blood and immune - bonini

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to Lesson

Podcast

Play an AI-generated podcast conversation about this lesson
Download our mobile app to listen on the go
Get App

Questions and Answers

What is the term for the process of generating mature blood cell components?

  • Phagocytosis
  • Homeostasis
  • Mitosis
  • Hemopoiesis (correct)

Which of the following is a mature cellular component produced during hemopoiesis?

  • Platelets (correct)
  • Muscle cells
  • Nerve cells
  • Epithelial cells

Which mature blood cell lacks a nucleus?

  • White blood cells (WBCs)
  • Red blood cells (RBCs) (correct)
  • Lymphocytes
  • Platelets

Granulocytes are a type of:

<p>White blood cell (B)</p> Signup and view all the answers

Which of the following are granulocytes classified into?

<p>Neutrophils, eosinophils, and basophils (B)</p> Signup and view all the answers

Platelets are fragments derived from what type of cell?

<p>Megakaryocytes (A)</p> Signup and view all the answers

What is the approximate lifespan of red blood cells (RBCs)?

<p>120 days (C)</p> Signup and view all the answers

In adults, hematopoiesis primarily occurs in which location?

<p>Bone marrow of skull, vertebra, sternum, and hips (A)</p> Signup and view all the answers

Hematopoietic stem cells initially emerge from which location during embryonic development?

<p>Yolk sac (D)</p> Signup and view all the answers

Which site has a high concentration of hematopoietic stem cells that are normally discarded after birth?

<p>Cord blood (A)</p> Signup and view all the answers

In adults, what percentage of bone marrow is expected to be present in a normal sample?

<p>40% (B)</p> Signup and view all the answers

Hematopoiesis follows a hierarchical tree model, with which cells at the top?

<p>Hematopoietic stem cells (HSCs) (A)</p> Signup and view all the answers

What is the name of the first marker cells express?

<p>CD34 (B)</p> Signup and view all the answers

What is a key characteristic of hematopoietic stem cells (HSCs)?

<p>Self-renewal ability (C)</p> Signup and view all the answers

Which of the following best describes HSCs?

<p>Multipotent (D)</p> Signup and view all the answers

What are two specific laboratory findings that characterize aplastic anemia?

<p>Chronic pancytopenia and hypocellular bone marrow (A)</p> Signup and view all the answers

In aplastic anemia, a low reticulocyte count indicates which condition?

<p>Reduced ability of the bone marrow to produce cells (A)</p> Signup and view all the answers

Why is there neutropenia and not lymphopenia in aplastic anemia?

<p>Neutrophils have a shorter half-life compared to lymphocytes. (C)</p> Signup and view all the answers

Aberrant autoreactive T lymphocytes in aplastic anemia target what?

<p>Antigens on stem cells and progenitors (A)</p> Signup and view all the answers

Which condition is NOT an exclusion from the definition of aplastic anemia?

<p>Pancytopenia with hypocellular bone marrow (B)</p> Signup and view all the answers

Trilinear cytopenia is a possible consequence of what condition?

<p>Bone marrow failure (A)</p> Signup and view all the answers

Pure red blood cell aplasia is an acquired autoimmune condition frequently associated with what?

<p>Thymoma (B)</p> Signup and view all the answers

The myelodysplastic syndromes are classified as what kinds of diseases?

<p>Clonal diseases (B)</p> Signup and view all the answers

What is the most common etiology of aplastic anemia?

<p>Unknown (C)</p> Signup and view all the answers

What characterizes hereditary aplastic anemia conditions?

<p>Genetic instability (B)</p> Signup and view all the answers

Fanconi anemia is characterized by alterations in genes involved in what process?

<p>DNA repair (C)</p> Signup and view all the answers

What is the most common technique for gene therapy, where cells are harvested and modified in the lab?

<p>Ex-vivo gene therapy (C)</p> Signup and view all the answers

What is a common sign or symptom of aplastic anemia related to low platelet count?

<p>Bleeding (A)</p> Signup and view all the answers

What finding characterizes aplastic anemia in the bone marrow?

<p>Hypocellularity with hematopoiesis replaced by fat cells (A)</p> Signup and view all the answers

In the context of treating aplastic anemia, what factor is NOT typically considered when deciding between immunosuppression and allogenic hematopoietic stem cell transplant?

<p>Patient's blood type (B)</p> Signup and view all the answers

What cells are used as a therapy in CAR-T cell treatment?

<p>T-lymphocytes (B)</p> Signup and view all the answers

What is the purpose of introducing a new gene into T-cells during CAR-T cell therapy?

<p>To encode a chimeric artificial protein (B)</p> Signup and view all the answers

In allotransplantation, cells are taken from?

<p>Different donors (D)</p> Signup and view all the answers

What is a primary target of CAR-T cell therapy?

<p>Cancer cells (C)</p> Signup and view all the answers

In what decade was the first transplant performed from a donor to a patient with acute leukemia?

<p>1950s (B)</p> Signup and view all the answers

The first transplant in Europe was performed for what type of accident?

<p>A radiation accident (C)</p> Signup and view all the answers

What was a major cause of patient deaths during the first transplant experiences in the late 1950s?

<p>Graft versus host disease (B)</p> Signup and view all the answers

What is the main cause of major complications in transplantations?

<p>T-cells (A)</p> Signup and view all the answers

What is the best way to avoid graft-versus-host disease (GvHD)?

<p>Performing a T-cell depleted transplant (C)</p> Signup and view all the answers

What is the term used to describe the immune reaction of the donor's immune system against the host?

<p>Graft-versus-host disease (GvHD) (A)</p> Signup and view all the answers

What is a significant downside to T-cell depleted allotransplantation??

<p>Higher rate of infections (B)</p> Signup and view all the answers

What does HSCT stand for?

<p>Hematopoietic Stem Cell Transplantation (A)</p> Signup and view all the answers

What must an antigen do to be recognized by CAR-T cells?

<p>Be exposed on the surface of cancer cells (C)</p> Signup and view all the answers

Where does the variable region of CAR-T cells, which recognizes the antigen, come from?

<p>An antibody (A)</p> Signup and view all the answers

What does CD19 refer to in the context of CD19 CAR-T cell therapy?

<p>A lineage antigen (B)</p> Signup and view all the answers

What are the six approved CAR-T cell therapies directed against?

<p>CD19 and BCMA (C)</p> Signup and view all the answers

What characterizes the challenges related to failure in CAR-T cell therapy?

<p>The patient doesn't respond to the treatment (D)</p> Signup and view all the answers

What is a common early side effect that occurs a couple of days after CAR-T cell infusion?

<p>Cytokine release syndrome (D)</p> Signup and view all the answers

What is the first step in treating any toxicities resulting from CAR-T cell therapy?

<p>Observation with supportive care (D)</p> Signup and view all the answers

What term would be most appropriate to describe the nature of side effects to CAR-T cell treatment neurotoxicity?

<p>Unpredictable (A)</p> Signup and view all the answers

First-level analysis in hematology includes which of the following?

<p>Complete blood count (CBC) (A)</p> Signup and view all the answers

Which characteristic describes a complete blood count (CBC)?

<p>Fully automated (D)</p> Signup and view all the answers

Morphology in first-level analysis is performed when?

<p>Only on CBCs showing signs of alarm (A)</p> Signup and view all the answers

In first-level assays, what is the primary goal?

<p>To capture every potential sign of disease (B)</p> Signup and view all the answers

Which of the following is an example of a second-level analysis?

<p>Flow cytometry (B)</p> Signup and view all the answers

Where should blood draws be performed in order to perform CBCs, morphology, or flow cytometry?

<p>In the blood (B)</p> Signup and view all the answers

What's crucial to avoid when a blood sample is obtained?

<p>Clotting (C)</p> Signup and view all the answers

Why are anticoagulants like EDTA used when collecting blood samples?

<p>To prevent clotting (A)</p> Signup and view all the answers

Which of the following anticoagulants is typically preferred because it doesn't affect cell morphology?

<p>EDTA (A)</p> Signup and view all the answers

In first-level analysis, manipulation of the blood sample should be...

<p>Avoided (A)</p> Signup and view all the answers

What type of stain is used upon finding alarming signals from a complete blood count?

<p>May Grunwald Giemsa staining (B)</p> Signup and view all the answers

What does flow cytometry frequently analyze?

<p>White blood cells (WBCs) (A)</p> Signup and view all the answers

What is essential for interpreting flow cytometry results?

<p>Clinical data (D)</p> Signup and view all the answers

What does a complete blood count (CBC) generally count and characterize?

<p>Mature elements of blood (B)</p> Signup and view all the answers

What is measured by the hematocrit?

<p>Volume of RBCs in the blood (D)</p> Signup and view all the answers

What does CBCs generally give information about?

<p>Hemoglobin, hematocrit, and RBC parameters (D)</p> Signup and view all the answers

What is the concentration of hemoglobin in the blood expressed in?

<p>g/dL (B)</p> Signup and view all the answers

What does the blood mirror for the patient?

<p>General health status (D)</p> Signup and view all the answers

Anemia is a condition with which of the following?

<p>Fewer red blood cells (D)</p> Signup and view all the answers

What cells are produced in the bone marrow?

<p>Circulating blood cells (C)</p> Signup and view all the answers

What do the asterisks on a CBC indicate?

<p>Something wrong (B)</p> Signup and view all the answers

What is the normal range for MCV's in women?

<p>81-99 fL (C)</p> Signup and view all the answers

MCV is used to define anemia as:

<p>Normocytic, microcytic, or macrocytic (A)</p> Signup and view all the answers

In myeloproliferative neoplasms, genetic alterations typically occur in which cells?

<p>Stem cells or early progenitor cells (A)</p> Signup and view all the answers

Unlike acute myeloid leukemia (AML), cells in myeloproliferative disorders:

<p>Maintain the ability to differentiate (A)</p> Signup and view all the answers

Which historical figure contributed significantly to the understanding of myeloproliferative syndromes?

<p>William Dameshek (B)</p> Signup and view all the answers

Chronic Myeloid Leukemia (CML) is characterized as a:

<p>Philadelphia chromosome positive disease (D)</p> Signup and view all the answers

Polycythemia Vera (PV) is mainly characterized by:

<p>Increased red blood cell count (B)</p> Signup and view all the answers

Essential Thrombocytosis (ET) is defined by an increase in:

<p>Platelets (B)</p> Signup and view all the answers

Primary Myelofibrosis (PM) is characterized by:

<p>Accumulation of reticulin and collagen fibrosis in the bone marrow (A)</p> Signup and view all the answers

What is a common characteristic of myeloproliferative neoplasms, relating to organ size?

<p>Hepatosplenomegaly (C)</p> Signup and view all the answers

The growth rate of neoplastic cells in myeloproliferative neoplasms can be described as:

<p>Not particularly high (C)</p> Signup and view all the answers

Many myeloproliferative neoplasms are often diagnosed when:

<p>The tumor burden is very high (B)</p> Signup and view all the answers

What organs are commonly infiltrated by leukemia in myeloproliferative diseases?

<p>Spleen and liver (A)</p> Signup and view all the answers

Polycythemia Vera and Essential Thrombocytosis are described as the most ______ of the myeloproliferative neoplasms.

<p>Indolent (B)</p> Signup and view all the answers

What is a potential risk of evolution in all myeloproliferative neoplasms?

<p>Transformation to acute myeloid leukemia (AML) (D)</p> Signup and view all the answers

The observation of transformation into AML in myeloproliferative neoplasms has informed researchers about:

<p>The potential common origin of these diseases (D)</p> Signup and view all the answers

According to the WHO classification, myeloproliferative neoplasms are classified based on:

<p>Philadelphia chromosome status (D)</p> Signup and view all the answers

In addition to clinical symptoms and lab results, what other criteria are used to classify and understand myeloproliferative neoplasms?

<p>Different cytogenetic findings (B)</p> Signup and view all the answers

What diagnostic procedure is typically performed when suspecting a myeloproliferative disorder to quantity bone marrow?

<p>Bone marrow biopsy (B)</p> Signup and view all the answers

What is the molecular counterpart of the Philadelphia chromosome?

<p>Bcr/Abl translocation (D)</p> Signup and view all the answers

A mutation in the JAK2 gene, specifically in position 617, results in:

<p>A change from valine to phenylalanine (C)</p> Signup and view all the answers

The Bcr-Abl translocation leads to the production of a:

<p>Chimeric aberrant protein (A)</p> Signup and view all the answers

The Bcr-Abl translocation results in a tyrosine kinase that is:

<p>Constitutively autophosphorylating (D)</p> Signup and view all the answers

What does TKI stand for in the genetics of CML?

<p>Tyrosine Kinase Inhibitor (D)</p> Signup and view all the answers

The tyrosine kinase produced in CML will phosphorylate adhesion molecules of the ________ proteins?

<p>Cytoskeleton (C)</p> Signup and view all the answers

In CML, the classical mutation of Bcr-Abl leads to a protein of:

<p>210 kilodalton (B)</p> Signup and view all the answers

The natural history of CML is made of how many phases?

<p>3 (B)</p> Signup and view all the answers

Which phase of CML is usually how the disease is diagnosed?

<p>Chronic phase (A)</p> Signup and view all the answers

Symptoms of CML that arise from the accumulation of the disease include:

<p>Copious sweating (D)</p> Signup and view all the answers

In CML, a complete blood count (CBC) will show:

<p>Increased number of WBC (A)</p> Signup and view all the answers

The Philadelphia chromosome is found using cytogenetics, and can be found in both:

<p>The peripheral blood and bone marrow (A)</p> Signup and view all the answers

What additional test can be done after cytogenetic analysis?

<p>FISH (B)</p> Signup and view all the answers

What is the primary focus of current gene therapy research related to hematopoietic stem cell transplantation?

<p>Enhancing the regenerative capabilities of hematopoietic stem cells. (A)</p> Signup and view all the answers

What does 'ex vivo' gene therapy involve?

<p>Modifying cells genetically in a lab and then re-introducing them to the patient. (C)</p> Signup and view all the answers

When introducing a CAR gene into T lymphocytes, what is the aim of this gene addition?

<p>To add a therapeutic gene that will mediate a clinical effect. (B)</p> Signup and view all the answers

What is the main goal of gene subtraction in gene therapy?

<p>To inhibit the expression of a specific protein. (C)</p> Signup and view all the answers

Which method is MOST associated with gene correction?

<p>Genome editing approaches. (A)</p> Signup and view all the answers

What is the primary difference between gene transfer and gene therapy?

<p>Gene transfer refers to transferring genetic material, while gene therapy aims to find therapies for diseases in a patient. (D)</p> Signup and view all the answers

Why is the ability to integrate a gene into the recipient cell considered a significant milestone in gene therapy?

<p>It enables stable expression of the transgene, leading to long-term cure. (B)</p> Signup and view all the answers

Which type of vector is MOST commonly used for integrating genes in hematopoietic stem cell-based gene therapy?

<p>Gamma retroviral and lentiviral vectors. (C)</p> Signup and view all the answers

What is a key advantage of lentiviral vectors compared to gamma retroviral vectors?

<p>Higher efficiency and integration profile. (A)</p> Signup and view all the answers

What is a defining characteristic of non-viral methods for gene transfer, such as transposons?

<p>They are less efficient but also less expensive than viral vectors. (A)</p> Signup and view all the answers

What is a significant limitation of RNA when used in gene therapy?

<p>It is much less stable and will not be integrated. (C)</p> Signup and view all the answers

What dictates the area of the genome where guide RNAs bind in the CRISPR-Cas9 system?

<p>Complementarity to a selected area of the genome. (D)</p> Signup and view all the answers

After a DNA double-strand break is created during genome editing, what is a 'quick and dirty' repair mechanism cells can use?

<p>Non-homologous end joining (NHEJ). (D)</p> Signup and view all the answers

Which of the following is used as a template to repair DNA after a double-strand break using homologous directed repair (HDR)?

<p>The other, undamaged chromosome. (C)</p> Signup and view all the answers

What is the primary advantage of CRISPR-Cas9 compared to older genome editing tools like ZFNs and TALENs?

<p>Ease to prepare based on RNA and a single protein. (D)</p> Signup and view all the answers

What is the purpose of the Cas protein nickase in base editing?

<p>To enable the editor to induce a change in a base of the DNA without cutting it. (D)</p> Signup and view all the answers

Why are hematopoietic stem cells (HSCs) frequently used in ex vivo gene therapy?

<p>They are easy to harvest. (A)</p> Signup and view all the answers

What is a key reason for targeting the lung and liver when designing vectors for IV injection in gene therapy?

<p>These organs serve as the first filter following IV injection. (B)</p> Signup and view all the answers

What is the overall survival rate since 2000 for patients with ADA-SCID treated with gene therapy?

<p>100% (A)</p> Signup and view all the answers

Gene therapy has improved for lysosomal disorders because modified enzymes are able to do what?

<p>Can go outside the cells that produce them and reach cells that lack the enzyme. (D)</p> Signup and view all the answers

Flashcards

Hemopoiesis

The process of generating mature cellular blood components.

Mature Cellular Components of Blood

RBCs, WBCs, and platelets

Primary Site of Hematopoiesis

Bone marrow.

Nature of Hematopoietic Diseases

Systemic, involving multiple sites.

Signup and view all the flashcards

Embryonic Development of Hematopoiesis

Yolk sac, then AGM, then liver-spleen, and finally bone marrow.

Signup and view all the flashcards

AGM

Aorta-gonad mesonephros.

Signup and view all the flashcards

Characteristics of a Stem Cell

The capability of self-renewal and differentiation.

Signup and view all the flashcards

First Marker Expressed by HSCs

CD34.

Signup and view all the flashcards

Stem Cell Traits

Low-proliferation, self-renewal ability, and self-differentiation ability.

Signup and view all the flashcards

Two Main Niches of Hematopoietic Stem Cells

Bone Niche and Vascular Niche.

Signup and view all the flashcards

Unique Growth Factor in Hemopoiesis

Erythropoietin.

Signup and view all the flashcards

Facilitator of Granulocyte Generation

G-CSF.

Signup and view all the flashcards

Negative Regulators of Hematopoiesis

MIP1, TNF, TGF-beta, and IFNs.

Signup and view all the flashcards

Harvesting HSCs

G-CSF

Signup and view all the flashcards

Hematology and Oncology Diagnostics

Diagnostic techniques focusing on blood counts and flow cytometry to identify and classify blood disorders and cancers.

Signup and view all the flashcards

First-Level Analysis

Includes complete blood count (CBC) and morphology (blood smear) for a quick, cheap initial assessment.

Signup and view all the flashcards

Complete Blood Count (CBC)

A cheap and quick automated blood analysis.

Signup and view all the flashcards

Morphology (blood smear)

Requires operator analysis that is performed only on CBCs showing signs of alarm.

Signup and view all the flashcards

Goal of First-Level Assay

Aims to detect any potential sign of disease even if its likely irrelevant.

Signup and view all the flashcards

Second-Level Analysis

Includes flow cytometry and morphology (bone marrow smear) to look for hematological malignancy.

Signup and view all the flashcards

Blood Sample

Requires an intact, mature blood element sample like blood draws.

Signup and view all the flashcards

Avoiding Clotting

Essential after the sample is obtained to preserve the blood elements.

Signup and view all the flashcards

EDTA

Usually the preferred solution because it does not affect the morphology of the cells.

Signup and view all the flashcards

May Grunwald Giemsa staining

Staining compound used to stain blood of the smear after the machine finds alarming signals .

Signup and view all the flashcards

Flow Cytometry Preparation

Requires washing or lysing cells, differentiating resting B and T lymphocytes, and the use of markers like CD19 and CD3.

Signup and view all the flashcards

Need for Clinical Data in Flow Cytometry

Required when interpreting flow cytometry results.

Signup and view all the flashcards

Three Types of Blood Cells

Red blood cells (erythrocytes), White blood cells (leukocytes), Platelets (thrombocytes).

Signup and view all the flashcards

CBC Parameters

Complete blood count (CBC) that gives information about hemoglobin, hematocrit, and RBC parameters.

Signup and view all the flashcards

Anemia

A low amount of total red blood cells.

Signup and view all the flashcards

Circulating Blood Cells

Including RBCs, WBCs, platelets, neutrophils, resting lymphocytes, monocytes, eosinophils, and basophils.

Signup and view all the flashcards

MCV (Mean Corpuscular Volume)

Calculated by HCT (%) / RBC (×10^6/μL) multiplied by 10, defining anemia.

Signup and view all the flashcards

Describing Anemia

Microcytic, normocytic, or macrocytic.

Signup and view all the flashcards

Microcytic Anemia Causes

Thalassemia and iron deficiency

Signup and view all the flashcards

Macrocytic Anemia Causes

Absence of folate or vitamin B12 and mild dysplastic syndrome

Signup and view all the flashcards

MCH (Mean Corpuscular Hemoglobin)

Calculated by dividing the total hemoglobin mass by the number of red blood cells in a blood volume.

Signup and view all the flashcards

MCHC (Mean Corpuscular Hemoglobin Concentration)

Calculated by dividing the hemoglobin by the hematocrit, defines anemia.

Signup and view all the flashcards

Hematocrit

The volume percentage of red blood cells in the blood.

Signup and view all the flashcards

RDW (Red Cell Distribution Width)

A measure that indicates the range of variation of RBC volume.

Signup and view all the flashcards

Causes of Anemia

Chronic diseases, Thalassemia trait, and Iron deficiency.

Signup and view all the flashcards

Chronic pancytopenia

A condition marked by reduced levels of red blood cells, white blood cells, and platelets.

Signup and view all the flashcards

Hypocellular bone marrow

Bone marrow with a deficiency of cellular components, leading to reduced blood cell production.

Signup and view all the flashcards

Normochromic, normocytic, hyporegenerative anemia

Term describes anemia characterized by normal cell size and hemoglobin content, but insufficient red cell production.

Signup and view all the flashcards

Low reticulocyte count

Low count of immature red blood cells, indicating reduced red blood cell production.

Signup and view all the flashcards

Neutropenia, not lymphopenia

Reduced numbers of neutrophils in the blood, but not lymphocytes.

Signup and view all the flashcards

Aberrant autoreactive T lymphocytes

T lymphocytes that mistakenly target and destroy an individual's own stem and progenitor cells.

Signup and view all the flashcards

Bone marrow failure

A condition where bone marrow function is compromised, leading to reduced output of blood cells.

Signup and view all the flashcards

Trilinear cytopenia

Condition where all three blood cell lines (red cells, white cells, and platelets) are reduced.

Signup and view all the flashcards

Monolinear cytopenia

A rare blood disorder where only one blood cell line is deficient.

Signup and view all the flashcards

Pure red blood cell aplasia

An acquired autoimmune condition characterized by the selective deficiency of red blood cells.

Signup and view all the flashcards

Myelodysplastic syndromes

Clonal disorders characterized by ineffective hematopoiesis and a risk of evolving into acute myeloid leukemia.

Signup and view all the flashcards

Gene therapy

Therapeutic approach that involves modifying genes within cells to treat diseases.

Signup and view all the flashcards

Ex-vivo gene therapy

A type of gene therapy where cells are modified outside the body and then reinfused.

Signup and view all the flashcards

Allogenic hematopoietic stem cell transplantation

Stem cells taken from a donor for transplantation into a patient.

Signup and view all the flashcards

Paroxysmal nocturnal hemoglobinuria (PNH)

Genetic mutations render hematopoietic cells susceptible to complement-mediated destruction

Signup and view all the flashcards

CAR-T cells

Genetically engineered T-lymphocytes used as a therapy to recognize and eliminate cancer cells.

Signup and view all the flashcards

Allotransplantation

Transplantation of cells from a donor to a patient, differing in genetic makeup.

Signup and view all the flashcards

Graft-versus-host disease (GvHD)

Immune reaction of the donor's immune cells against the recipient's tissues, causing damage.

Signup and view all the flashcards

Graft-versus-leukemia effect

Efficacy of donor lymphocytes in eradicating the recipient's cancer cells.

Signup and view all the flashcards

Suicide gene therapy

A therapy where a suicide gene is introduced into donor lymphocytes to eliminate them if GvHD occurs.

Signup and view all the flashcards

Chimeric Antigen Receptor (CAR)

A receptor engineered to recognize antigens on cancer cells, derived from antibodies, fused to T cell signaling domains.

Signup and view all the flashcards

Natural T cell receptor (TCR)

A normal T cell receptor made of alpha and beta chains that recognizes antigens presented by HLA molecules.

Signup and view all the flashcards

CAR-T cell target requirement

The molecules that must be on the surface of cancer cells for CAR-T cells to target them.

Signup and view all the flashcards

Antigen loss

A phenomenon where cancer cells evolve to lack the antigen targeted by CAR-T therapy, causing relapse.

Signup and view all the flashcards

Cytokine release syndrome (CRS)

Toxicity caused by the synchronous activation of CAR-T cells, leading to high levels of cytokines and systemic inflammation.

Signup and view all the flashcards

Neurotoxicity

Neurological complications resulting from CAR-T cell therapy, potentially life-threatening.

Signup and view all the flashcards

Tocilizumab

Monoclonal antibody against the IL-6 receptor, used to treat cytokine release syndrome.

Signup and view all the flashcards

CAR-T cell persistence

Ability of the T cells to persist in the body

Signup and view all the flashcards

CAR-T cell multi-specificity

An approach using multiple receptors on a single T cell to target two or more tumor antigens simultaneously.

Signup and view all the flashcards

Myeloproliferative Neoplasms (MPN)

Clonal myeloid neoplasms arising from genetic alteration in stem cells or early progenitors that lead to proliferation without blocking differentiation.

Signup and view all the flashcards

WHO MPN Classification

Disease categorized by Philadelphia chromosome presence (BCR-ABL1) or absence, indicating specific genetic mutations.

Signup and view all the flashcards

Philadelphia Chromosome

Acquired genetic defect resulting from translocation: involves fusion of BCR and ABL genes on chromosomes 9 and 22.

Signup and view all the flashcards

Bcr-Abl Tyrosine Kinase

Over-active enzyme, the product of Bcr-Abl translocation that induces autophosphorylation and substrate phosphorylation.

Signup and view all the flashcards

Imatinib (Gleevec)

Tyrosine Kinase Inhibitor, selectively targets Bcr-Abl, inducing apoptosis and altering CML's natural history.

Signup and view all the flashcards

BCR-ABL transcript monitoring

Quantitative PCR, molecular approach for detecting Bcr-Abl RNA, enabling sensitive disease monitoring and relapse prediction.

Signup and view all the flashcards

Chronic Phase of CML

Phase where CML is usually diagnosed; may involve constitutional symptoms and spleen enlargement.

Signup and view all the flashcards

CML Diagnostic Workup: CBC

Complete blood count with microscopic evaluation to assess cell counts, differentials, and identify immature precursors.

Signup and view all the flashcards

FISH (Fluorescent In Situ Hybridization)

Detects specific DNA sequences; useful for identifying Philadelphia chromosome, especially when translocation is minimal.

Signup and view all the flashcards

Conventional Cytogenetics

Analysis involving chromosome count in metaphases. Can identify Philadelphia chromosome but with lower sensitivity than FISH.

Signup and view all the flashcards

Thrombocytosis

A condition of abnormally high levels of platelets in the blood.

Signup and view all the flashcards

Second Level MPN Diagnostic

Evaluation involving cell counts, cytogenetics, FISH, and PCR to diagnose and assess disease characteristics.

Signup and view all the flashcards

Thrombohemorrhagic

Complications: Thromboembolic events and bleeding, particularly in essential thrombocythemia and polycythemia vera.

Signup and view all the flashcards

Budd-Chiari Syndrome

Splanchnic and hepatic vein thrombosis that can result in cirrhosis, splenomegaly, ascites, and portal hypertension.

Signup and view all the flashcards

General Thrombotic Risk Factors

Risk factors (hyperviscosity, leukocytosis) for this genetic defect are hypertension and hypercholesterolemia.

Signup and view all the flashcards

Erythropoietin (EPO) Test

Test that measures a hormone that regulates red blood cell production; assesses whether polycythemia is idiopathic or secondary.

Signup and view all the flashcards

Polycythemia Vera (PV) Diagnostic Criteria

It has hypercellularity in bone marrow and increased hemoglobin levels, potentially with a subnormal serum EPO level. 3 major criteria are needed.

Signup and view all the flashcards

Essential Thrombocythemia (ET) Diagnostic Criteria

Thrombocytosis in high range, bone marrow findings, and exclusion from other blood neoplasm criteria; involves JAK2 or CALR/MPL mutations.

Signup and view all the flashcards

Primary Myelofibrosis (PMF) Diagnostic Criteria

Megakaryocytic proliferation accompanied by reticulin or collagen fibrosis, plus needed criteria to diagnose this disease.

Signup and view all the flashcards

Gene Addition

Adding a therapeutic gene to replace a defective/missing gene or to introduce a new function.

Signup and view all the flashcards

Gene Subtraction

Inhibiting gene expression using RNAi or disrupting DNA sequences via genome editing.

Signup and view all the flashcards

Gene Correction

Modifying a mutated gene to restore it to its wild-type (normal) state.

Signup and view all the flashcards

Gene Therapy (Definition)

The use of gene-modified cells or vectors for therapeutic purposes in vivo.

Signup and view all the flashcards

Gene Transfer

Transferring/eliminating/correcting genetic material into a cell to gain a missing function.

Signup and view all the flashcards

Vectors

Tools used to insert or transfer genes of interest into cells (e.g., viral vectors).

Signup and view all the flashcards

Integrating Vectors

Viral vectors that integrate genes into the host cell's DNA for stable, long-term expression.

Signup and view all the flashcards

Non-integrating Vectors

Viral vectors that do not integrate into the host cell's DNA, resulting in transient gene expression.

Signup and view all the flashcards

Genome Editing Tools

Artificial molecules that induce DNA double-strand breaks at specific genomic locations.

Signup and view all the flashcards

Non-Homologous End Joining (NHEJ)

A method to induce gene disruption by a quick and dirty method of repairing double strand breaks.

Signup and view all the flashcards

Homologous Directed Repair (HDR)

A method to repair a DNA double-strand break by using a template to copy a sequence to completely repair the DNA

Signup and view all the flashcards

Base Editing

Editing DNA base by altering a single nucleotide without inducing double-strand breaks.

Signup and view all the flashcards

ADA-SCID

A severe combined immunodeficiency due to a deficiency in adenosine deaminase.

Signup and view all the flashcards

ERT with PEG-ADA

Enzyme replacement therapy for ADA-SCID using polyethylene glycol-modified ADA.

Signup and view all the flashcards

Retroviral Vector Integration

Retroviral vectors tend to integrate close to regulatory regions of the genome

Signup and view all the flashcards

Lentiviral Vector Integration

Lentiviral vectors tend to integrate far from the promoters in the genome

Signup and view all the flashcards

Lysosomal Storage Disease

Monogenic disorders caused by mutations of proteins localized in the lysosomal lumen

Signup and view all the flashcards

Study Notes

Gene Therapy Basics

  • Gene therapy is the manipulation of genes to treat, cure, or prevent human disorders, mainly focusing on hematopoietic stem cell-based approaches.
  • It involves using nucleic acids (DNA or RNA) to achieve a therapeutic effect.
  • Ex vivo gene therapy involves harvesting target cells from a patient, genetically modifying them in the lab, and re-infusing them to achieve a clinical effect through protein expression or lack thereof.

Gene Therapy Strategies

  • Gene addition involves adding a therapeutic gene to substitute for a defective or missing gene.
  • Gene addition can introduce a new gene, like CAR, to T lymphocytes.
  • Gene subtraction inhibits the expression or translation of a protein, using RNAi or antisense RNAs.
  • More efficient gene subtraction disrupts coding or regulatory DNA sequences via genome editing or modifies a gene's epigenetic context for silencing.
  • Gene correction modifies a mutated gene to transform it into the wild type, combining gene addition and subtraction in one manipulation.
  • Genome editing approaches such as homologous recombination, CRISPR editing, base editing, and prime editing facilitates this.
  • RNA approaches can also be used for gene correction to induce exon skipping.
  • Gene therapy involves using gene-modified cells or vectors in vivo for therapeutic purposes
  • Gene transfer refers to transferring, eliminating, or correcting genetic material in a cell to gain a missing function.
  • Gene transfer is largely used in research, while gene therapy is meant to be used to find therapies for diseases in a patient.

Gene Therapy Milestones and Vectors

  • Discovering and isolating disease-causing genes are crucial for effective gene therapy
  • Vectors are essential tools for inserting genes of interest into cells
  • Integrating vectors are used for stem cells to ensure long-term gene maintenance and expression in their progeny
  • Gamma retroviral vectors were first used, but lentiviral vectors are now preferred for integration due to high efficiency and integration profile
  • Lentiviral vectors can infect human cells and hematopoietic cells like CD4 T lymphocytes, monocytes, and macrophages such as HIV-1
  • Other vectors exist that are highly efficient transductors, but less able to integrate to HIV-1
  • Non-integrating vectors, such as adenoviral vectors or herpes virus, are currently used mainly in in-vivo gene therapy approaches
  • Non-viral approaches, like using transposons, are less efficient but much less expensive

Genome Editing Technology

  • Gene editing can be achieved using ZFNs, TALEN, and CRISPR, using artificial molecules composed of two moieties.
  • One moiety is designed to target a specific genomic DNA area.
  • The other moiety, a nuclease, induces a DNA double-strand break.
  • CRISPR-Cas9 uses RNA and a Cas9 protein.
  • The process involves a guide RNA complementary to the target genome region and a Cas9 protein inducing a DNA double-strand break
  • A Nobel prize was awarded for the development of CRISPR
  • Once double strand break, there are 3 outcomes
  • The cell cannot repair which means it would die
  • The second possibility, non-homologous end joining
  • The cell could copy an exact base using the other chromosome
  • The other chromosome makes an exact base that allows it to repair DNA by adding donor DNA template

DNA Repair Mechanisms

  • Following a DNA double-strand break, cells may undergo non-homologous end joining (NHEJ) a "quick and dirty" repair method that can disrupt gene function through insertions or deletions.
  • Homologous directed repair (HDR) is more precise but less efficient, using a donor DNA template with homologous flanking regions for gene correction
  • Genome editing technology allows for gene disruption via NHEJ or gene correction via HDR, moving gene therapy towards gene substitution and biological function alteration.
  • Base editing involves modifying multiple genes at the same time with high precision
  • Inducing simultaneous DNA double-strand breaks in different chromosomes poses translocation risks.
  • Base editing achieves gene disruption without double-strand breaks, using Cytosine Base Editors (CBE) or Adenine Base Editors (ABE) to change single bases
  • While base editing is cleaner, it cannot currently perform gene correction

Ex-vivo Gene Therapy Procedure

  • Ex vivo gene therapy typically involves harvesting hematopoietic stem cells due to their accessibility.
  • HSCs are harvested and then isolated, cultured, and exposed to genome editing tools before being re-infused into the patient.
  • HSCs will distribute themselves in bone marrow niches
  • The procedure could involve leukapheresis and IV infusions
  • This can treat numerous diseases except those in which there is the need to target cells not in the hematopoietic system
  • Vectors can be designed to target certain tissue which started with the liver.

Clinical Achievements in Gene Therapy

  • Retroviral vectors can be used to treat primary immunodeficiencies like ADA-SCID, WAS, X-SCID and chronic granulomatosis disease
  • Lentiviral vectors can also be used to treat Beta Thalassemia and Sickle Cell Disease and correct phenotype
  • Retroviral and Lentiviral vectors can be used to treat adoptive cancer immunotherapy, ALL, B lymphoma, MM
  • Editing ZFNs, TALEN and CRISPR can be used in HIV infection and CCR5 disruption
  • AAV has been used in the eye like Leber’s Congenital Amaurisis
  • AAV, Cas 9 and liver are used in Transthyretin Amyloidosis
  • Oncolytic viruses are use as gene therapy for cancer.

HSC and Gene Therapy History

  • 1957 saw the first allogenic transplants
  • 1992 saw the hematopoietic stem cell based gene therapy for ADA-SCID, using retroviral vectors.

Severe Combined Immunodeficiency (SCID)

  • Severe combined immunodeficiency (SCID) is a primary immunodeficiency involving alterations in adaptive and/or innate immunity development and function
  • SCID leads to heightened infection susceptibility, autoimmunity risk, and increased cancer risk
  • ADA-SCID is an exemple as its defect impacts both B and NK cells
  • Gene alteration can be on T cells, Perforin or CD40
  • Then Hematopoietic stem cell based gene therapy is used
  • HSC gene therapy is used because patients have active infections from allogenic transplantation with HSC

HSC Gene Therapy Overview

  • HSC gene therapy follows strict rules as part of the Advanced Therapy Medicinal Product (ATMP) group, which includes cell and tissue engineering
  • The Process inolves mobilization/harvest of bone marrow followed by CD34 selection.
  • Afterwards perform transduction and then infuse the cells fresh, test using quality controll to ensure quality of the product.

ADA-SCID

  • ADA-SCID causes a defect that accumulates toxic metabolites that impair immunity and lead to organ alterations.
  • ERT with PEG-ADA requires weekly injections and may provide inadequate immune reconstitution
  • Using Stem cells with wt adenosine are a big factor to help

ADA Treatment.

  • Long-Term Enzyme replacement helps
  • Allogeneic transplant could be alternative
  • Genetic therapy is also help
  • ADA genetic therapy began 1995
  • Systemized in that patient has high number of blood cells.
  • Since 2000 the over all survivle is 100% for those treated patients.

HSC - Clinical

  • Gamma retroviral were abandon
  • For other diseases,retro transformation caused stem cell to tranform
  • Translocation usually happens, this means random for every trans cell.
  • Vector have own integration, where the regulatory and promoters meet to make more genes and proteins

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Quiz Team

Related Documents

More Like This

K1-Hematopoiesis dan Sel Darah
10 questions
Blood Composition and Cell Formation
32 questions
Hematology: Blood Composition and Function
40 questions
Use Quizgecko on...
Browser
Browser