Immunologically-mediated Disease

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Questions and Answers

Which of the following best describes the relationship between basic immunological principles and immunopathology?

  • Basic immunological principles are irrelevant to the understanding of immunopathology.
  • Immunopathology operates under a completely different set of immunological principles than normal immunity.
  • The same principles and components applicable to normal immunity also apply to immunopathology. (correct)
  • Immunopathology selectively utilizes a subset of immunological principles unrelated to normal immune responses.

In immunology, what does 'tolerance' primarily signify?

  • The immune system's ability to reject foreign invaders aggressively.
  • The immune system's heightened response to self-antigens.
  • The immune system's indiscriminate attack on both self and foreign antigens.
  • The immune system's state of unresponsiveness to self-antigens. (correct)

During which life stage is immunological tolerance most readily developed?

  • Adulthood
  • Infancy
  • Old age
  • Fetal life (correct)

Which of the following is an example of central tolerance?

<p>Immunogen-induced apoptosis of IgM-expressing B cells. (C)</p> Signup and view all the answers

What is the primary mechanism behind peripheral tolerance?

<p>Immunogen-induced anergy in the absence of costimulation. (B)</p> Signup and view all the answers

Which cell type is associated with the induction of tolerance in the gut?

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

How does the thymus contribute to immunological self-tolerance?

<p>By expressing tissue-specific proteins. (B)</p> Signup and view all the answers

What is a key distinction between autoimmunity and autoimmune disease?

<p>Autoimmunity is a response to self-antigens, while autoimmune disease involves clinical symptoms and pathology. (B)</p> Signup and view all the answers

Which of the following is considered a possible mechanism for the development of autoimmune disease?

<p>Failure to delete an autoreactive clone by the thymus or bone marrow. (A)</p> Signup and view all the answers

Which of the following is a general characteristic of autoimmune diseases?

<p>They are often HLA-associated. (D)</p> Signup and view all the answers

Autoimmunity can involve which aspect of the adaptive immune response?

<p>Humoral and cell-mediated responses (A)</p> Signup and view all the answers

What is thought to be a key factor by some researchers regarding autoimmunity?

<p>Th17 cells. (B)</p> Signup and view all the answers

What term defines the normal immune response to a foreign antigen from the same species?

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

Which of the following is a clinically significant alloantigen system?

<p>All of the above (D)</p> Signup and view all the answers

In the context of maternal-fetal alloimmunity, which alloantigen system is most commonly associated with alloimmune disease of the newborn?

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

What is the primary mechanism of action of Rho(D) Immune Globulin (RhoGAM) in preventing maternal-fetal alloimmunity?

<p>It binds to fetal Rh-positive red blood cells in the maternal circulation and prevents the mother's immune system from recognizing them (A)</p> Signup and view all the answers

Which of the following blood components is NOT considered a blood product?

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

Besides transfusions, which other allograft mentioned can cause alloimmunity?

<p>Skin and Bone Marrow (B)</p> Signup and view all the answers

Which of the following is associated with hyperacute organ rejection?

<p>Pre-exisiting antibody (B)</p> Signup and view all the answers

Which of the following best describes the mechanism of acute organ rejection?

<p>T Cell mediated (B)</p> Signup and view all the answers

What is a component of chronic organ rejection?

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

What is a hallmark of Cyclosporine A?

<p>Inhibits T Cell proliferation (B)</p> Signup and view all the answers

How Steroids cross the cell mebrane?

<p>Steroids cross the cell membrane and bind to the steroid receptor complex (D)</p> Signup and view all the answers

Which of the following is a recognized side effect of GC (Glucocorticoid) therapy?

<p>HPTA (Hypothalamic–pituitary–adrenal axis) insufficiency (C)</p> Signup and view all the answers

When classifiying an Immunologically-mediated disease, what are the key things to assess?

<p>Source of the Antigen, Mechanism, Clinical presentation (A)</p> Signup and view all the answers

What is a shared characteristic of all four types of hypersensitivity reactions (Coombs and Gell classification)

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

What is the immunological definition of allergy?

<p>Immunologically-mediated tissue damage. (A)</p> Signup and view all the answers

In the context of allergy, what does 'sensitization' refer to?

<p>The process of immunization against an allergen, leading to an immune response. (D)</p> Signup and view all the answers

Which of the following is an example of a pharmacological effect that is an expected reaction when administering drugs?

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

Which hypersensitivity type is associated with IgE?

<p>Type I hypersensitivity (C)</p> Signup and view all the answers

What is a classic symptom caused by release of products from Mast Cell Degranulation?

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

What is the mechanism of damage for Type II Cytotoxic Allergy?

<p>Complement activation by IgG and IgM (D)</p> Signup and view all the answers

What is a hallmark of Type III: Immune Complex Disease?

<p>It involves the deposition of immune complexes in tissues. (D)</p> Signup and view all the answers

Which cells can be considered Immune Effectors for Type IV: Cell-mediated Allergy

<p>CD4+ T Cells (D)</p> Signup and view all the answers

A skin test for tuberculosis is considered what type of hypersensitivity reaction?

<p>Type IV hypersensitivity (B)</p> Signup and view all the answers

To establish tolerance as a clinical goal, which therapeutic intervention is commonly pursued?

<p>Therapy of allergy. (A)</p> Signup and view all the answers

Which of the following is a characteristic of central tolerance?

<p>Immunogen-induced apoptosis of IgM-expressing B cells. (C)</p> Signup and view all the answers

What is the primary mechanism behind peripheral tolerance involving T cells?

<p>Immunogen-induced anergy in the absence of costimulation. (B)</p> Signup and view all the answers

Which type of immune cells are typically associated with inducing tolerance in the gut?

<p>Regulatory T cells. (B)</p> Signup and view all the answers

What is an notable characteristic of autoimmunity?

<p>It involves an immune response directed against self-antigens. (B)</p> Signup and view all the answers

Which event is considered a possible mechanism for the development of autoimmune disease?

<p>Failure to delete an autoreactive clone by the thymus or bone marrow. (B)</p> Signup and view all the answers

Which of the following is often associated with autoimmune diseases?

<p>Being HLA-associated. (B)</p> Signup and view all the answers

Alloimmunity is best described as an immune response directed against:

<p>Foreign antigens from the same species. (C)</p> Signup and view all the answers

Which of the following alloantigen systems is most clinically significant in the context of blood transfusions?

<p>ABO Blood Groups. (D)</p> Signup and view all the answers

In maternal-fetal alloimmunity, which alloantigen system is most commonly associated with alloimmune disease of the newborn?

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

The primary mechanism by which Rho(D) Immune Globulin (RhoGAM) prevents maternal-fetal alloimmunity is:

<p>Neutralizing fetal RhD-positive red blood cells in the maternal circulation. (D)</p> Signup and view all the answers

Apart from transfusions, which other allograft can cause alloimmunity?

<p>Organ transplant. (A)</p> Signup and view all the answers

Hyperacute organ rejection primarily involves:

<p>Pre-existing antibodies. (B)</p> Signup and view all the answers

Acute organ rejection is mainly mediated by:

<p>T cells responding to MHC differences. (D)</p> Signup and view all the answers

Chronic organ rejection is characterized by which factor?

<p>Antibody-mediated damage and fibrosis. (D)</p> Signup and view all the answers

How does Cyclosporine A (CsA) exert it's effects?

<p>Blocking T cell proliferation. (D)</p> Signup and view all the answers

How do Glucocorticoids (Steroids) cross the cell membrane?

<p>By passive diffusion. (C)</p> Signup and view all the answers

Which of the following is a known side effect of Glucocorticoid (GC) therapy?

<p>HPTA insufficiency. (B)</p> Signup and view all the answers

When an immunologically-mediated disease is classified, what are the key things to assess?

<p>Source of the antigen, mechanism (Coombs &amp; Gell Types I-IV) and clinical manifestation. (D)</p> Signup and view all the answers

What is a key pathological aspect shared among Type I, III, and IV hypersensitivity reactions?

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

Which situation is best described as Allergy?

<p>When there's immunologically-mediated tissue damage. (B)</p> Signup and view all the answers

What immunological event does 'sensitization' specifically refer to in Type I allergy?

<p>The first exposure to an allergen, leading to IgE production. (D)</p> Signup and view all the answers

Which event corresponds to a pharmacological effect that is expected and predictable but not allergic?

<p>Gastric irritation from NSAIDs. (B)</p> Signup and view all the answers

In Type I hypersensitivity, what specific antibody isotype is primarily involved?

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

In the context of type I hypersensitivity allergic response, what is the role of histamine?

<p>Increases vascular permeability. (A)</p> Signup and view all the answers

What is the main mechanism of cell damage in Type II cytotoxic hypersensitivity reactions?

<p>Antibody-dependent cell-mediated cytotoxicity (ADCC). (D)</p> Signup and view all the answers

Which factor characterizes Type III immune complex hypersensitivity reactions?

<p>Antigen-antibody complexes. (A)</p> Signup and view all the answers

Which type of cells are immune effectors during Type IV: Cell-mediated Allergy?

<p>Helper T cells. (C)</p> Signup and view all the answers

A positive result in a contact dermatitis test indicates which specific type of hypersensitivity reaction?

<p>Type IV. (A)</p> Signup and view all the answers

What are the three main characteristics of Alloimmunity?

<p>Transfusion-reactions, organ-rejections, and maternal-fetal alloimmunity. (B)</p> Signup and view all the answers

Name the three main organ rejections types

<p>Hyperacute, Acute, and Chronic (E)</p> Signup and view all the answers

The mechanism of action Cyclosporine-A involves?

<p>Attenuating T-Cell Receptor signaling. (A)</p> Signup and view all the answers

What is a result of taking steroids?

<p>All of the above (E)</p> Signup and view all the answers

What is the key aspect of Central Tolerance

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

How does the concept of immunological 'Specificity' apply in the context of immunopathology?

<p>It ensures that the immune response is directed precisely against the etiologic agent or specific self-antigen involved in the disease. (B)</p> Signup and view all the answers

In the context of immunological tolerance, how does the timing of antigen exposure influence tolerance induction?

<p>Tolerance is most effectively developed during fetal life due to the relative immaturity of the immune system. (D)</p> Signup and view all the answers

Which of the following is a critical difference between central and peripheral tolerance?

<p>Central tolerance mainly involves physical elimination of self-reactive lymphocytes during development, while peripheral tolerance involves mechanisms that suppress or inactivate self-reactive lymphocytes in the circulation. (A)</p> Signup and view all the answers

How do genetic factors contribute to the development of autoimmune diseases?

<p>Specific genes, like those in the HLA complex, increase susceptibility to autoimmunity but do not guarantee disease development. (D)</p> Signup and view all the answers

How does molecular mimicry potentially initiate autoimmune disease?

<p>By presenting foreign antigens that are nearly identical to self-antigens, leading to cross-reactive immune responses. (A)</p> Signup and view all the answers

Why is it difficult to avoid immunogen exposure and manage therapy in autoimmunity?

<p>Because the specific self-antigen driving the autoimmune response is often unknown or impossible to eliminate. (B)</p> Signup and view all the answers

Which concept is important regarding HLA-associated diseases?

<p>In autoimmune diseases, most cases are HLA-associated (D)</p> Signup and view all the answers

What characterizes alloantigens?

<p>They are normal antigens from the same species that provoke an immune response. (D)</p> Signup and view all the answers

How does prior sensitization in multiply transfused patients affect their risk of transfusion reactions:

<p>It dramatically increases the risk of transfusion reactions due to the presence of pre-formed antibodies. (A)</p> Signup and view all the answers

What is the immunological basis of hyperacute organ rejection?

<p>A pre-existing antibody response against donor HLA antigens, leading to immediate complement activation and vascular damage. (C)</p> Signup and view all the answers

What is the mechanism of action of Cyclosporine A (CsA) and what pathway does it inhibit?

<p>CsA inhibits the TCR signaling pathway leading to IL-2 expression, preventing T cell activation. (C)</p> Signup and view all the answers

What are some of the effects of Glucocorticoids?

<p>They cross the cell membrane and induce immunosuppression, thus reducing T and B lymphocyte activity and cytokine production. (C)</p> Signup and view all the answers

Why does type II hypersensitivity not involve inflammation?

<p>The mechanism involves cell destruction without directly stimulating inflammation, thus, it does not involve specific inflammatory pathways. (D)</p> Signup and view all the answers

In the classification of immunologically-mediated diseases, what factors are important to consider?

<p>The source of the antigen (self, allo, or environmental) and the effector mechanism involved are the main factors. (C)</p> Signup and view all the answers

In Type I hypersensitivity, how does the allergen cause mast cell and basophil activation?

<p>The allergen binds to IgE antibodies already bound to Fc receptors on mast cells and basophils, causing cross-linking of the receptors and subsequent activation. (C)</p> Signup and view all the answers

Which of the following is a primary objective when studying immunologically-mediated diseases?

<p>To summarize how basic immunological principles relate to immunopathology. (D)</p> Signup and view all the answers

In what scenario does the actual immune response typically result in damage to the host?

<p>Due to the inflammatory response to the etiologic agent. (D)</p> Signup and view all the answers

How are immunologically-mediated diseases classified, considering the source of the offending antigen?

<p>Based on whether the antigen is self (autoimmune), non-self from the same species (alloimmune), or from the environment (allergy). (A)</p> Signup and view all the answers

What is the meaning of tolerance in the context of immunology?

<p>The active process where the immune system does not reject self. (D)</p> Signup and view all the answers

During which period is immunological tolerance most effectively developed?

<p>Fetal life, as the immune system is learning to distinguish self from non-self. (B)</p> Signup and view all the answers

What would be the result of immunogen-induced apoptosis of double-positive T cells?

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

What is the outcome of immunogen-induced anergy in the absence of costimulation, in regards to the Mechanisms of Tolerance?

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

Regulatory T cells (Tregs) inhibit autoimmune cell function by what mechanism?

<p>They produce primarily immunosuppressive cytokines. (D)</p> Signup and view all the answers

What is a fundamental feature that distinguishes autoimmunity from autoimmune disease?

<p>Autoimmunity can occur in healthy individuals without causing disease, whereas autoimmune disease involves inflammation and tissue damage. (C)</p> Signup and view all the answers

Which is a possible mechanism in the development of autoimmune disease?

<p>Failure of tolerance (B)</p> Signup and view all the answers

Which of the following is a shared trait among HLA-associated autoimmune diseases?

<p>They demonstrate a strong association to autoimmune disorders. (C)</p> Signup and view all the answers

What is a significant challenge in treating autoimmune diseases?

<p>The immunogen and underlying cause are often unknown, leading to suboptimal therapy. (B)</p> Signup and view all the answers

How can autoimmunity involve the adaptive immune response?

<p>It can involve either humoral or cell-mediated. (C)</p> Signup and view all the answers

What is the proper definition of alloimmunity?

<p>Normal immune response to a foreign antigen to the same species. (C)</p> Signup and view all the answers

What are the three clinically significant alloantigen systems?

<p>ABO, Rh, HLA (B)</p> Signup and view all the answers

What is the Rh alloantigen systems associated with in maternal-fetal alloimmunity?

<p>The mom is Rh-negative and the baby is Rh-positive. (C)</p> Signup and view all the answers

What is the primary reason of using Rho(D) Immune Globulin to prevent maternal-fetal alloimmunity?

<p>It prevents the development of immune memory. (B)</p> Signup and view all the answers

What is an example of alloimmunity outside of blood transfusions?

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

What is the primary mechanism of hyperacute organ rejection?

<p>Pre-existing antibodies (B)</p> Signup and view all the answers

What is the main mechanism of acute organ rejection?

<p>T cell response recognizing MHC. (A)</p> Signup and view all the answers

A hallmark of chronic organ rejection is...

<p>Antibody-mediated damage. (A)</p> Signup and view all the answers

How does Cyclosporine A (CsA) function as an immunosuppressant?

<p>It blocks the TCR signaling pathway. (D)</p> Signup and view all the answers

What is a recognized clinical application of glucocorticoids?

<p>Inhibition of cell division (A)</p> Signup and view all the answers

What is a known side effect of prolonged glucocorticoid therapy?

<p>Muscle atrophy. (D)</p> Signup and view all the answers

What factors are key when classifying an immunologically-mediated disease?

<p>Source of the antigen and mechanism. (C)</p> Signup and view all the answers

How does an expected pharmacological effect differ from an allergic reaction?

<p>Pharmacological - A consistent dose (C)</p> Signup and view all the answers

What is the underlying mechanism for Type I hypersensitivity reactions (immediate hypersensitivity)?

<p>IgE mediated. (B)</p> Signup and view all the answers

Type II hypersensitivity reactions involve which process.

<p>In the spleen. (D)</p> Signup and view all the answers

Immune complexes being deposited in the blood is characteristic of _________.

<p>Type III: Immune Complex Disease (C)</p> Signup and view all the answers

Which is an immune effector in a Type IV: Cell-mediated Allergy?

<p>CD8+ T Cells (C)</p> Signup and view all the answers

What is the correct order of events?

<p>Central Tolerance -&gt; Peripheral Tolerance -&gt; Autoimmunity (A)</p> Signup and view all the answers

What is the relation between IFNy and Th17 cells when discussing autoimmunity?

<p>Found that in IFNy deficient mice increased incidence of certain autoimmune diseases and Th17 cells found to be key in these responses (A)</p> Signup and view all the answers

Tolerance in mature immunogen responsive cells induces what cells?

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

What mechanisms are in place to perform immunological self-tolerance?

<p>Induction of anergy in autoreactive B and T cells (D)</p> Signup and view all the answers

The complement MAC complex inserts and causes cell death, while ADCC is an antibody driven cellular toxicity, which is the most relevant antibody?

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

How does the allergen cause mast cell and basophil activation?

<p>The cross linking of IgE (C)</p> Signup and view all the answers

Which of the following is correct regarding clinical uses of drugs and what they cause?

<p>A side effect has a pharmacological efffect, usually in a most patients at a usual dose. (D)</p> Signup and view all the answers

Which of the following is a key characteristic that distinguishes the ideal immune response from an actual immune response?

<p>The ideal immune response is completely protective, with no host tissue damage. (C)</p> Signup and view all the answers

Under what circumstance might it be difficult to differentiate between protective immunity and immunologically-mediated disease?

<p>When they are part of the same process, as normal immune responses can resemble abnormal ones. (B)</p> Signup and view all the answers

When classifying immunologically-mediated diseases, what is considered as the source of the antigen?

<p>Autoimmune, Alloimmune, or Allergic (A)</p> Signup and view all the answers

In the context of classifying immunologically-mediated diseases, what does the 'Mechanism' refer to?

<p>The immunological pathway, such as IgE-mediated or cell-mediated, involved in the disease. (A)</p> Signup and view all the answers

What does immunological tolerance primarily prevent?

<p>Rejection of self-antigens. (D)</p> Signup and view all the answers

During which stage of life is immunological tolerance most readily developed?

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

What event occurs because of immunogen-induced apoptosis of double-positive T cells, in regards to Central Tolerance?

<p>Elimination of self-reactive T cells. (D)</p> Signup and view all the answers

What would be the result of immunogen-induced anergy in the absence of costimulation, in regards to Peripheral Tolerance?

<p>The T cell becomes unresponsive. (B)</p> Signup and view all the answers

Which T helper cell subset is known to inhibit autoimmune cell function by producing immunosuppressive cytokines?

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

What characteristic distinguishes autoimmunity from autoimmune disease?

<p>The presence of clinical symptoms and tissue damage. (B)</p> Signup and view all the answers

Failure to adequately delete autoreactive clones can lead to what event?

<p>Development of autoimmune disease (D)</p> Signup and view all the answers

In the context of general characteristics of autoimmune disease, what best describes the cause?

<p>Multifactorial involving genetics, sex, epigenetics and environment (A)</p> Signup and view all the answers

What type of immune response does autoimmunity characteristically involve?

<p>Humoral and/or cell mediated adaptive immunity is possible (A)</p> Signup and view all the answers

In the context of alloimmunity, which alloantigen system is of greatest concern?

<p>ABO Blood Groups, Rh Blood Types, HLA Complex (MHC Complex) (C)</p> Signup and view all the answers

What is the primary reason for using Rho(D) Immune Globulin in maternal-fetal alloimmunity?

<p>To prevent the mother from developing antibodies against fetal RhD antigens (B)</p> Signup and view all the answers

Apart from blood transfusions, which clinical can cause alloimmunity response?

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

A hallmark of chronic organ rejection involves what?

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

How does Cyclosporine-A function when used during transplants?

<p>Inhibits TCR signaling pathway leading to (C)</p> Signup and view all the answers

Which of the following situations is best described as allergy?

<p>Immunologically-mediated tissue damage (C)</p> Signup and view all the answers

What immunological event does 'sensitization' specifically refer to?

<p>Inducing an immune response when exposed to drugs (D)</p> Signup and view all the answers

A pharmacological effect that is expected and predictable corresponds to:

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

In Type I hypersensitivity, what is the role of histamine after Mast Cell Degradulation?

<p>Increase vascular permeability and cause smooth muscle contraction (C)</p> Signup and view all the answers

Complement activation by is by IgG or IgM , and ADCC, is a result of:

<p>Type II: Cytotoxic Allergy (D)</p> Signup and view all the answers

In the context of type IV hypersensitivity reactions, what is the primary role of $CD4^+$ T cells?

<p>Promoting inflammatory response by Macs (A)</p> Signup and view all the answers

Which of the following mechanisms is involved in immunological self-tolerance?

<p>All of the Above (D)</p> Signup and view all the answers

What is a result of Type II: Cytotoxic Allergy, that targets blood cells?

<p>anemia, neutropenia, thrombocytopenia (B)</p> Signup and view all the answers

To provide clinicians with more appropriate and specific therapies for auto-immune diseases, what is a primary objective when studying immunologically-mediated diseases?

<p>Understanding which specific immune responses and malfunctions of components can affect the host for a give Immunologically-mediated diseases (C)</p> Signup and view all the answers

Complete this senetence: 'Establishment of tolerance as a clinical goal...'

<p>...requires therapy of allergy and allografs (B)</p> Signup and view all the answers

Bacterial endocarditis, Mixed cryoglobulinemia, Systemic lupus erythematosus all have what in common?

<p>Immune-complex disease (type III) (C)</p> Signup and view all the answers

Type 1 diabetes (insulin-dependent diabetes mellitus), Rheumatoid arthritis and Multiple sclerosis are what T-cell mediated diseases?

<p>T cell-mediated disease (type IV) (A)</p> Signup and view all the answers

Which of the following would be the next immediate step after the MAC complex inserts into the target membrane?

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

An Idiosyncrasy is described as:

<p>Pharmacological, unexpected, usual dose, few patients (C)</p> Signup and view all the answers

The establishment of allografts have the following in store:

<p>Establishment of tolerance as a clinical goal (C)</p> Signup and view all the answers

In the context of immunologically-mediated tissue damage, how does an allergic response fundamentally differ from a normal immune response?

<p>Allergic responses are detrimental and cause tissue damage, whereas normal responses are protective and resolve the threat. (A)</p> Signup and view all the answers

Which scenario exemplifies how the typical immune response leading to allograft rejection differs from graft-versus-host disease (GVHD)?

<p>Allograft rejection involves the recipient's immune cells attacking the graft, whereas GVHD involves the graft's immune cells attacking the recipient's tissues. (C)</p> Signup and view all the answers

If a patient exhibits symptoms indicative of an adverse drug reaction, which factor would suggest the reaction is an 'idiosyncrasy' rather than a 'side effect'?

<p>The reaction is unexpected and occurs in only a small subset of patients at the typical dosage. (C)</p> Signup and view all the answers

In a Type I hypersensitivity reaction, what is the immunological basis for why cross-linking of IgE antibodies is required to initiate mast cell degranulation?

<p>Cross-linking of IgE molecules bound to the Fce receptors on mast cells triggers receptor aggregation and downstream signaling pathways for degranulation. (D)</p> Signup and view all the answers

How does the mechanism of tissue damage in Type II hypersensitivity (cytotoxic) reactions differ fundamentally from that in Type I, III, and IV hypersensitivity reactions?

<p>Type II hypersensitivity involves direct cell lysis or antibody-dependent cell-mediated cytotoxicity (ADCC), while Types I, III, and IV primarily involve inflammation (A)</p> Signup and view all the answers

In Type III hypersensitivity reactions, also known as immune complex diseases, what is the primary mechanism driving tissue damage, and where does this process typically localize?

<p>Deposition of antibody-antigen complexes in small blood vessels, leading to complement activation and inflammation (C)</p> Signup and view all the answers

How do Th1 and Th17 cells contribute differently to the pathogenesis of immunologically-mediated tissue damage?

<p>Th1 cells promote macrophage activation and cell-mediated immunity, while Th17 cells recruit neutrophils and enhance inflammation (B)</p> Signup and view all the answers

Central tolerance primarily involves the elimination of autoreactive lymphocytes during immune cell development. Which process exemplifies this mechanism?

<p>Immunogen-induced apoptosis of double-positive T cells in the thymus. (C)</p> Signup and view all the answers

Under what circumstances would a clinician consider establishing tolerance as a primary clinical goal?

<p>In the management of allergy or to ensure the survival of allografts. (A)</p> Signup and view all the answers

In clinical settings, which treatment strategy is most aligned with the objective of inducing peripheral tolerance?

<p>Blocking costimulatory signals to induce anergy in self-reactive T cells. (A)</p> Signup and view all the answers

What is the mechanism that leads to tolerance within the gut?

<p>Through regulatory T cells, CD103+ dendritic cells, and the production of IL-10. (B)</p> Signup and view all the answers

What triggers hyperacute rejection?

<p>Preexisting antibodies in to the donor's blood group. (D)</p> Signup and view all the answers

If a patient has chronic organ rejection, what is a known hallmark?

<p>Antibody mediated damage. (A)</p> Signup and view all the answers

Cyclosporine A acts on what pathway?

<p>TCR signaling pathway that leads to IL-2 Expression. (D)</p> Signup and view all the answers

What is the MOA (mechanism of action) for Glucocorticoids (Steroids)?

<p>It enters into DNA and alters the expression of genes. (C)</p> Signup and view all the answers

Flashcards

Immunologically-mediated Disease

Diseases where the immune system causes damage to the body.

Loss of Tolerance

Loss of the ability to ignore self-antigens.

Alloimmunity

Normal immune response against foreign antigen from the same species.

Alloantigens

Antigens that vary genetically between individuals of the same species.

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Allergy

IgE-mediated hypersensitivity to environmental antigens.

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Tolerance in immunology

The body not attacking itself.

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Fetal life tolerance

Tolerance is more readily developed during this time.

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Central Tolerance

Apoptosis of T and B cells that react strongly to self-antigens.

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Peripheral Tolerance

Anergy if no co-stimulation.

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Induction of tolerance

Process by which the immune system is confronted with self-antigens.

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Alloimmunity clinical significance

Pregnancy, transfusion and transplantation.

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maternal/fetal alloimmunity

Where the mother reacts to fetal alloantigens.

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Hyperacute organ rejection

Pre-existing antibodies against donor antigens.

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Acute organ rejection

T cells recognize donor MHC molecules as foreign.

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Chronic organ rejection

Antibody and cell-mediated damage to the graft over time.

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Graft-versus-host disease

Transplanted immune cells attack the recipient's tissues.

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Cyclosporine A

Inhibits T cell signaling pathway leading to IL-2 expression.

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Corticosteroids

Binds steroid receptors, modifies gene transcription and reduces inflammation.

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Side effect

Pharmacological effect that is expected at a usual dose.

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Direct toxicity

Pharmacological dose that results in high exposure to the drug.

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Idiosyncrasy

Pharmacological unexpected reaction.

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Allergy (Hypersensitivity)

An immunological unexpected reaction.

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Type I Allergy

IgE response to common environmental antigens.

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Type II Allergy

IgG or IgM mediated-Cell lysis.

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Type III Allergy

Immune-complex mediates deposits and inflammation.

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Type IV Allergy

Cell-mediated, Th1 or Th17 response with inflammation.

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Immunopathology

Study of diseases resulting from abnormal immune responses.

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Diversity (Immunology)

Ability to respond to a wide variety of antigens.

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Immunologic Memory

The immune system remembers past encounters, allowing for quicker responses.

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Termination of Immune Response

Process of stopping an immune response.

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Ideal Immune Response

An immune response directed only against harmful invaders.

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Actual Immune Response

Immune response resulting in damage to the host.

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Iatrogenic Response

Therapy induces adverse immune reaction.

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Immunological Classification

Classifying disease by antigen source: self, same species, or environmental.

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Disease Mechanism

Classifying by mechanism (I-IV): IgE, cytotoxic, complex, cell-mediated

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Tolerance acquisition

Not inherited; acquired by active response, most readily during fetal life.

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Central T Cell Tolerance

Apoptosis of immature T cells in the thymus due to self-recognition.

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Central B Cell Tolerance

Immature B cells undergo apoptosis self-recognition in bone marrow.

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Immunogen-induced anergy

Anergy induced due to a lack of co-stimulation.

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Specific Suppressive Cells

Specific cells suppress autoimmunity via immunosuppressive cytokines.

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M Cells

M cells that take up antigen in gut

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Gut Dendritic Cells

Gut dendritic cell taking up antigen.

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Normal Autoimmunity

Occurs in everyone, role in abnormal cell destruction.

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Effect of Autoimmunity

Not an autoimmune disease, cause of inflammation and tissue damage.

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Autoimmune Disease Mechanisms

Failure to delete autoreactive clones or breakdown of tolerance.

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Autoimmune Disease Characteristics

Multi-factorial causes, associated with HLA genes.

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Anti-idiotypic antibodies

Occurs in anyone

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Normal alloimmunity

Normal immune response to same species antigens.

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Isoantigens

Alloantigen nomenclature

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Alloantigen Systems

RBC antigen systems with clinical significance.

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Pregnancy alloimmunity

Occurs when the mother's immune system reacts to fetal antigens.

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RhoGAM

Maternal anti-Rh antibodies prevent sensitization in future pregnancies.

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Transfusion Reactions

Reactions to blood products; ABO, Rh, HLA mismatches.

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Blood Derivatives

Blood products containing cells, proteins, and clotting factors.

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Transplantation

Organ rejection: HLA complex

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Immunosuppressants

Treatment for allogenic reactions

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Cyclosporine immunosuppressant

Lacks overt myelotoxicity

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T Lymphocyte Effects

Reduces expression of IL-2/3/4/GM-CSF/TNF-a

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B Lymphocyte inhibition

Reduces expression of IL-2

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Immune-complex disease

Rheumatoid factor IgG complexes

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Steroids on Mast Cells

Blocks release from mast of cytokines

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Hypersensitivity Type 1 reactions

Drug reaction: immunological, unexpected, usual dose

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Cytotoxic reaction

Memory reaction of IgG or IgM

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Cytotoxicity

Autoimmune in cells

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Immune response

CD49s/CD 29 or VLA-4

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Immediate allergic response:

IgE response from environmental antigen

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Cell receptor reaction

Requires IgE and is polyvalent

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Activation of cell release

Causes degranulation of cells

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Study Notes

Immunologically-mediated Disease

  • Objectives include: describing immunological abnormalities, summarize basic immunological principles related to immunopathology, comparing ideal vs. actual immune response, and listing parameters to classify immunologically-mediated disease.

Immunological Abnormalities

  • It is possible to define deficiency through knowledge of physiological function relating to immunological deficiency disorders
  • A function of the immune system is to prevent neoplastic growth when the host is immunocompromised

Actual Immune Response

  • It is not always easy to distinguish between protective immunity and immunologically-mediated disease because they are often part of the same process
  • Adverse effects that result in damage to the patient include: the etiologic agent before immunity or deficiency, inflammatory or immune response to agent, autoimmunity against self-antigens, and iatrogenic meaning adverse response to therapy

Mechanisms of Tolerance

  • Central Tolerance involves immunogen-induced apoptosis of double-positive T cells and IgM-expressing B cells
  • Peripheral Tolerance involves immunogen-induced anergy in absence of co-stimulation
  • The induction of tolerance in mature cells can include oral tolerance through regulatory T cells to proteins using CD103+ dendritic cells in the gut from high dose tolerance to aqueous proteins
  • Gut induction: M Cells process antigen and is taken up by gut dendritic cells which then then travel to mesenteric lymph nodes to make IL-10 and thus favor Treg development
  • Specific suppressive cells (Treg, M2 macrophages and Nkreg cells) exist that produce immunosuppressive cytokines

General Characteristics of Autoimmune Disease

  • Autoimmune diseases involve a failure to delete autoreactive clones by the thymus or bone marrow, breakdown of peripheral tolerance, antigen-nonspecific lymphocyte activation, molecular mimicry, or abnormalities in lymphocyte interactions

Effects of Autoimmunity

  • Autoimmunity can be the cause of inflammation and tissue damage
  • In IFNγ deficient mice, there is an increased incidence of certain autoimmune diseases, where Th17 cells are key in responses

Definitions of Alloimmunity

  • Alloimmunity can cause clinical significance as three main alloantigen systems ABO, Rh, and HLA

Treatment of Alloimmunity

  • Rho(D) Immune Globulin Human can be used for prophylaxis during pregnancy
  • For transplants; Kidney, Cornea, Liver, Heart, Lung and Pancreas. Alloimmunity and rejection can occur

Alloreactions from Drugs

  • Drugs dervied from humans cause allergic reactions
  • Potential allergic reaction must be evaluated from human
  • Factors to be considered is how conserved is the gene? How big is the protein? How are you going to administer it?
  • Chance of allergic reaction depends on the manufacturing of the drug

Organ transplant Rejection

  • Transplants can lead to allograft rejection vs Graft vs Host Disease
  • There are three types: hyper acute rejection from pre-existing antibody, acute rejection through T cells, and chronic due through antibody mediated decreased perfusion

Hyper acute vs Acute Rejection

  • In hyperacute rejection antibodies bind vascular endothelium of graft by initiating an inflammatory response that occludes blood vessels
  • In Acute rejection T cells recognize Class I and ClassII
  • A treatment is Cyclosporine A which inhibits signal pathways

Actions of Cyclosporine A

  • An immunosuppressant without myelotoxicity
  • Inhibits TCR signaling pathway in expression II-2 and T call proliferation
  • Does not kill T cells
  • Steroids for clinical use in rehumatoid arthritis, transplantation from systemically local applications

Corticosteroids Effects and Side Effects

  • Clinical systemic uses extend to rheumatoid arthritis, IBS, SLE, sarcoidosis, post-transplantation, CNS edema and toxic shock.
  • Side effects such as Skin atrophy, muscle atrophy, VAT, Infections Peptic ulcers

Clinical Applications and Mechanisms

  • Side effects that are long term; resistance GC therapy and cataracts
  • Local and systemically has a big impact on the liver
  • Long term effects with many side effects. Peptides ulcers.

Alloimmunity and Pregnancy Interactions

  • Pregnancy can affect HLA
  • With transplant from the mother vs pregnancy
  • Transplant rejection vs Graft-host disease
  • GVH will be discussed

Mechanisms of Allergy Types

  • Includes terminology of Hypersentitivity
  • Side effects, all end up being from adverse reactions
  • Drugs as factor in all reactions.

Type II Allergies

  • IgC and 1gm for immune effector complement.
  • Abcde ad cc as well
  • Chock tissues which involves circulatory cells
  • Main problem and cause is a high dose to cause disease

Mechanisms of Damage

  • I, III and IV involves immune type factors
  • All lead to inflammation
  • Each involves complex tissue
  • Some time is not endpoint

Type 1 Allergy

  • Type 1 is where effector,
  • Can lead to 270,000 CE receptors
  • May need to change antibody for the better or it will no stick

Type 3 mechanisms

  • Can come from classical complex from high dose and more

Terms to know

  • Ig Mediated allergy and Anaphylatic Hypersensitivity
  • Know where in the body it happens with these diseases
  • Type 3 - those which can kill because there is tons vessel involvement
  • It is important that DTH used is used as a test Anergy - is used as the test as indicator or if have
  • Sects for the assignment 14+ on
  • Not specific with diagnoises

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