Immunology: Grafts, Transplant, Drugs

Front 1

What is an autograph?

Back 1

A graft from self

Front 2

What is a syngeneic graft?

Back 2

A graft from an identical twin or clone

Front 3

What is a allograft?

Back 3

A graft from a nonidentical individual of the same species

Front 4

What is a xenograft?

Back 4

A graft from a different species

Front 5

What is hyperactue rejection?

Back 5

It is antibody mediated (type II) due to presence of preformed antidonor antibodies in the transplant recipient. Occurs within minutes after the transplantation

Front 6

What is acute rejection?

Back 6

It is cell mediated due to cytotoxic T cells reacting against foreign MHCs. Occurs weeks after transplantation. It is reversible with immunosuppressants such as cyclosporine and OKT3.

Front 7

What type of transplant rejection is reversible? What do you use to halt the rejection?

Back 7

Acute. Can use cyclosporine or OKT3

Front 8

What is chronic rejection?

Back 8

T-cell or antibody mediated vasuclar damage (obliterative vascular fibrosis); occurs months to years after transplantation. Irreversible. Class I MHC (non-self) is perceived by CTLs as class I MHC self presenting a non-self antigen

Front 9

What is graft vs. host disease?

Back 9

When T cells in the graft attack the recipients tissues results in severe organ dysfunction. Major symptoms include: maculopapular rash, juandice, hepatosplenomegaly, diarrhea

Front 10

What is the MOA of cyclosporine?

Back 10

Binds to cyclophilins. Complex blocks the differentiation and activation of T cells by inhibiting calcineurin, thus preventing the production of IL-2 and its receptor.

Front 11

What immunosupressant blocks the production of calcineurin thus blocking the differentiation of T cells, decreasing IL-2 production?

Back 11

Cyclosporine

Front 12

What is cyclosporine used to treat?

Back 12

acute graft rejection, selected autoimmune disorders

Front 13

What are the toxicities of cyclosporine?

Back 13

predisposes patients to viral infections and lymphoma; nephrotoxic (preventable with mannitol diuresis)

Front 14

How is one of the toxicities of cyclosporine prevented?

Back 14

nephrotoxicity can be prevented by using mannitol diuresis

Front 15

What immunosuppressant puts a patient at an increased risk for viral infections and lymphoma?

Back 15

Cyclosporine

Front 16

What is the MOA of Tacrolimus (FK506)?

Back 16

binds to FK binding protein, inhibiting secretion of IL-2 and other cytokines
*similar to cyclosporine

Front 17

What is Tacrolimus used for?

Back 17

potent immunosuppressive used in organ transplant recipients

Front 18

What are the toxicities of Tacrolimus?

Back 18

Significant: nephrotoxicity, peripheral neuropathy, HTN, pleural effusion, hyperglycemia

Front 19

What is the MOA of azathioprine?

Back 19

Antimetabolite precursor of 6 mercaptopurine that interferes with the metabolism and synthesis of nucleic acids. Toxic to proliferating lymphocytes.

Front 20

What is the immunosupressant that is toxic to proliferating lymphocytes?

Back 20

azathioprine

Front 21

What is a pro-drug of 6-MP? What is its clinical use?

Back 21

Azathioprine: used for kidney transplantation, autoimmune disorders (glomerulonephritis and hemolytic anemia)

Front 22

What are the toxicities of azothioprine?

Back 22

bone marrow suppression. active metabolic 6-MP is metabolized by xanthine oxidase - thus toxic effects may be increased by allopurinol

Front 23

What is Muromonab-CD3 (OKT3)?

Back 23

a monoclonal antibody that binds to CD3 (epsilon chain) on the surface of T cells. blocks cellular interaction with CD3 protein responsible for T cell signal transduction

Front 24

What is muromonab-CD3 used for?

Back 24

for immunosuppression after kidney transplantation

Front 25

What are the toxiciites of muronmonab-CD3?

Back 25

cytokine release syndrome, hypersensitivity reaction

Front 26

What immunosupressant causes cytokine release syndrome?

Back 26

muronmonab-CD3

Front 27

what is the MOA of sirolimus (rapamycin)?

Back 27

bind to mTOR. inhibits T cell proliferation in response to IL-2

Front 28

What is the immunosupressant that binds to mTOR?

Back 28

sirolimus (rapamycin)

Front 29

What is sirolimus (rapamycin) used for?

Back 29

immunosupression after kidney transplant in combination with cyclosporine and corticosteroids

Front 30

What are the toxicities of sirolimus?

Back 30

hyperlipidemia, thrombocytopenia, leukopenia

Front 31

What is the MOA of mycophenolate mofetil?

Back 31

inhibits de novo guanine synthesis and blocks lymphocyte production

Front 32

What is the MOA of dacclizumab

Back 32

monoclonal antibody with high affinity for the IL-2 receptor on activated T cells

Front 33

What cytokine is aldesleukin and what is it used for?

Back 33

IL-2
used for renal call carcinoma and metastatic melanoma

Front 34

What cytokine is erythropoietin? What is it used for?

Back 34

epoetin used for anemias (especially in renal failure)

Front 35

What cytokine is filgrastim? What is it used for?

Back 35

granulocyte colon stimulating factor - used for recovery of the bone marrow

Front 36

What is cytokine is Sargramostim? What is it used for?

Back 36

granulocyte macrophage colony stimulating factor - used for recovery of the bone marrow

Front 37

What is IFN-a used for?

Back 37

Hep B and C, Kaposi's sarcoma, leukemias, malignant melanoma

Front 38

What is IFN-B used for?

Back 38

MS

Front 39

What is IFN-y used for?

Back 39

CGD

Front 40

What cytokine is Oprelvekin? What is it used for?

Back 40

IL-11: used for thrombocytopenia

Front 41

What is thrombopoietin used for?

Back 41

thrombocytopenia