destruction of the lacrimal and salivary glands.
  • decrease in tears and saliva (sicca syn- drome) is the result of lymphocytic infiltration and fibrosis of the lacrimal and salivary glands.
50
Q

Evaluation of Sjögren syndrome

A
  • SSA, SSB, RF, ANA, complement
  • SSA antibodies: Want to evaluate for primary Sjogren’s as opposed to secondary
  • Check cell count and liver kidney function test: It can affect the kidneys and tends to cause interstitial nephritis
  • Complement deficiency: A deficiency can be present and may predispose to malignancy
  • could do a biopsy of the salivary glands: evaluate for lymphocytic infiltration of glands
51
Q

Counseling woman with lupus about pregnancy

A
  • Her infant could be at increased risk for neonatal lupus because antibodies that are manifesting in mom can be directly pathogenic against the developing fetus and in particular the fetal myocardium
  • situation where Rho-involved antibodies cross passively through from mom to baby, pass through the placenta - they’re IgG antibodies, and they’re directly pathogenic against the developing heart.
  • there is a stage in-utero from weeks 16-26 where a developing baby is at risk for developing third-degree heart block; so basically complete heart-block can occur that is incompatible with life without placement of a pacer right after birth: developing cardiocytes - the myocardium cells as the baby is developing are undergoing transformation, they’re apoptosing and Rho antibodies can directly attack or engage with the apoptotic debris and that will lead to the production of TGF-beta and pro-fibrotic cytokines that can lead to scaring within the myocardium, and that leads to complete blockage of the electrical transduction system of the heart, and that can lead to complete heart blockage
52
Q

autoimmune disease and agonistic antibodies

A
  • not causing damage to the tissues, they’re just stimulating the receptors that they’re directed against
  • Grave’s disease, they are stimulating the thyroid tissue, so you end up being hyper-thyroid –> your metabolism gets really high and you get really hot all of the time; But, there is NO damage to the thyroid itself
53
Q

Auto-inflammatory diseases

A
  • mediated by the innate immune cells

- ex. Familial Mediterranean Fever

54
Q

Grave’s disease and pregnancy

A
  • antibodies for Grave’s disease can cross the placenta and affect the developing infant
  • IgG crosses via the Brambell’s receptor (FcRN)
  • With plasmapheresis they take those antibodies out, and they don’t have the auto antigen and they haven’t broken tolerance in their bodies, and so they’re normal after plasmapheresis
55
Q

Raynaud’s syndrome

A
  • vasospastic phenomenon with exposure to cool or other stressful situations that basically leads to decreased perfusion of the digits
  • cyanotic process that’s ongoing with the small vessels and manifests with cyanosis of the digits, the toes, fingers, the tip of the nose or ears
56
Q

Systemic sclerosis

A
  • SCL70 antibodies are associated with a more diffuse manifestation of systemic sclerosis
  • fibrotic changes occurring at the bases of the lung with honeycomb appearance
  • inflammatory process drives fibrosis development into the peripheral tissues; eosinophilic collagen deposition that’s associated with scarring
  • have scarring in the lungs, scarring in the digits, scarring of the vasculature
57
Q

categories of systemic sclerosis

A
  • diffused variant: affect multiple internal organs - the lungs, the kidneys; it can affect the heart in rare instances, and on the skin it tends to affect all of the limb including the skin that’s proximal to the elbows; can affect the pulmonary parenchyma as well as the kidneys
  • limited cutaneous: skin manifestations seem to be isolated to the distal limbs and the face; associated with pulmonary artery hypertension
58
Q

Errosive Osteo arthritis

A
  • DIP and PIP joints involved
  • appropriate way to manage: NSAIDs- relieving the pain and inflammation, but we’re not preventing the disease or the progression of disease; analgesics; Glucocorticoid injections
59
Q

Aspirin

A

irreversible COX inhibition-Not usually prescribed by physician for arthritis, because it’s used more as an anti-platelet drug.

60
Q

Why would you need to have COX-2 selectivity? Why would we prefer this

A
  • COX-1 is a housekeeping gene within GI system, renal system. Prostaglandins are required for normal functioning. So in the GUT, if you inhibit prostaglandins, you’re going to have increased GI dysfunction-like ulcers.
  • would not prescribe to A pt with cardiovascular conditions d/t increased risk of thrombosis.
61
Q

Why might it be important to consider half-life of NSAID

A

Overdosing, toxicities associated with long-term use

62
Q

What are the differences between methylprednisolone, prednisone, and prednisolone

A
  • Methylprednisolone can be given IV

- Prednisone is the prodrug: Prednisone is metabolized to prednisolone in the liver

63
Q

RA

A
  • small joint arthritis, multiple joints affected, symmetry to hands, also including large joints, she has seropositivity (+Rf) and + anti-CCP, and systemic inflammatory markers elevated.
  • going on for a long while–>greater than 6 weeks
  • If pt has RA prior to pregnancy, the signs and symptoms are alleviated during pregnancy, and return shortly after giving birth.
64
Q

treatment of RA

A
  • goal: prevent progression of RA and to prevent disability d/t disease
  • NSAIDs and Systemic steroids
  • Methotrexate (MTX): dihydrofolate reductase inhibitor and the resultant effect is decreased DNA synthesis. Also, Amino-imidazolecarboxamide ribonucleotide (AICAR) transformylase inhibitor. Inhibiting AICAR transformylase leads to an accumulation of AMP intracellularly, which gets pushed out into extracellular compartments, where it’s made into adenosine, which is a really strong anti-inflammatory molecule. Counter side effects with Folic Acid inhibits the effects of dihydrofolate reductase inhibition, but we don’t affect AICAR transformylase inhibition, so you continue to see the anti-inflammatory effects of MTX.
65
Q

significance of initiating an OCP with MTX

A

○ MTX is profoundly teratogenic. You should have in depth discussion with pts (male or female) before starting MTX.

66
Q

vaccines and immunosuppressive therapy

A

If you’re suppressing the immune system and then you administer the vaccines, the response to those vaccines may be suboptimal. It’s better than not giving the vaccine at all, but if you can give the vaccines before starting immunosuppressive therapy, then do it.

67
Q

Latent infections and DMARDs

A

-before starting a DMARD must make sure that the patient does not have hx of latent Tb or viral hepatitis (B and C)

68
Q

Treatment after MTX failure

A

TNF-alpha inhibitors: Etanercept binds TNF in serum

69
Q

cytokines might be pro-inflammatory that we can block

A
  • IL-6 receptor antagonists including tocilizumab. It binds the cell-surface receptor but also binds the soluble receptors of IL-6.
70
Q

what happens to CRP if IL6 is blocked?

A

goes down dramatically

71
Q

Rituximab

A
  • a monoclonal antibody that’s directed against CD20, and CD20 is identified on B lymphocytes.
  • B-cell wouldn’t be able to continue to mature to become a plasma cell and cause the release of ab, so you would see a decrease in those ab produced in RA. This drug has been shown to be very effective for RA. However, ○ Plasma cells that are already in the body are not affected. They can still continue to produce antibodies.
72
Q

Abatacept

A

-CTLA4 derivative that competes with CD28 to bind to B7 and inhibits activation of T cell

73
Q

Tofacitinib

A

Jak1/JAK3 inhibitor: IL-6 binds to this cell surface receptor and when IL-6 binds to its receptors, it leads to signal transduction that is facilitated in part by JAK/STAT pathway. So when we block this pathway, we reduce the inflammatory response

74
Q

management of scleroderma lung

A
  • Cyclophosphamide can be utilized. It’s an alkylating agent. It’s a terrible drug and causes tremendous side effects. Pts who are alkylating agents feel horrible and they’re at risk for adverse effects like increased infection and increased mortality.
  • Mycophenolate can be better than cyclophosphamide. It’s not the cleanest drug, but it’s A LOT better than cyclophosphamide.
75
Q

Mycophenolate mofetil

A

-block inosine monophosphate dehydrogenase and inhibits lymphocyte proliferation