Points to learn in Clinical Immunology

General
- The basic biological functions of cell mediated immunity system is?
- What are the characteristic of primary IR?
- What is ment by an Ab?
Protein of the immune system that recognizes and binds to foreign molecules (Ags)
- What are the characteristic of a secondary IR?
- What is meant by Tolerance?
- When Ag is injected intravenously, where does primarily is the Ab formation?
- What is the central paradigm of IR? (Ga yakin bner jg sh ni) Central paradigm=Clonal
selection; the principle: virgin B cells/naive B cells --> ktmu dgn matched Ag --> only B cells
matching the Ag selected --> komando/bantuan dr T-helper --> cloned B cells
Antigen
- Give examples of immunogen?
Lipopolisakarida dinding sel bakteri,
chemical nature of immunogens: macromolecule protein, polysaccharides, synthetic
polypeptides, synthetic polymers, Ab which react with nucleic acid
- What causes cross-reaction?
Cross reaction: reaksi Ab dgn Ag, ttp Ag-nya bukan Ag yg mginduksi tbntuknya Ab tsb. Tjd
karena 2 Ag ini punya epitope yg sama
- Give the properties of a molecule that influence antigenicity
- What substance is the most likely to induce a strong IR?
Adjuvants (substances which non-specifically enhance the IR to Ag)
- What is an auto-Ag?
Self-Ag, released from epithelial cells by either secretion, vesicle shedding or cell death. (Ag1st-lecture_a slide 21)
- Where is the main location of an Ag being processed?
Intracellular (ag-1st-lect_a slide 18)
- What substance play a key role in processing endogenous Ag?
The endo Ag are degraded into fragments (e.g., peptides) within the cell and displayed at the
surface of the cell nestled within a MHC class 1. Here they may be recognized by CD8+
Tcells. Most CD8+ Tcells are cytotoxic, they have machinery to destroy he infected cell
- What is an endogenous Ag?
Antigens that are generated within a cell (e.g., viral proteins in any infected cell)
Antbodies
- How many C domains does the HC of IgE contain?
4
- What is the name of the Ag-combining site of an Ab mole called?
Fab
- Upon binding with an Ag which class of Ig activates C?
Most of IgG1 and IgG3 molecules
- Mention the characteristic pattern if serum IgE
- What is the name of the molecule that is being shared by the Ig superfamily?
- Which portion of an Ab bind to Rs on effector cells?
- What part of Ig is bound to an Ag? epitopes
- What is meant by avidity of an Ab? Affinity?
Avidity: pengikatan yg multivalensi antara Ab dan Ag (functional affinity)
Affinity: attractive and repulsive forces. Afinitas bgmn Ab mngikat Ab brasal dr
keseimbangan daya tarik dan daya tolak. Kalo Ab afinitas tinggi brarti good fit, kalo afinitas
rendah brarti poor fit
- Genes coding the Ig Lc are?
- One characteristic difference between constructions of Ig Hc from Ig Lc is?
HC is twice th length of the LC
- What do & gene code for?
- What causes class switching?

Once a particular line of B cells has been selected by Ag recognition, other changes also occur
in particular the Ab is changed by a 2nd genetic rearrangement known as class-switching.
Class switching affected only the Heavy chain
What 2 Ig can be expressed together on B cell surface? IgD dan Ig
What is the contents of secretory IgA (chains & component)
What Ig classes protect body surface?

Lymphoid organs
- What is a thymus? Membentuk t-cell
- In which part of the lymph node are T cells mainly found?
- In which part of the lymph node is the memory cells?
- What cells dominates germinal centers of lymphoid tissues?
- What part is most dominated by B cells in the spleen?
- What is the major activity occurring within germinal centers?
Effector cells
- What is the predominant type of leukocyte in the blood?
neutrofil
- What is the chemotactic factor that order neutrophils to move?
IL-8
- What complement protein do neutrophils contain a receptor which is important in
phagocytosis?
-

What is the name of the R that binds Ig to a cell surface?

Fc R
One function of eosinophils is?
Allergic&worm infection
Name the ILs produced by MO
IL-1, IL-1, IL-6, IL-8, IL-10, IL-12
Name to specific cells that eradicate microbes from the bloodstream

What is the constituent cell of mononuclear phagocytic system?

What is the name of the MO lining the sinuses of the liver?
Kupffer cell
What cytokines/lymphokine activates MO?
IFN-
What causes the killing of intracellular microbes by MO?
fagolisosom
What is the key protein produced by MO when exposed to a microbe?

In peripheral blood what percentage is T cell?

How can one distinguished between T and B cells?

What is the name for IgE-R in B cell?

CD8 is a R for what molecule?

MHC class I molecules
Found in the T-cell membranes, CD8 binds to MC class I proteins; function: helps to stabilize
T cell receptors/Ag/MHC complex
What is the name of the 3rd distinct type of the lymphocyte?

What is a CD4 molecule?

Protein found in T cell membranes next to the T cell receptor. Binds to MHC class II proteins.
What are the Ag Rs on T cells?
CD 4+8
What is the marker for TH cells?
CD 4
What are the major cytokines of TH1 cell?
IL-1, IL-2, INF-, TNF-
Which T helper cells promote IgE production?

Th2
How does TH cell recognize an Ag on APC?
Karena ada MHC dan CD harus
What protein is needed to help induce an IR by APC?
MHC
What is a plasma cell?
B cell yg bisa menghasilkan antibodi
The B cell Ag-R typically consists of what constituents?
Fab
In each TCR how many C region genes are found?
Which TCR gene product can express 2 diversities?

MO can be cytotoxic for other target cells as a result of the release of?

What is the function of CD8 on the surface of lymphocytes interacting with other cell?
What helper cell activity is predominant in the intestine?
Which mouse lymphocytes population is rich in/ TCR?
What cells is the dendritic cells population?
What key cell is involved in Dth?
(Sensitized) T-cell

Complement
- Which complement component produces an anaphylatoxin? C3a c4a c5a
- For serological testing, Complement is derived from what animal?
- Which C has chemotactic properties? C3a C5a
- What is the major ligand for CR1?
- What triggers the activation of Classical C pathway?
Binding of antibody to its antigen
- Deficiency for C4 will cause what disease?
SLE-like illness, characterized by photosensitive skin rashes, renal disease and occasionally
arthritis. Whipple disease
- In serum, which C component has the highest concentration?
C3
- What component will inhibit the alternate C pathway?
-

C9 component is a member of which family proteins?

Which factor is coded for by cl 3 MHC genes?

Tolerance
- What cell types can be made tolerant?
B cells and T cells
- When is tolerance is most readily induced?
T cell dihasilkan di bone marrow, dimaturasi di thymus. B cell dihasilkan + maturasi di bone
marrow.
- Where does the major step in inducing T cell tolerance?
- What do well the mechanism of The elimination of self-reactive T cell in the thymus?
Dieliminasi, apoptosis deah oleh negstive selection of themocytes
- What is the condition called when a T cell is made tolerant by receiving insufficient or
inappropriate co-stimulation
- What can happen when one induces a very high concentration of Ag?
Producing AFC blockade
- What is the name of the mechanism when we induce tolerance in B cell?
- Which Ag can cause B cell tolerance by blocking Rs?
Orchestration & Integration of IR
What is an integrin?
- What is the R glycoprotein that bind foreign Ag?
- How are cell membrane recycles?
- Describe the basic feature of glycoproteins of the Igs superfamily
- What do we call the need for TH and B cells to recognize two different epitope on an Ag?

What is being expressed by B cell after IL-2 action on it?

What part conformed is important for recognition by B cell?
Which portion of an Ig mol is essential for control of Ab production?
Which class Ab is induced only by T-indep Ag?
What is the name of the epitope formed by an Ig Ag-binding site?
What is the suppressive chemical produced as a suppressive factor by MO?
Where can we find mostly the Tcs cell?

MHC (HLA)
- Where can we find class 1 MHC mols?
all nucleated infected cell
- How is the composition proteins molecule in class 2 MHC molecule?
- What is a pseudogene?
Gen yg ga ada fungsinya lg
- What is an individual HLA haplotype?
Human 1 haploid genotype of HLA derived from each parent
- What is meant by LD (Linkage Disequilibrium)?
Mhc-1st-lect slide 13-14
- What is name of the intrgral part of class 1 MHC?
2 microglobulin
- Describe the structure of class 2 MHC molecules
Has 2 chains, and , of equal length; sharing the job of binding protein fragment
- How can one identify class 2 MHC?
HLA dp-dq-dr ada alpha beta LI
- How can one identify class 1 MHC?
HLA a-b-c, ada alphadan beta microglobulin
- What is meant by MHC rstriction?
Cuman bisa baca MHC dari tubuh sendiri, ga bisa dari luar
Lymphokines/Cytokines/Chemokines
- What does IFN- ?
Aktifasi makrofag, dihasilkan th1
- What are the 3 major cytokines secreted by MO?
IL-1, IFN-, TNF-
- Give some examples of lymphokines?
IFNg
Interleukins 2,3,5,6,9,10,12,13,14
- What cells produce IL-2?
T helper 1
- Name some examples of chemokines
CXC, MPI-1 ( and ), RANTES
- What are the key cytokines produced by TH1 cells?
IL-1, IL-2, INF-, TNF-
- What is the major role of IL-4?
IgE activation, bcell proliferasi, th2 differerntiation
- What cells is the targetr of IL-10?
Active macrophage, B cell, mast cell, macrophage
- What is the function of TGF-?
Embryonal development, tumorigenesis, wound healing, fibrosis, immune regulation, cell
proliferation &differentiation
- Which T cell derived cytokine triggers the class switch from Ig to IgE production?
IL-4
- Which IL is classified as chemokine?
IL-8, IL-1
- IL-1 causes fever to what organ?
Vaccines/Vaccination
- What is the disadvantage of passive immunization?

Tdk trbntuk memory cell trhdap pnyakitnya

What is the disadvantage of active immunization?
Pd org immune-compromised malah bs jd infeksi
How can one produce vaccine from living microbes?
Melemahkan seluruh bagian microbes tsb, atau sebagian dr virulence factornya
What vector is mostly used to produce recombinant vaccine?
Pd recombinant vaccine, yg dipakai sbg vektor adlh organisme yg dilemahkan (attenuated
organisms). Bbrp yg sering dipake antr lain: vaccinia virus, the canary poxvirus, attenuated
poliovirus, adenoviruses, attenuated strains of Salmonella, and the BCG strain of
Mycobacterium bovis.
Name the most known adjuvant
Freunds adjuvant
Explain the cause of failure in vaccinating very young infants?
(logika) Cause of failure: salah dosis, cara pemberian yg ga bener, portal of entry nya salah,
What is the danger of using modified live vaccines?
Bs menyebabkan infeksi berat pd immune-compromised

Immunity to infection & Inflammation

- Explain what is meant by self cure in worm infection
-

What mechanism cause protection of Ab against viral diseases?

Bacterial cell wall cause activation of which defense system?

What is meant by attenuation?
(logika) melemahkan mikroorganisme hidup untuk mbuat attenuated vaccine
What cells is most important in the destruction of virus-infected cells?

What cytokines appear to be responsible for the diminished IR to lepromatous leprosy?

What cytokine is primarily responsible for activation of MO?

IFNg
Mention examples of acute phase proteins
C reactive protein, plasminogen, il 1, il 6, il 8, tnf-a
Prolonged chronic inflammation around a foreign body such as shistosome eggs will cause?

Defect in the IS
- The failure of the thymus and parathyroids to develop is called .?
Thymic aplasia
- An inherited failure to develop a functioning IS is called?
primary immunodeficiency
- What mineral is the most cause of ID?
Fe, Se, Cu, Zn, vit.A, vit.B6, vit.C, vit.E
- What microbe is the characteristic cause of ID?
virus
- Which component of the IS appear to be the most impaired in old age?
T cell
- What is the normal ratio of CD4/CD8 of an individual?
1:2 3:5
- Which component of HIV envelope is responsible for binding to T cell?
Mannan binding protein
- Which cell is deteriorated in AIDS?
CD4+ t helper
Hypersensitivity Reactions
- What is produce by mast cells?
Histmine: mediator untuk vasodilataion
- Name the conditions involved in IgE mediated degranulation
Type 1 hypersensitivity
- What is the major function of eosinophils?

Worm&allergic response
On degranulation what does a mast cell produce?
histamine
What cytokine is being produce in overproduction of IgE in atopy?

Beside IgE ligand, FcRII has also what ligand?

What cause the stopping of blood clotting during anaphylaxis?

histamine
What particles can cause Hypersensitivity pneumonitis?
In the beginning what is the history of serum sickness?
What causes Arthus phenomene?
Hs3, aktivasi komplemen sistem
How does IC causes hypersensitivity?

How can one differentiate HR type IV with HR type III?

Hs3 imune complex, hs4 delayed
How can one prevent HDNB(Hemolytic Disease of the New Born)?
Injection of anti-Rh-Ab post partum, so it will eliminates the Rh+ red cells and prevents
sensitization (hypersensitivity reaction-lecture, slide 40)

Autoimmune disease
- What cause AI disease?
Tubuh ga mampu membedakan self dan non-self determinants
- What characteristic Ab is most characteristic in SLE?
SLE: an autoimmune disease in which B-lymphocytes produce IgG upon stimulation by
nuclear components of disintegrating white blood cells
- What kind of Ab is Rheumatoid Factor?
- What is the best example of an AI disease mediated by HR type I?
- What is meant by molecular mimicry?
- Which microorganism cross react with normal tissue in ankylosing spondylitis?
C3a untuk ngeluarin chemotaxis + kirim sinyal ke mast cell utk keluarin histamine
C3b opsonin : ngiket bakteri untuk dimakan, abis titu di sitolisis oleh c8+c9
IFNa dikeluarkan oleh makrofag, IFNg dikeluarkan oleh t helper cell
Agam

maglobulin: ga ada sel B