Immunologically-Mediated Disease

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Questions and Answers

Which of the following is a key characteristic of an ideal immune response?

  • Is directed against all immunogens, regardless of their potential harm.
  • Leads to chronic inflammation
  • Is completely effective at eradicating harmful immunogens, without causing host tissue damage. (correct)
  • Causes extensive host tissue damage.

Which of the following best illustrates a fundamental principle of immunology relevant to immunopathology?

  • Specificity in the immune system means any antigen will trigger any immune cell.
  • Immunological memory only occurs in adaptive immunity.
  • The ability to discriminate between self and foreign antigens is crucial in preventing autoimmunity. (correct)
  • The immune system always targets foreign substances with 100% accuracy.

Which of the following mechanisms is most directly associated with central tolerance?

  • Development of regulatory T cells in the periphery.
  • Immunogen-induced apoptosis of double-positive T cells. (correct)
  • Immunogen-induced anergy in the absence of costimulation.
  • Suppression of autoimmune cell function by immunosuppressive cytokines released by Treg cells.

What is a key distinction between central and peripheral tolerance?

<p>Central tolerance involves deletion of self-reactive lymphocytes; peripheral tolerance involves mechanisms like anergy or suppression. (D)</p> Signup and view all the answers

What is the primary role of regulatory T cells (Tregs) in maintaining immunological tolerance?

<p>Producing immunosuppressive cytokines that inhibit autoimmune cell function. (B)</p> Signup and view all the answers

Which of the following is a recognized mechanism by which autoimmunity can develop?

<p>Molecular mimicry, where an infectious immunogen cross-reacts with self-antigens. (B)</p> Signup and view all the answers

Why is the pharmacological treatment of autoimmunity often challenging?

<p>It is challenging to selectively suppress the autoreactive immune response without broadly suppressing the entire immune system. (A)</p> Signup and view all the answers

Which of the following characteristics is commonly associated with autoimmune diseases?

<p>They are often idiopathic with multi-factorial causes, including genetics and environmental factors. (B)</p> Signup and view all the answers

Which of the following immune mechanisms is associated with autoimmune diseases, according to the Coombs and Gell classification?

<p>Type II, III, and IV, involving antibody-mediated, immune complex-mediated, and cell-mediated responses, respectively. (A)</p> Signup and view all the answers

What is a key role of Th17 cells in the context of autoimmunity?

<p>Driving inflammatory responses and contributing to tissue damage in autoimmune diseases. (D)</p> Signup and view all the answers

Which of the following best defines 'alloantigen'?

<p>A foreign antigen from the same species that elicits an immune response. (C)</p> Signup and view all the answers

Which of the following alloantigen systems is clinically most significant regarding pregnancy complications?

<p>Rh blood types. (A)</p> Signup and view all the answers

What is the primary purpose of administering Rho(D) immune globulin (RhoGAM) to Rh-negative pregnant women?

<p>To prevent the mother from developing an immune response against fetal Rh-positive red blood cells. (A)</p> Signup and view all the answers

Which of the following is a major clinical concern associated with blood transfusions?

<p>Alloimmune reactions due to mismatched blood groups. (C)</p> Signup and view all the answers

Which of the following best describes hyperacute rejection?

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

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

<p>It primarily involves T cells recognizing donor MHC molecules as foreign. (A)</p> Signup and view all the answers

What is a key characteristic of chronic organ rejection?

<p>It leads to antibody-mediated injury and decreased perfusion. (D)</p> Signup and view all the answers

How does graft-versus-host disease (GVHD) differ from typical organ rejection?

<p>In GVHD, the donor's immune cells attack the recipient's tissues, while in organ rejection, the recipient's immune cells attack the donor tissue. (B)</p> Signup and view all the answers

Cyclosporine A is used as an immunosuppressant to prevent rejection. What is its primary mechanism of action?

<p>Inhibiting the TCR signaling pathway leading to IL-2 expression and T cell proliferation. (C)</p> Signup and view all the answers

What is the mechanism of action of corticosteroids?

<p>They cross the nuclear membrane and bind to gene regulatory sequences. (C)</p> Signup and view all the answers

What is the definition of allergy?

<p>Immunologically-mediated tissue damage due to environmental stimuli. (B)</p> Signup and view all the answers

Which of the following accurately describes the difference between a 'side effect' and an 'allergy' in the context of drug reactions?

<p>Side effects are pharmacological and usually dose-dependent, while allergies are immunological and not necessarily dose-dependent. (D)</p> Signup and view all the answers

According to the Coombs and Gell classification, which type of hypersensitivity reaction is mediated by IgE antibodies and involves mast cell activation?

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

Which of the following is a key characteristic specific to Type I hypersensitivity reactions?

<p>Requires cross-linking of IgE antibodies on mast cells by a polyvalent antigen. (A)</p> Signup and view all the answers

Which type of hypersensitivity reaction involves antibody-dependent cell-mediated cytotoxicity (ADCC)?

<p>Type II. (C)</p> Signup and view all the answers

Which of the following mechanisms is associated with Type III hypersensitivity reactions?

<p>Formation of immune complexes that deposit in tissues. (B)</p> Signup and view all the answers

Which of the following best describes the effector cells involved in Type IV hypersensitivity reactions?

<p>CD4+ and CD8+ T cells. (A)</p> Signup and view all the answers

What is a key distinction between Type II and Type III hypersensitivity reactions?

<p>Type II involves antibodies binding to cell-bound antigens, while Type III involves immune complexes depositing in tissues. (C)</p> Signup and view all the answers

Type IV hypersensitivity is also known as delayed-type hypersensitivity. What contributes to the 'delayed' nature of this reaction?

<p>The time it takes for T cells to migrate to the site of antigen and initiate an immune response. (C)</p> Signup and view all the answers

Which of the following is a distinguishing characteristic of Type IV hypersensitivity reactions compared to Types I, II, and III?

<p>Does not involve antibodies. (A)</p> Signup and view all the answers

In the context of allergy, what is meant by 'sensitization'?

<p>Immunization in the context of allergy (C)</p> Signup and view all the answers

Which of the follow is an inhaled allergin?

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

Which of the following cells is activated in Type II hypersensitivity and leads to phagocytosis of RBC?

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

A patient has a nickel allergy following recent ear piercing. Which cells are mainly responsible for a Type IV hypersensitivity reaction?

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

Following exposure to a pathogen, an actual immune response, as opposed to an ideal immune response, may cause damage as a result of:

<p>Inflammatory and/or immune response to the etiologic agent. (C)</p> Signup and view all the answers

What is the underlying significance of immunological tolerance?

<p>Ensuring the immune system does not react against self-cells or cell products. (B)</p> Signup and view all the answers

Which characteristic distinguishes central tolerance from other forms of immunological tolerance?

<p>It occurs during lymphocyte development in primary lymphoid organs. (C)</p> Signup and view all the answers

A researcher is investigating potential therapeutic targets for autoimmune diseases. Which of the following mechanisms of central tolerance is most likely to provide a specific target to prevent autoreactive T-cells from developing?

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

A scientist is studying peripheral tolerance mechanisms in the context of autoimmune disease. Which of the following is an example of peripheral tolerance?

<p>Anergy in T cells due to lack of co-stimulation. (A)</p> Signup and view all the answers

In which scenario would the establishment of immunological tolerance be a clinical goal?

<p>Treatment of an allergic condition. (A)</p> Signup and view all the answers

A pharmaceutical company is developing a new drug to promote tolerance in mature, immunogen-reactive cells. Which cellular process should this drug primarily aim to enhance?

<p>Activity of specific suppressive cells like Tregs (C)</p> Signup and view all the answers

What is the primary role of M cells in the induction of oral tolerance in the gut?

<p>Processing and transporting antigens to dendritic cells. (A)</p> Signup and view all the answers

Which of the following best describes how high doses of intravenous aqueous proteins can induce tolerance?

<p>By generating regulatory T cells (B)</p> Signup and view all the answers

Which process is most directly associated with the induction of tolerance in the gut-associated lymphoid tissue (GALT)?

<p>Presentation of antigen by M cells leading to Treg development. (A)</p> Signup and view all the answers

In cancer immunology, what role does the immune system play in preventing neoplastic growth?

<p>Preventing the growth of neoplastic cells. (D)</p> Signup and view all the answers

Which of the following is the most accurate statement about autoimmunity?

<p>Some level of autoimmunity can occur in healthy individuals. (C)</p> Signup and view all the answers

Which of the following scenarios is most likely to result in a breakdown of peripheral tolerance and subsequent autoimmunity?

<p>Failure in checkpoint mechanisms leading to Treg deficiency. (A)</p> Signup and view all the answers

How does molecular mimicry contribute to the development of autoimmune diseases?

<p>By causing infectious immunogens to cross-react with self-antigens. (D)</p> Signup and view all the answers

What role do Th17 cells play in autoimmunity, as opposed to that of Th1 cells?

<p>They are key in autoimmune responses, whereas Th1 were previously thought to be. (D)</p> Signup and view all the answers

Which of the following factors is least likely to be implicated in contributing to the development of autoimmune diseases?

<p>Age related decline in cellular repair mechanisms. (D)</p> Signup and view all the answers

Which therapeutic principle is most effective for managing autoimmune diseases?

<p>Targeting the disease using an unknown cause resulting in sub-optimal therapy. (B)</p> Signup and view all the answers

A patient with systemic lupus erythematosus (SLE) is found to have glomerulonephritis and vasculitis. According to the Coombs and Gell classification, which type of immune mechanism is most likely contributing to these conditions?

<p>Type III hypersensitivity, involving immune complex deposition. (A)</p> Signup and view all the answers

Which component of the adaptive immune response is most likely involved in autoimmune disorders?

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

An individual receiving a blood transfusion experiences a severe reaction due to incompatibility with the donor's blood type. This scenario represents an example of:

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

Why are alloantigens clinically significant in the context of pregnancy?

<p>They are involved in the development of maternal alloimmune diseases. (B)</p> Signup and view all the answers

Which of the following alloantigen systems is the most clinically significant regarding pregnancy?

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

Based on clinical significance, which of these blood groups can be easily treated if known for incompatibility?

<p>The ABO blood groups. (B)</p> Signup and view all the answers

What is the cause of the greatest problems with alloimmunity in pregnancy?

<p>Multiparous women have the greatest problems. (C)</p> Signup and view all the answers

Apart from pregnancy-related complications, what is another key area where alloimmunity is clinically significant?

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

A patient undergoing chemotherapy requires regular blood transfusions. What immunological issue is most likely to arise in this patient?

<p>Increased risk of alloimmunization and transfusion reactions. (C)</p> Signup and view all the answers

Which blood group system is most often implicated in transfusion reactions?

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

In organ transplantation, what is the primary target of alloimmune responses that leads to graft rejection?

<p>Alloantigens expressed on the graft's cells. (C)</p> Signup and view all the answers

Which component is more clinically relevant regarding transplantation?

<p>HLA complex class I. (A)</p> Signup and view all the answers

What type of organ is a kidney in regards to transplantation?

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

Which of the following best describes the alloantigens driving acute rejection?

<p>HLA differences. (B)</p> Signup and view all the answers

Which statement accurately compares acute transplant rejection with chronic transplant rejection?

<p>Acute rejection is primarily T cell-mediated, while chronic rejection is antibody-mediated. (C)</p> Signup and view all the answers

What is the fundamental element necessary for the establishment of allograft tolerance?

<p>chronic immunosuppressive therapy like CSA, glucocorticoids. (C)</p> Signup and view all the answers

Which of the following best describes the mechanism of action of Cyclosporine A?

<p>inhibits T cell proliferation via calcineurin pathway (D)</p> Signup and view all the answers

A patient with rheumatoid arthritis is prescribed corticosteroids. How do these drugs work to alleviate the patient's symptoms?

<p>Reducing immune cell recruitment and cytokine production. (D)</p> Signup and view all the answers

Which of the following is a common side effect associated with corticosteroid use?

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

What is the most accurate definition of allergy?

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

How does an idiosyncratic drug reaction differ from an allergic reaction?

<p>Idiosyncratic reactions are unexpected and occur in few patients, while allergic reactions are immunological and also occur in few patients. (B)</p> Signup and view all the answers

Based on the objective, which of the following would be the most effective approach for a student to understand the scope of an allergic or hypersensitivity condition?

<p>Studying the underlying immunological mechanism that is involved. (D)</p> Signup and view all the answers

A researcher aims to study IgE-mediated allergic reactions. Which characteristic is essential for the activation of mast cells in this type of allergy?

<p>Cross-linking of IgE antibodies by a polyvalent antigen. (B)</p> Signup and view all the answers

What would happen if insufficient antibodies are present or the dose is too high for activation of the cells that may experience IGE-Mediated Allergy?

<p>The activation of the cell may not occur. (B)</p> Signup and view all the answers

In a Type II hypersensitivity reaction, what is the role of IgG or IgM antibodies?

<p>Activate cytotoxic responses. (D)</p> Signup and view all the answers

What is the end point of a Type II hypersensitivity reaction?

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

Where is mainly impacted in a Type II hypersensitivity reaction?

<p>Spleen-related. (D)</p> Signup and view all the answers

What primarily mediates Type III hypersensitivity reactions?

<p>Antibody:Ag:C. (B)</p> Signup and view all the answers

What is a prototype lesion of a Type III hypersensitivity reaction?

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

In Type IV hypersensitivity reactions, what type of cells is used for the immune effector?

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

What best describes Type IV hypersensitivity?

<p>It has a delayed phase, with maximum onset lasting 48-72 hours. (A)</p> Signup and view all the answers

What is the underlying mechanism by which termination of the immune response prevents immunopathology?

<p>Preventing excessive inflammation and tissue damage. (C)</p> Signup and view all the answers

In the context of the 'ideal' immune response, which outcome is most representative?

<p>Complete eradication of a harmful immunogen without any host damage. (B)</p> Signup and view all the answers

Which classification parameter is best represented by the determination of whether an immunologically-mediated disease targets self-antigens?

<p>Source of the antigen (D)</p> Signup and view all the answers

If an individual is experiencing a drug-induced autoimmune reaction, which characteristic is most likely?

<p>The condition may slowly reverse after stopping the drug. (B)</p> Signup and view all the answers

How do abnormalities in lymphocyte interactions contribute to the development of autoimmune diseases?

<p>By causing imbalances in T helper cell subsets. (B)</p> Signup and view all the answers

How does central tolerance primarily prevent autoimmunity?

<p>By eliminating autoreactive clones in the thymus and bone marrow. (D)</p> Signup and view all the answers

What is the primary mechanism by which oral tolerance is induced in the gut?

<p>Induction of regulatory T cells and involvement of CD103+ dendritic cells. (A)</p> Signup and view all the answers

Alloimmunity arises when the immune system responds to alloantigens. Which of the following is a key feature of alloantigens?

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

Why are multiply transfused patients at a higher risk for alloimmune reactions?

<p>Repeated exposure to alloantigens increases the likelihood of sensitization. (A)</p> Signup and view all the answers

In organ transplantation, what immunological process is the primary cause of acute rejection?

<p>T cell recognition of alloantigens. (C)</p> Signup and view all the answers

How does Cyclosporine A prevent organ rejection?

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

What is a key difference between a typical immune response and an allergic reaction?

<p>Allergic response results in immunologically-mediated tissue damage. (C)</p> Signup and view all the answers

How does antibody excess inhibit activation of cells in Type I hypersensitivity?

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

What is the role of anaphylatoxins in Type III hypersensitivity reactions?

<p>Attracting Chemotactic factors (B)</p> Signup and view all the answers

How is delayed-type hypersensitivity used as a test in medicine?

<p>Evaluating Cellular Immunity (C)</p> Signup and view all the answers

Which immunological deficiency primarily stems from a lack of knowledge regarding the physiological function of the immune system?

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

When the immune system fails to prevent neoplastic growth, what is the most likely underlying condition?

<p>Host immunocompromise. (C)</p> Signup and view all the answers

Which immunological principle is most relevant when considering how the immune system distinguishes between pathogens and the body's own cells?

<p>Discrimination of self and foreign (C)</p> Signup and view all the answers

Why is the termination of an immune response a crucial aspect of immunological homeostasis?

<p>It prevents immunopathology from prolonged immune activity. (A)</p> Signup and view all the answers

In the context of central tolerance, what cellular event is most critical for preventing autoimmunity?

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

Which of the following is a characteristic of tolerance acquired in fetal life?

<p>It requires the continued presence of the immunogen. (D)</p> Signup and view all the answers

What is the primary reason for targeting the establishment of immunological tolerance as a clinical goal?

<p>To prevent organ rejection in transplant recipients. (B)</p> Signup and view all the answers

A patient has developed immune-mediated anergy due to lack of co-stimulation. In which organ might an immunologist evaluate this?

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

What is the consequence of M cells transporting antigens to gut dendritic cells?

<p>Promotion of Treg development. (B)</p> Signup and view all the answers

While autoimmunity is generally harmful, when might an immune response to self-antigens be considered beneficial?

<p>To destroy abnormal cells thus acting as part of immune surveillance. (B)</p> Signup and view all the answers

How does molecular mimicry lead to autoimmune disease?

<p>By infectious antigens cross-reacting with self antigens. (A)</p> Signup and view all the answers

Which of the following is a reason that therapeutic principles for autoimmune disease, like minimizing immunogen exposure, may not be effective?

<p>The cause and immunogen are unknown and unavoidable. (D)</p> Signup and view all the answers

What is the most comprehensive way to characterize an immunologically-mediated disease?

<p>By determining whether the disease targets self-antigens. (C)</p> Signup and view all the answers

Which component is the major contributor to kidney transplant rejection:

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

Alloimmunity is most clinically significant in which situation?

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

Transfusion reactions are more often caused by which three of the following:

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

A patient requires regular blood transfusions during cancer chemotherapy. What is the most likely immunological issue that will arise?

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

What is the general process that occurs during kidney transplant rejection?

<p>Dendritic cells travel to the recipient's spleen, and activate the T cells. (A)</p> Signup and view all the answers

What is a hallmark of chronic allograft rejection?

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

How does Cyclosporine A work to prevent organ rejection?

<p>Inhibits t-cell proliferation (C)</p> Signup and view all the answers

What adverse reaction may occur when drugs are derived from human origin?

<p>Alloantigens within humans cause an allergic reaction. (B)</p> Signup and view all the answers

If IgE is stimulated too much, a patient experiences an allergic response. Which cell is impacted?

<p>Mast cell mediator (B)</p> Signup and view all the answers

What is meant by the term "sensitization"?

<p>Immunization in the context of allergy (D)</p> Signup and view all the answers

In an allergic response, a shock tissue would mainly affect what part of our body

<p>Areas will smalls vessels like kidneys, joints, lungs and skin (C)</p> Signup and view all the answers

Which Immune Effector commonly promotes inflammatory response by Macs?

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

What mechanism causes the damage in Type I, II, III, and IV hypersensitivity reactions?

<p>Inflammation, except for Type II (B)</p> Signup and view all the answers

Which of the following hypersensitivity reactions involves macrophages?

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

What are the products that mast cells produce?

<p>Histamine, Leukotrienes (A)</p> Signup and view all the answers

A newly identified disease shows increased fluid secretion as the main symptom in the gastrointestinal tract. What kind of "response" is this?

<p>Mast cell response for increased fluid secretion and increased peristalsis. (A)</p> Signup and view all the answers

What is the role of Leukotrienes C4, D4, and E4?

<p>Causes mucus production (B)</p> Signup and view all the answers

How does ADCC activate immune response?

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

What type of cell leads to tissue rejection?

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

One of the objectives is to "Identify which Coombs and Gell class does not involve inflammation and why." Which of the following would that be?

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

A Type III Complex mainly has issues where?

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

When autoantibodies form because Rheumatic fever begins with strep throat, and cross-react with cardiac muscle antigen, what kind of antibody-mediated disease is created?

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

Which of the following cytokines produced by macrophages, promotes T2-cell response?

<p>Interleukin 4 (IL-4) (D)</p> Signup and view all the answers

Which of the following immune-related events is NOT classified as immunopathology?

<p>Clearance of virally infected cells by cytotoxic T lymphocytes (C)</p> Signup and view all the answers

In pregnancy, the greatest alloimmunity problems are caused by what?

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

The thymus expresses proteins to induce a better response to what?

<p>Negative selection of T cells (D)</p> Signup and view all the answers

Which scenario demonstrates the principle that the same immunological mechanisms apply to both normal immunity and immunopathology?

<p>Development of immunological memory after a pathogen exposure. (A)</p> Signup and view all the answers

A patient experiences a reaction to a therapeutic drug, leading to symptoms of inflammation and tissue damage. How would this be classified?

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

In an individual with a genetic predisposition, which event is most likely to initiate autoimmunity?

<p>A failure in the normal regulation of self-reactive lymphocytes. (A)</p> Signup and view all the answers

Which of the following is most likely to occur due a breakdown of immunological tolerance?

<p>The development of an autoimmune disorder. (A)</p> Signup and view all the answers

A researcher is investigating potential therapeutic targets for autoimmune diseases. Which of the following approaches would be most consistent with re-establishing central tolerance?

<p>Increasing the expression of tissue-specific proteins within the thymus. (D)</p> Signup and view all the answers

In a study examining mechanisms of peripheral tolerance, which outcome would indicate successful induction of anergy in autoreactive T cells?

<p>Reduced responsiveness to antigen stimulation, even with co-stimulation. (C)</p> Signup and view all the answers

High doses of intravenous aqueous proteins can sometimes induce tolerance. What is the primary mechanism behind this?

<p>Induction of T cell anergy or regulatory T cell activation. (A)</p> Signup and view all the answers

How do M cells contribute to the induction of oral tolerance to antigens in the gut?

<p>By transporting antigens to gut-associated lymphoid tissue (GALT), where dendritic cells can take them up. (A)</p> Signup and view all the answers

Which of the following scenarios best illustrates how molecular mimicry can lead to autoimmunity?

<p>A viral protein shares structural similarities with a self-antigen, causing the activation of self-reactive T cells. (D)</p> Signup and view all the answers

A patient with an autoimmune condition exhibits elevated levels of Th17 cells. What is the primary role of Th17 cells in the context of this autoimmune response?

<p>Promoting chronic inflammation and tissue damage through the recruitment of neutrophils. (B)</p> Signup and view all the answers

Which therapeutic approach aligns with minimizing immunogen exposure in an autoimmune disease?

<p>Avoiding environmental triggers that exacerbate the autoimmune response. (B)</p> Signup and view all the answers

According to the Coombs and Gell classification, which type of hypersensitivity reaction is primarily mediated by T cells and results in delayed inflammation?

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

A patient develops hemolytic anemia due to antibodies targeting their own red blood cells. According to the Coombs and Gell classification, this would be classified as which type of hypersensitivity reaction?

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

What is the underlying principle of therapies that aim to induce immunological tolerance in the context of allergic diseases?

<p>To shift the immune response away from IgE production towards IgG4. (B)</p> Signup and view all the answers

How do alloantigens principally differ from self-antigens?

<p>Alloantigens are polymorphic variants of proteins present in genetically different individuals of the same species. (A)</p> Signup and view all the answers

Why are multiply transfused patients at higher risk of experiencing alloimmune reactions?

<p>Repeated exposure to alloantigens in transfused blood can sensitize the recipient's immune system. (A)</p> Signup and view all the answers

Which immunological scenario primarily characterizes acute organ rejection?

<p>T cells recognize donor MHC molecules as foreign and directly attack the graft. (A)</p> Signup and view all the answers

A transplant patient is treated with Cyclosporine A to prevent graft rejection. What aspect of the immune response is targeted by this drug?

<p>T cell signaling and IL-2 expression (D)</p> Signup and view all the answers

Which of the following best explains why blood transfusions can lead to alloimmune reactions?

<p>The recipient's immune system recognizes alloantigens on the donor's blood cells as foreign. (A)</p> Signup and view all the answers

How does the presence of pre-existing antibodies against donor antigens lead to hyperacute rejection in organ transplantation?

<p>By activating complement and causing rapid destruction of the graft vasculature. (C)</p> Signup and view all the answers

In the context of allergic reactions and hypersensitivity, what does 'sensitization' refer to?

<p>The process by which an individual develops an IgE response to an allergen after initial exposure. (D)</p> Signup and view all the answers

A patient presents with allergic rhinitis, characterized by sneezing, runny nose, and nasal congestion, after exposure to pollen. Which type of hypersensitivity reaction is primarily responsible for these symptoms?

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

What is the primary effector cell involved in Type I hypersensitivity reactions?

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

How can antibody excess sometimes inhibit the activation of cells in Type I hypersensitivity reactions?

<p>By blocking the interaction of IgE antibodies with the FcεRI receptor on mast cells and basophils. (B)</p> Signup and view all the answers

In a Type II hypersensitivity reaction, what is the primary mechanism by which tissue damage occurs?

<p>Antibody-mediated activation of complement or antibody-dependent cell-mediated cytotoxicity (ADCC) (D)</p> Signup and view all the answers

A patient develops a drug-induced Type II hypersensitivity reaction that causes thrombocytopenia (low platelet count). Where is the primary site of cell destruction likely to occur?

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

A patient with serum sickness develops vasculitis and glomerulonephritis due to the deposition of immune complexes in blood vessel walls and kidney glomeruli. This condition is an example of which type of hypersensitivity reaction?

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

What is the role of anaphylatoxins, such as C3a and C5a, in Type III hypersensitivity reactions?

<p>To recruit and activate neutrophils, leading to increased vascular permeability and inflammation. (D)</p> Signup and view all the answers

How is delayed-type hypersensitivity (DTH) used as a diagnostic test in medicine?

<p>To evaluate T cell competence (A)</p> Signup and view all the answers

Type IV hypersensitivity reactions typically involve which type of immune cell as the primary effector?

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

Which of the following best describes a key difference between Type I and Type IV hypersensitivity reactions?

<p>Type I reactions occur rapidly upon exposure to an antigen, whereas Type IV reactions are delayed. (A)</p> Signup and view all the answers

If during a Type IV Hypersensitivity response, the incorrect amount of T-cells are used, what immune pathology may be triggered?

<p>Delayed-type hypersensitivity or contact dermatitis. (C)</p> Signup and view all the answers

A researcher finds that mast cells produce tryptase, chymase, cathepsin G, and carboxypeptidase. What can be inferred from this research?

<p>The cells remodel connective tissue by releasing the compounds to be used as building blocks. (A)</p> Signup and view all the answers

In a parasitic attack, mast cells may have a Typical Th2 response. What can be typically expected?

<p>Increased Blood Flow (A)</p> Signup and view all the answers

Leukotrienes $C_4$, $D_4$, and $E_4$ play a role in a Type I hypersensitivity reaction. What is that role?

<p>Cause smooth muscle contraction, increase vascular permeability, and cause mucus secretion. (D)</p> Signup and view all the answers

A researcher develops a technique to promote ADCC. What cells does it activate to lead to immune response?

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

Memory T cells lead to what

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

According to what you know about inflammation, which immune response does not involve inflammation and why not?

<p>Type II: The cell lysis and phagocytosis does not cause inflammation. (D)</p> Signup and view all the answers

In a Type III Complex that has immune issues, where is it mainly impacted?

<p>High small vessel regions (D)</p> Signup and view all the answers

What cytokines are the most impactful for TH2 cell response?

<p>Interlukin-4 and Interlukin-13 (C)</p> Signup and view all the answers

How does an actual immune response differ from an ideal immune response regarding tissue damage?

<p>Ideal immune responses never cause host tissue damage, whereas actual immune responses may result in such damage. (B)</p> Signup and view all the answers

Following a bee sting, an individual experiences a systemic allergic reaction, leading to difficulty in breathing and a drop in blood pressure. Categorically, this would fall under which classification of immunologically-mediated disease?

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

Which of the following best describes the role of 'Specificity' in the context of immunopathology?

<p>Specificity requires an immune response to be directed precisely against a particular antigen, whether harmful or self. (C)</p> Signup and view all the answers

How does 'molecular mimicry' potentially trigger autoimmune diseases?

<p>Molecular mimicry involves infectious immunogens sharing structural similarities with self-antigens, causing the immune system to attack self. (A)</p> Signup and view all the answers

A patient requires a blood transfusion, but experiences a severe reaction due to mismatched blood type antigens. Which type of immunologically-mediated disease is this?

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

What is the primary mechanism by which Cyclosporine A prevents organ rejection in transplant patients?

<p>By blocking the TCR signaling pathway, which leads to reduced IL-2 expression and T cell proliferation. (A)</p> Signup and view all the answers

Why might therapeutic strategies that focus on minimizing immunogen exposure not be effective in autoimmune diseases?

<p>Because, in autoimmune diseases, the immunogen is a self-antigen that cannot be avoided. (C)</p> Signup and view all the answers

What is the role of M cells in the context of oral tolerance?

<p>M cells process antigens for uptake by gut dendritic cells, favoring Treg development and tolerance. (C)</p> Signup and view all the answers

How corticosteroids reduce inflammation?

<p>Corticosteroids modulate gene transcription, leading to decreased production of inflammatory cytokines. (C)</p> Signup and view all the answers

After accidental exposure in a lab, a researcher develops contact dermatitis and tests positive for tuberculin hypersensitivity. Which immune cells are primarily responsible for the condition?

<p>CD4+ T cells (B)</p> Signup and view all the answers

The underlying reason for allergic reactions involve what?

<p>An error by the normal immune response (C)</p> Signup and view all the answers

In a Type I hypersensitivity reaction, cross-linking of IgE antibodies on mast cells by an allergen leads directly to:

<p>Secretion of histamine and other mediators (C)</p> Signup and view all the answers

Systemic lupus erythematosus (SLE) is characterized by the widespread deposition of immune complexes in various tissues. Which type of hypersensitivity reaction is primarily involved in causing tissue damage in SLE?

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

What is the primary difference of the function of CD4+ Helper T cells and of CD8+ cytotoxic T cells in Type IV hypersensitivity reactions?

<p>CD4+ T cells promote inflammation by macrophages; CD8+ T cells mediate tissue rejection. (A)</p> Signup and view all the answers

Which of the following best explains why multiply transfused patients are at higher risk for alloimmune reactions?

<p>Multiple transfusions expose patients to a broader range of alloantigens, increasing the likelihood of sensitization. (A)</p> Signup and view all the answers

Which of the following is least aligned with the concept of an ideal immune response?

<p>The actual immune response is completely protective and does not cause host tissue damage. (B)</p> Signup and view all the answers

What immunological principle is most relevant when considering the capability of the immune system to respond to a vast variety of antigens?

<p>Diversity-Heterogeneity (B)</p> Signup and view all the answers

Which of the following most accurately describes the relationship between normal immunity and immunopathology?

<p>Normal immune responses can cause immunopathology. (B)</p> Signup and view all the answers

A patient is experiencing a drug-induced autoimmune reaction. Which of the following characteristics is most likely?

<p>The immune response is directed against self-antigens due to the drug. (D)</p> Signup and view all the answers

What is the primary mechanism by which high doses of intravenous aqueous proteins can induce tolerance?

<p>Inducing anergy or deletion of antigen-specific T cells. (A)</p> Signup and view all the answers

What is the primary event that occurs during central tolerance to prevent autoimmunity?

<p>Deletion of autoreactive lymphocytes. (B)</p> Signup and view all the answers

Why are sex hormones considered multi factorial contributors to autoimmune disease?

<p>They influence immune responses and disease susceptibility. (A)</p> Signup and view all the answers

Which parameter is not necessarily useful in classifying an immunologically-mediated disease?

<p>Speed of recovery. (D)</p> Signup and view all the answers

Which of the following is a potential outcome of abnormalities in lymphocyte interactions?

<p>Development of autoimmune diseases. (C)</p> Signup and view all the answers

What is the underlying reason that a therapeutic principle for autoimmune disease, like minimizing immunogen exposure, may not be effective?

<p>Autoimmune diseases have an unknown origin. (C)</p> Signup and view all the answers

Which of the following alloantigen systems is most often implicated in transfusion reactions, leading to the most severe outcomes?

<p>ABO blood groups (D)</p> Signup and view all the answers

What makes multiparous women have the greatest problems with alloimmunity?

<p>They have been exposed to fetal alloantigens in previous pregnancies. (D)</p> Signup and view all the answers

What is true when the ABO or minor blood groups are incompatible in pregnant women?

<p>It can be easily treated if known today (B)</p> Signup and view all the answers

In the context of organ transplantation, the HLA complex is most associated with what?

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

A kidney is an allograft in an organ transplant. What does 'allograft' specify?

<p>A graft between genetically different individuals of the <em>same</em> species. (B)</p> Signup and view all the answers

What type of differences causes hyperacute transplant rejection?

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

When considering differences between acute and chronic transplant rejection, which is more antibody mediated?

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

Why is it necessary to provide chronic immunosuppressive therapy after an organ transplant?

<p>There has been little tolerance established (A)</p> Signup and view all the answers

Apart from preventing transplant rejection, glucocorticoids are used to treat cytokine storms. How does it achieve this?

<p>Decreases cytokine production (A)</p> Signup and view all the answers

What will happen if there is an excess of a certain antibody of required specificity in a Type I reaction?

<p>The cell will not be activated. (C)</p> Signup and view all the answers

Based on the location of allergic reactions, what will be mainly affected by shock tissue?

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

During products of mast cell degranulation, a physiological effect is the promotion of Th2 cell responses. Which product does this?

<p>IL-4 (D)</p> Signup and view all the answers

If mast cells have been activated and degranulation of an individual is observed, and testing the same individual reveals that they have increased fluid secretion, what location should be examined first?

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

What occurs as a result of the release of Leukotrienes $C_4$, $D_4$, and $E_4$ from eosinophils?

<p>Induces smooth muscle contraction, vascular permeability, and mucus secretion. (B)</p> Signup and view all the answers

How can ADCC lead to an immune response?

<p>Inducing cellular cytotoxicity. (D)</p> Signup and view all the answers

What is always the end point to an Immune Effector in Cytotoxic (Type II) Allergy?

<p>It depends on other factors. (B)</p> Signup and view all the answers

Type III reactions impact a specific part of our body which is characterized by lots of small vessels. Which is most aligned with this information?

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

A patient with a suspected Type IV hypersensitivity reaction to poison ivy would likely show what in the skin?

<p>Virtually any reaction, but skin is very common (D)</p> Signup and view all the answers

What is used as a test for immunocompetence or suppression?

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

Inflammation occurs in Type I, Type III, and Type IV mechanisms of damage. What happens in Type II?

<p>There is no inflammation. (B)</p> Signup and view all the answers

In the context of immunology, what distinguishes autoimmunity from a normal immune response?

<p>Autoimmunity is directed against self-antigens, leading to potential tissue damage. (C)</p> Signup and view all the answers

Which of the therapeutic agents for allergic diseases is associated with an increased development of insulin resistance?

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

In chronic transplant rejection, what type of rejection is likely going on?

<p>Immune response stimulated by the indirect pathway of allorecognition (C)</p> Signup and view all the answers

When are there most drugs of human origin manufactured?

<p>This has to do with manufacturing methods (C)</p> Signup and view all the answers

Why is knowledge of the physiological function of the immune system essential when considering immunological deficiency disorders?

<p>It is essential to define what constitutes a deficiency. (A)</p> Signup and view all the answers

How does the specificity of the immune system relate to immunopathology?

<p>Specificity dictates the range of antigens that the immune system can recognize, potentially leading to targeted damage in immunopathology. (B)</p> Signup and view all the answers

What is the primary distinction between an 'ideal' immune response and an 'actual' immune response?

<p>An ideal response eradicates harmful immunogens without causing host tissue damage, while an actual response may result in such damage. (B)</p> Signup and view all the answers

Which classification parameter is most appropriate when categorizing an immunologically-mediated disease that targets the body's own tissues?

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

What is the significance of failure to terminate the immune response in the context of immunopathology?

<p>It can result in chronic inflammation and tissue damage. (D)</p> Signup and view all the answers

What is a key mechanism by which central tolerance prevents autoimmunity?

<p>Deleting autoreactive T cells in the thymus. (C)</p> Signup and view all the answers

Which of the following is a characteristic of tolerance that is acquired, not inherited?

<p>It is an active process requiring the continued presence of an immunogen. (A)</p> Signup and view all the answers

Why is the establishment of immunological tolerance often a clinical goal?

<p>To treat allergies and facilitate allograft acceptance. (A)</p> Signup and view all the answers

In peripheral tolerance, what is the consequence of immunogen exposure in the absence of co-stimulation?

<p>Immunogen-induced anergy of T cells. (C)</p> Signup and view all the answers

What is a key feature of autoimmune diseases that complicates therapeutic intervention?

<p>They often have an unknown cause and involve multiple immune mechanisms. (C)</p> Signup and view all the answers

In autoimmune diseases, what is the role of Th17 cells, and how does it differ from the role of Th1 cells?

<p>Th17 cells promote autoimmunity, while Th1 cells are involved in viral immunity. (D)</p> Signup and view all the answers

Why is minimizing immunogen exposure not always an effective therapeutic principle for autoimmune disease?

<p>Because the specific autoantigen triggering the response may be unknown or unavoidable. (D)</p> Signup and view all the answers

What is the fundamental concept behind 'alloimmunity'?

<p>Immune response against foreign antigens from the same species. (A)</p> Signup and view all the answers

What component is most clinically relevant for kidney transplant rejection?

<p>The HLA complex (D)</p> Signup and view all the answers

In organ transplantation, HLA is the main concern. It is more clinically relevant due to which qualities?

<p>HLA Class I &gt; Class II (D)</p> Signup and view all the answers

What occurs within the process of kidney transplant rejection?

<p>T cells attack the transplanted kidney as the recipient’s T cells attack the transplant (A)</p> Signup and view all the answers

What is a common problem that arises when drugs are derived from humans?

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

Which drugs are often derived from humans, and lead to allergic reactions?

<p>Recombinant proteins and monoclonal antibodies (D)</p> Signup and view all the answers

Cross-linking IgE leads to activation of cells, but what happens if that can not be promoted correctly?

<p>Antibody excess or deficiency of required specificity (A)</p> Signup and view all the answers

If a child gets a peanut allergy, a Mast Cell will cause which kind of reaction?

<p>Mast cells degranulate, resulting in fluid secretion and increasing secretion in the gastrointestinal tract (C)</p> Signup and view all the answers

Patient A has mast cell degranulation and now is experiencing more fluid in their gastrotestinal tract. What kind of response is this most likely?

<p>Typical TH2 (B)</p> Signup and view all the answers

Leukotrienes C4, D4, and E4 all play a role in Type I Hypersensitivity. What specifically do they do?

<p>Smooth muscle contraction, increase vascular permeability, and cause mucus secretion (B)</p> Signup and view all the answers

How does ADCC promote an immune response?

<p>Antibody-dependent Cell-mediated Cytotoxicity (C)</p> Signup and view all the answers

In regard to the objectives of this course, if there is more emphasis on inflammation for each I, II, and IV hypersensitivity, which one does not have inflammation?

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

What does B-Cell bind to for Activation?

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

During the process of hyperacute organ rejection, that takes place over a few days, why is there hemorrhage?

<p>Antibodies against donor blood group antigens bind vascular endothelium of graft (D)</p> Signup and view all the answers

What is the step-by-step process needed to have a well sustained chronic rejection from alloimmunity?

<p>The antibodies result from an immune response stimulated by the indirect pathway of alloimmunity (C)</p> Signup and view all the answers

Cyclosporine A, an immunosuppressant drug, works because it promotes what?

<p>Inhibit T-cell proliferation (C)</p> Signup and view all the answers

When using Corticosteroids, what result occurs at a molecular level?

<p>Steroid-receptor can now cross the unclear membrane; and the nucleus receptors activates transcription (B)</p> Signup and view all the answers

With reference to side effects, glucocorticoid therapy resistance is often described as:

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

What is a product of Eosinophils?

<p>Amplifies eosinophil production in bone marrow Activates eosinophils (B)</p> Signup and view all the answers

Based on the information provided, what process helps increase the production?

<p>IL-3, IL-5, GM-CSF (C)</p> Signup and view all the answers

Considering a TH2 cell response, what will likely bind in this process?

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

What role does termination of the Immune Response have?

<p>To prevent chronic inflammation and any type of continuous inflammation. (D)</p> Signup and view all the answers

Describe the primary relationship between autoimmunity and autoimmune disease.

<p>Autoimmunity is a process of removing abnormal cells but sometimes causes disease. (A)</p> Signup and view all the answers

What is most likely associated to Alloimmunity?

<p>Alloantigens from genetically different individuals of the same species (D)</p> Signup and view all the answers

In an actual immune response, what is the most likely source of damage?

<p>Inflammatory response to the etiologic agent. (C)</p> Signup and view all the answers

Which of the following is a classification parameter for immunologically-mediated diseases based on the source of the antigen?

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

How does the concept of immunological tolerance relate to autoimmunity?

<p>It signifies the acceptance of self-antigens by the immune system. (D)</p> Signup and view all the answers

Central tolerance involves immunogen-induced apoptosis of double-positive T cells and IgM-expressing B cells to mediate to tolerance of self-antigens. Where does central tolerance take place?

<p>Thymus and bone marrow. (A)</p> Signup and view all the answers

Induction of anergy in mature immunogen-reactive cells is a critical mechanism for maintaining tolerance. What cell type is critical to this particular mechanisms?

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

What is the role of M cells in the gut?

<p>Transporting antigens to gut dendritic cells. (A)</p> Signup and view all the answers

Autoimmune diseases often present a challenge therapeutically because:

<p>It is difficult to avoid immunogen exposure. (C)</p> Signup and view all the answers

What role do Th17 cells play, as opposed to Th1 cells?

<p>Promotion of autoimmunity (A)</p> Signup and view all the answers

Which of the following alloantigen systems is NOT clinically significant?

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

Why do multiparous women have the greatest problems with pregnancy?

<p>Alloimmunity disease is less common today (B)</p> Signup and view all the answers

Tolerance has not yet been established in allograft. Because of that, what is needed?

<p>chronic immunosuppressive therapy (C)</p> Signup and view all the answers

With acute organ rejection, T cells "see" Classes I and II as foreign. What immune molecules are the T cells reacting to?

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

Allergic reactions to substances of human origin relate mostly to what?

<p>the methods of manufacturing. (D)</p> Signup and view all the answers

How are enzymes created by Products of Mast Cell Degranulation supposed to help?

<p>Remodel connective tissue matrix (B)</p> Signup and view all the answers

In Type II, anemia, neutropenia, may occur in the shock tissues. What also happens?

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

In the context of immunological abnormalities, what distinguishes immunological deficiency disorders?

<p>They are defined by a lack of knowledge regarding physiological function (C)</p> Signup and view all the answers

How does the immune system's function relate to the prevention of neoplastic growth?

<p>It serves as a primary line of defense to prevent neoplastic growth. (A)</p> Signup and view all the answers

What critical role does the immune system play in distinguishing between self and foreign substances?

<p>It selectively targets foreign entities while preserving self-tissues. (B)</p> Signup and view all the answers

How does specificity manifest as a fundamental principle of immunology?

<p>The immune response is tailored to target particular antigens with remarkable precision. (B)</p> Signup and view all the answers

What does 'diversity' or 'heterogeneity' refer to in the context of fundamental immunology principles?

<p>The broad capabilities of the immune system to respond to particular antigens. (D)</p> Signup and view all the answers

How is the discrimination between self and foreign crucial in immunology?

<p>To ensure that an immune response is directed against foreign antigens. (B)</p> Signup and view all the answers

What characteristics do immunologic memory contribute to the immune system?

<p>An elevated response upon repeat encounter with the same antigen. (A)</p> Signup and view all the answers

What is the significance of 'termination of the response' in immunology?

<p>To help prevent immunopathology and maintain homeostasis. (A)</p> Signup and view all the answers

In an ideal immune response, what is the primary target of the immune system?

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

What is the expected outcome of an ideal immune response regarding the causative immunogen?

<p>Complete eradication of the harmful immunogen. (C)</p> Signup and view all the answers

Which of the following characteristics defines an ideal immune response in how tissue damage is mitigated?

<p>It is completely effective with protective immunity and no host tissue damage. (B)</p> Signup and view all the answers

What is the process of damage that can occur as a result of an actual immune response?

<p>The etiologic agent's attack before immunity develops. (B)</p> Signup and view all the answers

In what scenario does an inflammatory and/or immune response contribute to damage during an actual immune response?

<p>When it is directed toward self-antigens, resulting in autoimmunity. (C)</p> Signup and view all the answers

What is characteristic of autoimmunity as a source of damage during an actual immune response?

<p>It involves the immune system targeting self-antigens. (A)</p> Signup and view all the answers

How do iatrogenic factors contribute to tissue damage as a result of an actual immune response?

<p>They involve adverse reactions to therapies. (D)</p> Signup and view all the answers

What is the significance of distinguishing between protective immunity and immunologically-mediated disease?

<p>It is challenging, as they can be part of the same process. (C)</p> Signup and view all the answers

Regarding classification of immunologically mediated disease, what best describes the source of the antigen?

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

Regarding classification of immunologically mediated disease, which option describes the mechanism?

<p>IgE-mediated, cytotoxic, or Cell-Mediated. (A)</p> Signup and view all the answers

When classifying an immunologically-mediated disease clinically, what is considered?

<p>A mixture of source of antigen, mechanism, and other things like impacted organ. (A)</p> Signup and view all the answers

In the context of immunology, what does tolerance essentially entail?

<p>Not rejecting yourself. (D)</p> Signup and view all the answers

How does the concept of immunological tolerance relate to the function of the immune system?

<p>The immune system does not see its own cells/ cell products as foreign invaders. (C)</p> Signup and view all the answers

Which statement correctly characterizes the genetic basis of immunological tolerance?

<p>It is not inherited but acquired as an active process. (A)</p> Signup and view all the answers

When is immunological tolerance most readily established?

<p>During fetal life. (A)</p> Signup and view all the answers

What maintenance factor does immunological tolerance require to be sustained?

<p>Continued presence of immunogen. (C)</p> Signup and view all the answers

In what therapeutic context might the 'establishment of tolerance' be a goal?

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

What is a function of Immunogen-induced apoptosis of double-positive T cells?

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

What is meant by immunogen-induced anergy in absence of costimulation?

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

What type of cells may be found to induce tolerance in mature immunogen reactive cells?

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

What is the function of M cells in the gut induction of tolerance?

<p>Take up pathogens to gut dendritic cells (D)</p> Signup and view all the answers

Which of the following does not support Central Tolerance?

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

Autoimmunity is not autoimmune disease? What does it mean?

<p>Some level occurs in everyone (D)</p> Signup and view all the answers

Which of the following is a possible mechanism of autoimmune disease?

<p>Breakdown of peripheral tolerance (D)</p> Signup and view all the answers

Which statement is most accurate regarding general characteristics of autoimmune disease?

<p>It is commonly a HLA-associated disease (D)</p> Signup and view all the answers

What is a characteristic of multiple immune mechanisms in play? (Coombs and Gell classifications)

<p>It may result in suboptimal therapy (C)</p> Signup and view all the answers

Regarding autoimmune disease, what aspects of the adaptive immune response can it involve?

<p>Humoral or Cell Mediated (C)</p> Signup and view all the answers

What was discovered about Th17-cell and IFNy-mice regarding autoimmunity?

<p>It was found in IFNy mice where autoimmune related diseases had increased (B)</p> Signup and view all the answers

Which of the following systems contain alloantigens?

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

Alloimmunity mainly occurs in clinical significance in what circumstances?

<p>In Blood transfusion, Pregnancy-Alloimmune disease of the newborn, etc. (C)</p> Signup and view all the answers

In what situation is RhoGAM a standard treatment?

<p>Alloimmune disease for an Rh factor regarding maternal/fetal alloimmunity (C)</p> Signup and view all the answers

What type of blood is more common to experience transfusion reactions?

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

Allograft rejection and Graft vs Host Disease both pertain to what?

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

Which is not a tissue that requires a perfect HLA complex match?

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

Graft vs host disease is due to what mechanism?

<p>The T cells attack the recipient's tissue after a mismatch. (D)</p> Signup and view all the answers

How can one evaluate the general scope of allergy?

<p>Know that it is immunologically-mediated tissue damage. (C)</p> Signup and view all the answers

There may be a change of allergenicity for all drugs derived from human origin. What is the main reason for this?

<p>The methods of manufacturing. (D)</p> Signup and view all the answers

Which of the following best describes how immunological deficiency disorders are typically defined?

<p>By understanding the physiological function of the deficient component. (C)</p> Signup and view all the answers

In the context of immunology, what does 'tolerance' primarily refer to?

<p>The active process of the immune system not reacting against self-antigens. (D)</p> Signup and view all the answers

Why is continued presence of an immunogen necessary for the maintenance of tolerance?

<p>To persistently signal to the immune system not to react, reinforcing the tolerant state. (A)</p> Signup and view all the answers

Which cellular event is most critical for preventing autoimmunity during central tolerance?

<p>Apoptosis of double-positive T cells and IgM-expressing B cells. (C)</p> Signup and view all the answers

Peripheral tolerance relies on immunogen-induced anergy. What is the absence of that leads to this?

<p>Absence of co-stimulation (C)</p> Signup and view all the answers

How do regulatory T cells (Tregs) suppress autoimmune cell function?

<p>By releasing primarily immunosuppressive cytokines such as TGF-β and IL-10. (C)</p> Signup and view all the answers

What is the role of M cells in the context of tolerance induction within the gut?

<p>They transport antigens to gut dendritic cells. (D)</p> Signup and view all the answers

How can high doses of intravenous aqueous proteins be used to induce tolerance?

<p>By inducing anergy or deletion of antigen-specific T cells. (D)</p> Signup and view all the answers

Autoimmunity is NOT autoimmune disease. What would best describe the difference between these two?

<p>Autoimmunity happens to everyone without disease (B)</p> Signup and view all the answers

A failure to delete an autoreactive clone by the thymus or bone marrow can lead to autoimmunity. Why?

<p>The lymphocytes can directly target self-antigens (A)</p> Signup and view all the answers

In the context of autoimmunity, what role have Th17 cells been more recently found to play?

<p>Being key in autoimmune responses (C)</p> Signup and view all the answers

Why is it difficult to create therapeutic principles for autoimmune diseases?

<p>Inability to completely avoid immunogen and unknown cause (B)</p> Signup and view all the answers

According to Coombs and Gell Classifications, an autoimmune disease can involve any aspect of the adaptive immune response. Which of the two following responses would those be?

<p>Humoral/Cell Mediated (D)</p> Signup and view all the answers

What does the term 'alloantigen' refer to in the context of immunology?

<p>Antigens that differ between individuals of the same species and give rise to alloimmunity. (C)</p> Signup and view all the answers

What is the clinical significance of alloimmunity?

<p>4 circumstances which include blood and blood derivatives (C)</p> Signup and view all the answers

What are the major alloantigen systems?

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

Why are multiparous women known to have the greatest problems with alloimmunity

<p>They are less often easily treated if known for incompatibility today (A)</p> Signup and view all the answers

Which of the following is NOT an indication for using blood and blood derivatives?

<p>Enhancement of neoplastic development (C)</p> Signup and view all the answers

What primarily mediates Acute Organ Rejection?

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

For Cyclosporine A, what pathway is inhibited in order to cause immunosuppression

<p>Inhibits cytokine production through the blockade of the IL-2 expression (calcineurin) (C)</p> Signup and view all the answers

Which is NOT a side effect of immunosuppressant Corticosteroids?

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

In the context of allergy, what best describes 'sensitization'?

<p>Immunization in the context of allergy (D)</p> Signup and view all the answers

According to the overview, what is an allergy?

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

How does an adverse effect Side Effect differ from Direct Toxicity?

<p>Direct Toxicity uses an 'over dose' (A)</p> Signup and view all the answers

In a Type I hypersensitivity reaction, which class of antibody primarily mediates the allergic response?

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

Estimated to be 270,000 which cells cross linking with Anti-IgE antibody in a Type I hypersensitivity reaction?:

<p>Mast-Cells (D)</p> Signup and view all the answers

What products are typically produced from mast cell degranulation?

<p>Kill parasites; increase vascular permeability; Cause smooth muscle contraction (B)</p> Signup and view all the answers

A patient with a suspected parasitic infection is showing increased fluid secretion, and increased peristalsis. This indicates what kind of parasitic event and response?

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A 30 year old is experiencing the effects of Leukotrienes C4, D4, and E4. Which is a symptom commonly expressed from these?

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In Antibody-Dependent Cell-Mediated Cytotoxicity (ADCC), which of the following immune cells is activated to induce cell lysis?

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Type II cytotoxic shocks mainly impact what tissues?

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Which describes the product of an Immune Effector in a Type III hypersensitivity?

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What is a prototype lesion of Type III Hypersensitivity?

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Which cells are immune effectors in a Type IV hypersensitivity reaction?

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How do CD8+ T cells lead to the shock effect in Type IV Hypersensitivity

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Remember: the mechanism of damage for I, III, and IV involves:

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Which hypersensitivity reaction type does NOT involve inflammation?

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An individual with a genetic predisposition experiences an infection that triggers an autoimmune response. Which mechanism is most likely to have initiated this autoimmunity?

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A researcher discovers a novel protein that, when administered intravenously at high doses, induces immunological tolerance to a specific antigen. What cellular process is most likely mediating this tolerance?

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In the context of oral tolerance, how do M cells contribute to immune homeostasis in the gut?

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Which scenario best exemplifies how abnormalities in lymphocyte interactions can result in the development of autoimmune diseases?

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According to the classification of immunologically-mediated diseases, what is the most important parameter to consider when determining if a disease is autoimmune in nature?

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A patient receiving a blood transfusion experiences a severe allergic reaction with systemic vasodilation and edema. Which alloantigen class is the most probable root of the problem in this case?

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A physician is determining the best treatment approach for an autoimmune disease, but minimizing immunogen exposure doesn't result in change. What is the most likely reason for this therapeutic failure?

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Which of the following best describes a key difference between acute and chronic organ rejection?

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A transplant patient is treated with cyclosporine A to prevent organ rejection. What is the primary molecular mechanism by which cyclosporine A exerts its immunosuppressive effects?

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How do corticosteroids work to reduce inflammation in conditions such as rheumatoid arthritis?

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In a Type I hypersensitivity reaction, cross-linking of IgE antibodies on mast cells by an allergen directly leads to:

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A patient presents with allergic contact dermatitis after wearing jewelry containing nickel. Which cells are mainly responsible for this Type IV hypersensitivity reaction?

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What characteristic is exclusive in Type II hypersensitivity reactions?

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Which immune response commonly promotes inflammatory response by macrophages?

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What inflammatory mediator is impacted in a typical Th2 cell response?

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Flashcards

Immunologically-mediated Disease

Also known as immunopathology, involves immunological abnormalities.

Immunological Deficiency Disorders

Disorders where a part of the immune system is missing or not functioning correctly.

Autoimmune Disease

A disease where the body's immune system attacks its own cells or tissues.

Alloimmune Disease

A reaction of the immune system to antigens from another individual of the same species.

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Allergic Disease

An inappropriate and excessive reaction to an allergen that is normally harmless (e.g., pollen).

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Specificity

The ability of the immune system to recognize and respond specifically to a wide variety of antigens.

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Diversity-Heterogeneity

The system's capacity to encounter, differentiate, and respond to a large number of antigens

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Discrimination of self and foreign

The ability to distinguish between its own cells and tissues, and foreign or dangerous substances.

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Immunologic Memory

The ability of the immune system to mount a faster and stronger response upon repeated exposure to the same antigen.

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Termination of the response

Controls the immune response and prevents excessive inflammation of other tissue damage.

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Autoimmunity

An immune response directed against the body's own tissues, leading to inflammation and damage.

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Central Tolerance

Central tolerance occurs when self-reactive lymphocytes are eliminated during their development in the thymus (T cells) or bone marrow (B cells).

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Peripheral Tolerance

Peripheral tolerance occurs when self-reactive lymphocytes are inactivated or suppressed outside of the primary lymphoid organs.

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Mechanisms of Tolerance

Tolerance that is acquired, active and requires the continued presence of immunogen.

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Central Tolerance in T Cells

Central tolerance is promoted by immunogen-induced apoptosis of double-positive T cells.

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Central Tolerance in B Cells

Central tolerance is promoted by Immunogen-induced apoptosis of IgM-expressing B cells.

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Peripheral Tolerance Induction

Peripheral tolerance is promoted by Immunogen-induced anergy in absence of costimulation.

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Treg Cells

Specific suppressive cells, Treg, produce immunosuppressive cytokines, inhibiting autoimmune cell function.

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HLA

HLA-associated autoimmune diseases are autoimmune.

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Alloimmunity

Immune response to foreign antigens from the same species.

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Alloantigens

Antigens that vary genetically between individuals of the same species.

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Important Alloantigen Systems

The most important alloantigen systems are ABO blood groups, Rh blood types, and the HLA complex.

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Pregnancy: Alloimmunity

Occurs with multiple pregnancies, where fetal red blood cells can enter the mother's circulation.

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Transfusion Reactions

Occurs when a person's immune system reacts against antigens present on transfused blood cells.

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Transplantation

HLA complex matters for long-term survival, and needs to be addressed for proper organ match.

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Hyperacute

Hyperacute organ rejection in solid organs is caused pre-existing antibodies

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Acute

Acute organ rejection

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Chronic Rejection

Chronic organ rejection is caused by antibody mediated factors.

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Cyclosporine A

Cyclosporine A inhibits TCR signaling pathway

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Transplant rejection

When a solid organ is transplanted the T cells of the recipient attack the graft

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Cytokines as a therapeutic target

Cytokines are released in order to increase inflammation

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Allergy definition

Immune response to environmental antigen allergens.

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Adverse Drug Review

Normal dose causes side effects in most persons but a few react in an unexpected manner.

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IgE

IgE causes a quick reaction then causes a lot of inflammation. Immediate response.

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Antibody-dependent cytotoxicity

Antibody binds to the surface of a cell and tags the cell for destruction

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Immune complex.

Antibody+ Antigen causes vasulitis

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TB skin test

Cell mediated allergy

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IgE mediated

Type I: involves Mast-cell activation

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Cytotoxic

Type II: causes antibody-dependent cell-mediated cytotoxicity

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Immune Complex

Type III: is a result of Complement+ Ab+Ag

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Cell-mediated

Type IV: is a result of cell-mediated immunity

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Allergy

A condition where the immune system responds inappropriately to a harmless substance.

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Immunological Tolerance

The concept of the immune system not attacking its own tissues.

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Immunological Specificity

A measure of how well the immune system can distinguish between different antigens.

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Etiologic agent

Agent-prior to development of immunity or due to deficiency

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Clinically Tolerant

High dose tolerance to aqueous proteins

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Gut Process

M cells process antigen after it is takenup by gut dendritic cells

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Normal Alloimmunity

Normal immune response to a foreign antigen of the same species

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Acute transplant

Acute organ rejection in solid organs is caused T cells "seeing" the MHC class I

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Steroid location

Steroid receptors are found in the cytoplasm

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Mast activation

Mast cell degranulation: Typical Th2 response

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Hypersensitivity Type I

Type I: is a result of Immediate or Anaphylactic Hypersensitivity

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Tolerance

A state where the immune system does not react against self-antigens.

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Iatrogenic

Adverse response to therapy

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Immunologically-mediated Disease Classification

Source of the Antigen, Mechanism, or Clinical Presentation from an organ system

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Acute rejection

T cells of recipient attack the MHC class 1 and 2, of the donor organ

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Alloantigen Systems

Three main that have implications for transplant and blood transfusion

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Loss of Tolerance

The failure of the immune system to recognize and tolerate self-antigens, leading to an attack on the body's own tissues.

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Oral Tolerance

Oral administration of an antigen leads to tolerance, especially in the gut.

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Pregnancy:Alloimmunity Risk

The first pregnancy leads to exposure, with later pregnancies causing a strong response.

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Transplantation Success

HLA matching improves allograft tolerance.

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Cytokines Adverse effects

Antibodies block T cell function and have adverse sequelae.

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Hypersensitivity

Exposure to a innocuous substance

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Tissues mainly affected

Adverse reactions caused by Cytotoxic antibody effects

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Tissue affect in Tb test

Contact allergy with skin involvement

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Immunopathology

Source of the Antigen, Mechanism, or Clinical Presentation causes an adverse outcome.

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Alloantigen recognition

Acute organ rejection of a MHC matched organ

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Study Notes

Immunologically-Mediated Disease (Immunopathology)

  • Objectives include describing immunological abnormalities.
  • Summarizing basic immunological principles related to immunopathology.
  • Comparing an ideal vs. an actual immune response.
  • Listing the parameters for classifying immunologically-mediated disease

Immunological Abnormalities

  • Immunological Deficiency Disorders, as discussed in Chapter 13, can be defined through knowledge of physiological function.
  • Cancer, as detailed in Chapter 17, involves the immune system's role in preventing neoplastic growth; the host is often immunocompromised.
  • Immunologically-mediated Disease distinguishes between self and non-self.
  • Autoimmune Disease, expanded upon in Chapter 16, involves the immune system attacking the body's own tissues.
  • Alloimmune Disease, discussed in Chapter 15, the immune system reacts against antigens from a genetically different individual of the same species.
  • Allergic Disease, covered in Chapters 14, involves hypersensitivity reactions to otherwise harmless substances.

Fundamental Principles of Immunology

  • Immunology shares specificity with immunopathology.
  • Diversity or heterogeneity is shared across immunology and immunopathology
  • Both involve discrimination of self from foreign elements.
  • Both fields recognize immunologic memory.
  • Both exhibit termination of the immune response

Comparison of Ideal vs Actual Immune Response

  • An ideal immune response would be directed against harmful immunogens only.
  • The ideal immune response would be completely effective, eradicating all harmful immunogens
  • An ideal immune response offers complete protection without host tissue damage
  • Actual immune responses can result in damage from the etiologic agent before immunity develops or due to deficiency
  • Inflammatory or immune responses against the etiologic agent can cause damage.
  • Autoimmunity, the immune response against self-antigens, can be detrimental.
  • Iatrogenic responses, which are adverse reactions to therapy, can lead to damage
  • Protective immunity and immunologically-mediated disease are often intertwined.
  • A normal immune response can be similar to abnormal ones.

Immunologically-Mediated Disease Classification

  • Classification by the antigen source includes autoimmune, alloimmune, and allergy.
  • Classification by Mechanism, uses Coombs & Gell (1963) Types I-IV
    • IgE-mediated
    • Cytotoxic
    • Immune Complex
    • Cell Mediated
  • Clinical classification involves a mixture of the above and considers organ systems.

Autoimmunity Objectives

  • Objectives include summarizing tolerance.
  • Identification of basic concepts of how tolerance is acquired from infancy to adulthood.
  • Describe the two primary mechanisms of tolerance, central and peripheral
  • A primary reason pharmacological treatment of autoimmunity is difficult should be described
  • It should be identified what roles antibodies can play in autoimmunity
  • Identify which T helper cell types(s) inhibit autoimmunity

Mechanisms of Tolerance

  • Tolerance, as it relates to immunology, means preventing self-rejection.
  • The immune system does not recognize self cells or products as foreign invaders

Mechanisms of Tolerance

  • Tolerance is an acquired, active process, not inherited.
  • Tolerance is most readily developed during fetal life.
  • Tolerance requires the continued presence of the immunogen.
  • Tolerance can be induced in adult animals under certain conditions.
  • Establishing tolerance is a clinical goal in allergy therapy and establishment of allografts.

Mechanisms of Tolerance: Central

  • Central tolerance involves immunogen-induced apoptosis of double-positive T cells.
  • Central tolerance also includes immunogen-induced apoptosis of IgM-expressing B cells.

Mechanisms of Tolerance: Peripheral

  • Peripheral Tolerance involves immunogen-induced anergy in the absence of co-stimulation.

Induction of Tolerance in Mature Immunogen Reactive Cells

  • Specific suppressive cells exist for inducing tolerance.
    • Regulatory T cells (Treg) are a distinct helper subset known to be antigen-specific.
    • Tregs primarily produce immunosuppressive cytokines to inhibit autoimmune cell function.
    • M2 macrophages and Nkreg cells also contribute to tolerance.
  • TGFb and IL-10 contribute to the induction

Induction of Tolerance Clinically

  • Oral tolerance to proteins involves regulatory T cells and CD103+ dendritic cells in the gut.
  • High-dose tolerance can be induced with aqueous proteins administered systemically.
  • Low-dose tolerance can be achieved with repeated, low doses administered systemically.

Induction of Tolerance: Gut

  • M cells process antigens in the gut.
  • Gut dendritic cells take up processed antigens.
  • Antigen-loaded dendritic cells travel to mesenteric lymph nodes.
  • Dendritic cells make IL-10, which prompts Treg development to induce tolerance.

Mechanisms of Immunological Self-Tolerance

  • Negative selection of B cells occurs in the bone marrow.
  • The thymus expresses tissue-specific proteins.
  • Negative selection of T cells occurs in the thymus.
  • Lymphatic exclusion isolates the brain, eye, and testis.
  • Anergy can be induced in autoreactive B and T cells.
  • Treg cell suppression of autoimmune responses is active.

Autoimmunity Overview

  • Autoimmunity is an immune response to self-antigens, indicating a loss of tolerance.
  • Autoimmunity does not equal autoimmune disease.
  • Some level of autoimmunity occurs in everyone without disease.
  • Anti-idiotypic antibodies are common in low levels.
  • A major function for autoimmunity helps to destroy abnormal cells.
  • Autoimmunity can be the cause or effect of disease and the source of inflammation and tissue damage.

Possible Mechanisms of Autoimmune Disease

  • A loss of tolerance due to the failure to delete an autoreactive clone by the thymus or bone marrow.
  • Breakdown of peripheral tolerance, such as checkpoint failure or Treg deficiency.
  • Antigen-nonspecific lymphocyte activation, like superantigens, can trigger autoimmune disease.
  • Molecular mimicry involving infectious immunogens cross-reacting with self-antigens.
  • Abnormalities in lymphocyte interactions.
    • Including imbalances in TH1, TH2, TH17, and Treg cells.

General Characteristics of Autoimmune Disease

  • Autoimmune diseases are often idiopathic, except when drug-induced.
    • Drug-induced is sometimes reversible but often slowly; viral infection is suspected
  • Multi-factorial causes include sex, genetics, epigenetics, age, infection, immune system, and environment.
  • Most HLA-associated diseases are autoimmune.
  • Autoimmune diseases involve multiple immune mechanisms such as the Coombs and Gell classifications (1, 2, 3, 4).
  • An inability to avoid immunogens with an unknown cause results in suboptimal therapy and poor prognosis.
  • Autoimmunity can involve humoral and cell-mediated aspects of the adaptive immune response.

Th17 Cells and Autoimmunity

  • An increased incidence of certain autoimmune diseases was found in IFNy deficient mice.
  • Th17 cells are key in these responses, not Th1 cells as previously thought.

Alloimmunity

  • Three main alloantigen systems are ABO, Rh, and HLA.
  • Clinical significance manifests in 4 circumstances.
  • The use of blood and blood derivatives has indications and hazards.

Alloimmunity Objectives

  • Describe the term alloantigen.
  • Describe two clinically relevant sources of alloantigens.
  • Describe the most common pathologies associated with blood transfusions.
  • List the three types of organ rejection.
  • Describe the basic immune mechanism of hyper acute organ rejection.
  • Describe the basic immune mechanism of acute organ rejection.
  • Describe the basic immune mechanism of chronic organ rejection.
  • Contrast graft vs host disease with organ rejection.
  • Summarize in basic terms the mechanism of glucocorticoids.
  • Summarize in basic terms the mechanism of CsA.
  • List the two most common alloantigens associated with maternal/fetal disease.
  • State the treatment for Rh factor associated maternal/fetal alloimmunity.

Alloimmunity Definitions

  • Alloimmunity is a normal immune response to a foreign antigen.
  • Foreign antigen comes from the same species and is known as alloantigen.

Alloantigens Definitions

  • Alloantigens result from polymorphic gene systems.
    • Synonyms: isoantigens and isoimmunity.

Alloantigen Systems of Clinical Significance

  • ABO Blood Groups
  • Many possess immunity to blood groups naturally.
  • Rh Blood Types
  • HLA Complex (MHC Complex)
  • Minor Blood Group Systems (20+)

Clinical Significance of Alloimmunity: Pregnancy

  • Pregnancy can lead to alloimmune disease of the newborn.
  • The Rh system is a more significant risk than ABO and minor blood groups.
  • Multiparous women face the greatest risks, though these are less common today.
    • Alloimmune reactions can be easily treated if known incompatibility in pregnancy.

Clinical Significance of Alloimmunity: Pregnancy Treatment

  • Rho(D) Immune Globulin Human is used for prophylaxis (RhoGAM).

Clinical Significance of Alloimmunity: Transfusion of Blood and Blood Derivatives

  • Transfusion reactions can occur due to ABO, Rh, minor blood groups, and HLA incompatibilities
  • Transfusions are needed due to chemotherapy, dialysis, surgery, etc.
  • Epoetin and oprelvekin have reduced the need for transfusions.
  • Multiply transfused patients have the biggest problems.

Blood and Blood Derivatives

  • Products include whole blood, cells, and proteins.
  • Indications include Replacement Therapy, Passive Immunization, Immunosuppression, Diagnostic Products.
  • Hazards include Transfusion Reactions such as hemolytic and febrile reactions, and Infectious Disease.

Transplantation

  • Transplantation is Allograft Rejection and Graft vs Host Disease
  • Reactions can come from HLA Complex (Class I > Class II) ABO
  • The kidney, Cornea, Liver, Heart, Lung, and Pancreas, commonly transplanted.
  • Skin and Bone Marrow transplantion use Ideally autologous tissues
  • Tolerance is hard to be established in allografts requiring long term immunosuppressive therapy like CSA, glucocorticoids.

Types of Organ Rejection

  • Hyperacute rejection is initiated by pre-existing antibodies
  • Acute rejection is T Cell mediated and the result of HLA differences
  • Chronic rejection is caused by antibody-mediated interactions or decreased perfusion

Cyclosporine A

  • An important immunosuppressant.
    • Lacks secondary toxicities, ie. myelotoxicity
  • It inhibits TCR signaling pathway leading to IL-2 expression (calcineurin).
  • Inhibits T cell proliferation
  • Does not kill T cells
  • For signal transduction
    • Zap70
    • PLCγ
    • PIP2, DAG, and IP3
    • Ca++

Clinical Uses of Corticosteroids

  • Systemic uses: rheumatoid arthritis, IBS, SLE, sarcoidosis, post-transplantation, CNS edema, Toxic shock which includes Cytokine storm
  • Local uses: dermatitis, ophthalmological, asthma

Side Effects of Corticosteroids

  • GC therapy resistance resulting in a disease that becomes "refractory"
  • Impaired wound healing.
  • Skin atrophy
  • Muscle atrophy
  • VAT accumulation ("cortisol belly")
  • Infections
  • HPTA insufficiency
  • Cataracts
  • Peptic ulcers
  • Metabolic disorders
    • Insulin resistance
    • Hyperglycemia
  • And more

Allergy Overview

  • Allergy definition: Immunologically-mediated tissue damage
  • An Environmental Antigen is an Allergen
  • Sensitization is immunization in the context of allergy
  • Hypersensitivity and Sensitivity synonyms has some confusing uses
  • Symptoms are independent of allergen characteristics
  • Allergy is a major group of diseases to environmental substances
  • Allergy is a major group of adverse drug reactions

Allergy Objectives

  • Objectives are to:
    • Contrast in very basic terms allergy versus the normal immune response.
    • Identify at least one allergen associated with each route of exposure.
    • Describe and contrast the terms associated with adverse drug reactions including: Side Effect, Direct Toxicity, Idiosyncrasy, and Allergy.
    • List the four Coombs and Gell classifications of hypersensitivity.
    • Recognize the Types I-IV of the Coombs and Gell classifications with regard to Pathology, Cells involved, Immunological mediators involved, and Time course.
    • Identify which Coombs and Gell class does not involve inflammation and why.Suggest basic therapy for each allergic response.

Adverse Drug Reactions: Side Effect

  • Expected
  • Pharmacological
  • Usual dose and most patients

Adverse Drug Reactions: Direct Toxicity

  • Expected
  • Pharmacological
  • Over dose, and most patients

Adverse Drug Reactions: Idiosyncrasy

  • Unexpected
  • Pharmacological
  • Usual dose and few patients

Adverse Drug Reactions: Allergy (Hypersensitivity)

  • Unexpected
  • Immunological
  • Usual dose
  • Few patients

Mechanisms of Allergy

  • Type I: IgE Mediated
    • Allergen
    • IgE Ab
    • mast cell
    • Histamine
    • Leukotrienes etc
    • Inflammation
  • Type III: Immune Complex
    • IgG Complement
    • Anaphylatoxins
    • Chemotactic Factors etc
    • Inflammation
  • Type IV: Cell Mediated
    • T Cell
    • Lymphokines
    • Inflammation

Mechanisms of Allergy

  • Cytotoxic
    • Target Cell
    • IgG or IgM
    • Macrophage
    • NK Cell, etc
    • ADCC
    • Cell death

Hypersensitivity Reactions

  • Type 1 involves mast cells
  • Type 2 involves B cells
  • Type 3 involves B cells, infused mouse antibody
  • Type IV involves T cells and DC cells

Type I: IgE-Mediated Allergy

  • Synonyms: Immediate or Anaphylactic Hypersensitivity
  • Immune Effectors: IgE
  • Estimated to be 270,000 Fce receptors/(mast)cell
  • Passively transferred IgE bound to mast cells for up to 6 weeks
  • Activation of cell requires cross-linking IgE (polyvalent Ag) is required
  • Activation may be prevented by, insufficient antibody
  • Or antibody excess

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