Immunomodulation

Question 1

When is immune modulation indicated?

Answer 1

• Suppression of inappropriate immune responses
• Enhance immune response against neoplasia
• Limit the immune response in degenerative disease

Question 2

Which hypersensitivity reaction is IgG mediated?

Answer 2

Type II

Question 3

What is the action of anti-inflammatory medications?

Answer 3

Act to block some effector mechanisms of the innate immune system

Question 4

What is the action of immunosuppressive medications?

Answer 4

Mainly act to reduce the function of the adaptive immune system
Reduce lymphocyte proliferation

Question 5

What are the 3 main groups of immunosuppressive drugs used in a veterinary practice?

Answer 5

Drugs which inhibit:

• Cytokine gene expression
• IL-2 production
• DNA synthesis

Question 6

What is used as the first line immunosuppressive treatment for many immune mediated diseases?

Answer 6

Glucocorticoids

Question 7

Where are glucocorticoids metabolised and excreted?

Answer 7

Metabolised in the liver

Excreted by the kidneys

Question 8

Describe the MOA of glucocorticoids?

Answer 8

• Bind to receptors in the cytoplasm
• Transit to nucleus and bind to DNA influencing transcription of a huge number of genes in many tissues
• Reduce degranulation
• Reduce pro-inflammatory cytokine production
• Reduce antigen presentation

Question 9

The effect of glucocorticoids depends on..?

Answer 9

Dose and formulation

Question 10

List some adverse effects of glucocorticoids

Answer 10

• Skin thinning
• Weight gain
• Muscle loss
• Polyphagia
• PU/PD
• GI bleeding
• Lethargy

Question 11

What systemic effects are expected of glucocorticoids?

Answer 11

• Stimulate gluconeogenesis
• Suppress inflammation
• Alter fat, protein and carbohydrate metabolism
• Suppress HPA axis

Question 12

Which cells produce IL-2?

Answer 12

CD4+ cells

Question 13

IL-2 leads to stimulation of…?

Answer 13

• Activation of T-cells
• B-cell proliferation
• Activity of innate immune cells (macrophages, NK cells)

Question 14

What occurs when IL-2 is inhibited?

Answer 14

• Reduced activity of all functions requiring helper T-cells (adaptive immunity)
• Cytokine suppression

Question 15

Which 2 drugs are most commonly used to inhibit IL-2 production/action?

Answer 15

Ciclosporin

Tacrolimus

Question 16

Which molecule is blocked by the drugs which inhibit IL-2 production?

Answer 16

Calcineurin

Question 17

Name 2 drugs which inhibit DNA synthesis

Answer 17

Azathioprine
Mycophenolate mofetil (MMF)

Question 18

Which enzyme is targeted by drugs which inhibit DNA synthesis?

Answer 18

Purine

Question 19

What are second line immunosuppressives used in conjunction with?

Answer 19

Steroids

Question 20

What are immunosuppressives and steroids used in conjunction for?

Answer 20

• To increase the immunosuppressive effect
• To increase the rate at which steroids can be withdrawn
• To reduce dose and adverse effects of steroids

Question 21

What is the action of imiquimod?

Answer 21

Applied to the skin and it stimulates the immune system

Question 22

What is the action of a vaccine dependant on?

Answer 22

• Route of vaccine
• Type of vaccine
• Presence or absence of co-stimulatory molecule