Chapter 19 Reading Worksheet

Name ________________________

1. List the 4 types of hypersensitivity reactions:

1) Type I: anaphylactic/immediate
- <30 min
2) Type II: cytotoxic
- 5-12 hours
3) Type III: immune complex
- 3-8 hours
4) Type IV: delayed cell-mediated, or delayed hypersensitivity
- 24-48 hours
2. Type 1 Hypersensitivity
a. Two other names for this type of hypersensitivity:
- Hypersensitivity reaction (allergy)
- Intolerance
b. How soon does the reaction begin after exposure?
- 2-30 minutes
c. Two cell types involved include: (1) Mast cells

(2) Basophils

d. What type of antibody (class) is involved?

- IgE
e. Sketch (draw) a diagram of how this antibody (in part d) binds to the cells (in part c):

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f.

Name the chemicals included in the granules of the cells in part c (above) and indicate
the activity of each of these chemicals.
Chemical
Histamine

Leukotrienes

Prostaglandins

Activity
Increased vascular permeability, mucus secretion, and
smooth muscle contraction
Prolonged contraction of smooth muscles, asthma bronchial
spasms
Increased mucus production, smooth muscle contraction
within respiratory tract

g. (a.) Define anaphylaxis

- Reactions caused when certain antigens combine with IgE antibodies
- Hypersensitivity reaction involving IgE antibodies, mast cells, and basophils
(b.) Differentiate systemic and localized anaphylaxis
- Systemic: hypersensitivity reaction causing vasodilation and resulting in shock
anaphylactic shock
- Results when an individual sensitized to an antigen is exposed to it again
- Commonly caused by injected antigens
- Localized: immediate hypersensitivity reaction restricted to a limited area of skin
or mucous membrane
- Hayfever, skin rash, asthma
- Usually associated with antigens that are ingested (foods) or inhaled
(pollen)
(c.) List several examples of systemic anaphylaxis
- Reactions to insect stings, animal bites or stings
- Medications penicillin
(d.) List several examples of localized anaphylaxis
- Inhaled into respiratory tract hayfever, pollen, dust, fungal spores, animal dander
- Food allergies severe reactions can become systemic and cause death
(e.) Differentiate between a true food allergy (hypersensitivity) and food intolerance?
- Food intolerance is not true allergy lactose intolerance not caused by allergy to
milk, but an inability to digest milk sugar that leads to gastric distress
- Hives are more characteristic of true food allergy and ingestion of antigen may
result in systemic anaphylaxis
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(e.) Briefly describe allergy

- Altered, enhanced immune reaction leading to pathological changes
(f) List several treatments for Type 1 hypersensitivity
- Desensitization: series of gradually increasing dosages of the antigen carefully
injected beneath the skin
- Cause production of blocking (IgG) antibodies rather than IgE
- Antihistamines
- Epinephrine
- Corticosteroids found in some nasal sprays
The text includes Type II and Type III hypersensitivity but these topics will not be included in
this course.
3. Type IV Hypersensitivity
a. What is another name for this type of hypersensitivity?
- Delayed cell-mediated reactions/hypersensitivity
b. How soon after exposure does the reaction appear?
- More than 24 hours peaks at 48-72 hours
c. Cell types involved in these reactions include:
- T cells
- Macrophages
d. Provide three examples of Type III hypersensitivity:
(1) Allergic contact dermatitis
(2) Thrombocytopenic purpura
(3) Glomerulonephritis
4. a. Define autoimmunity:
- System of immune responses of an organism against its own cells and tissues
- Failure of an organism to recognize its own constituent parts as self loss of selftolerance
b. Define self-tolerance
- Immune systems ability to discriminate self from non-self
c. What is the relationship between autoimmunity and self tolerance?
- Autoimmune diseases occur when there is a loss of self-tolerance
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d. Provide 4 examples of autoimmune diseases:

(1) Graves disease
(3) Hashimotos thyroiditis
(2) Rheumatoid arthritis

(4) Systemic lupus erythematosus

5. Define histocompatibility antigens

- An antigen on the surface of human cells MHC I and II
- Also known as HLA (human leukocyte antigens)
a. What is tissue typing?
- DNA matching
- Match MHC/HLA type
b. Define privileged site.
- Transplants to these areas of the body does not elicit an immune response
- Corneal transplant
c. Define privileged tissue.
- Does not stimulate an immune reaction when implanted in someone else
- Porcine heart valve
d.

Differentiate the 4 types of grafts:

(1) Autograft
- Use of ones own tissue
(2) Isograft
- Use of identical twins tissue
(3) Allograft
- Use of tissue from another person whos not an identical twin
(4) Xenograft
- Use of nonhuman tissue

e. Define graft versus host disease. GVH

- Condition that can result from transplanted bone marrow that contains
immunocompetent cells
- Transplanted tissue has an immune response to the tissue recipient
Why is GVH most often associated with bone marrow transplants?
- Transplanted bone marrow contains immunocompetent cells that mount primarily
a cell-mediated immune response against the tissue into which they have been transplanted
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- The recipients lack effective immunity

f.

Why are tissue/organ recipients intentionally immunosuppressed?

- In an attempt to prevent rejection

g. List several drugs that are used to immunosuppress transplant recipients:

- Cyclosporine, tacrolimus
- Mycophenolate mofetil
- Sirolimus
- Basilximab and daclizumab
How do these drugs work?
- Cyclosporine, tacrolimus: suppresses the secretion of interleukin-2 (IL-2)
- Mycophenolate mofetil: inhibits T cell and B cell reproduction
- Sirolimus: inhibit both cell-mediated and humoral immunity
- Blocks IL-2
- Basilximab and daclizumab: blocks IL-2
What is a potential side effect of using these drugs?
- The body becomes less resistant to infection because immunosuppressant drugs
weaken the immune system
- Infections that develop will be more difficult to treat
- The drugs increase the likelihood of uncontrolled bleeding due to injury or infection
6. Define immune surveillance and explain the role it plays in cancer immunity.
- The bodys immune response to cancer
- Cancer cells have tumor-associated antigens
- Cancer cells removed by immune surveillance
- CTL (activated Tc) cells lyse cancer cells
7. Define congenital immunodeficiency and provide several examples.
- The inability, due to an individuals genotype, to produce specific antibodies or T cells
due to defective or absent genes
- Common variable hypogammaglobinulinemia
- Reticular dysgenesis
- Severe combined immunodeficiency
- Thymic aplasia (DiGeorge syndrome)
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- Wiskott-Aldrich syndrome
- X-linked infantile (Brutons) agammaglobulinemia
8. Provide several examples of acquired immunodeficiencies:
- Hodgkins lymphoma
- AIDS
9. HIV
a. When/how/where is AIDS believed to have originated?
- SIV (simian immunodeficiency virus) believed to have crossed species barrier into
humans in Africa around 1908
- Patient who died in 1959 in Congo is oldest known case
- Spread in Africa the result of urbanization
- Spread worldwide though modern transportation and unsafe sexual practices
- Norwegian sailor who died in 1976 is first known case in Western world
b. Structure of HIV
(1) Nucleic acid:
- Retrovirus two identical strands of RNA
(2) What enzymes are packed with the nucleic acid?
- Reverse transcriptase, integrase, protease
(3) Surface spikes: What molecule on the surface of HIV binds to the receptors of T
cells?
- Glycoprotein spike (gp120) combines with CD4 + receptor found on each CD4+ T
helper cell
(4) Does HIV have an envelope?
- Yes, it has a phospholipid envelope
c. Differentiate latent infection from active infection?
- Latent: viral DNA is integrated into cellular DNA as a provirus that can later be
activated to produce infective viruses
- Active: provirus is activated, allowing it to control the synthesis of new viruses
- Final assembly takes place at the cell membrane, taking up the viral
envelope proteins as the virus buds from the cell
d. Differentiate the stages of HIV infection:
(1) Phase 1
- Asymptomatic or chronic lymphadenopathy
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- Billions of CD4+ T cells infected within the first couple of weeks

- Seroconversion: HIV blood test becomes +
(2) Phase 2
- Symptomatic early indications of immune failure
- Yeast infections, diarrhea, shingles
- Numbers of CD4+ T cells decline steadily
(3) Phase 3
- AIDS indicator conditions
- Toxoplasmosis (encephalitis)
- CMV (encephalitis, blindness)
- MAI (Mycobacterium avium intracellulare)
- Pneumocystis jirovecii (pneumonia)
- Histoplasma capsulatum (disseminated infection)
- Cryptococcus neoformans (disseminated infection, meningitis)
- Kaposis sarcoma
- <200 CD4+ T cells/ul of blood
e. List and compare diagnostic methods for HIV
- Seroconversion takes up to 3 months
- Screening: ELISA detects antibodies to HIV
- Confirmation: Western Blot test
- APTIMA (RNA testing): detects viral RNA
- Plasma viral load (PVL): determined by PCR or nucleic acid hybridization (Nucleic
acid testsNATS)
- Nucleic acid tests (NATS): can detect infection within 7-10 days of infection
What is meant by seroconversion?
- Change in persons response to an antigen in a serological test
What is meant by PVL (plasma viral load)?
- A measurement of how much HIV is in the blood detect viral RNA
f.

How is HIV transmitted?

- HIV survives 6 hours outside a cell and less than 1.5 days inside a cell
- Infected body fluids transmit HIV via:

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- Sexual contact
- Breast milk
- Transplacental infection of fetus
- Blood-contaminated needles
- Organ transplants
- Artificial insemination
- Blood transfusion
g. Describe the infectious cycle of HIV and explain how different anti-HIV medications
interfere with this cycle
1) Retrovirus enters by fusion between attachment spikes and the host cell
receptors
* Fusion inhibitor blocks entry of virus into cell
2) Uncoating releases the two viral RNA genomes and the viral enzymes reverse
transcriptase, integrase, and protease
3) Reverse transcriptase copies RNA to produce double-stranded DNA
* Reverse transcriptase inhibitor analogs of nucleosides cause termination of viral
DNA by competitive inhibition
4) The new viral DNA is transported into the host cells nucleus, where it is
integrated into a host cell chromosome as a provirus by viral integrase
- Provirus may be replicated when the host cell replicates
* Integrase inhibitor blocks integration of viral DNA into host cell chromosome
5) Transcription of the provirus may also occur, producing RNA for new retrovirus
genomes and RNA that encodes the retrovirus capsid, enzymes, and envelope proteins
6) Viral proteins are processed by viral protease some of the viral proteins are
moved to the host plasma membrane
* Protease inhibitor blocks processing of precursor proteins into structural and
functional proteins
7) Mature retrovirus leaves the host cell, acquiring an envelope and attachment
spikes as it buds out
h. List several HIV medications and explain how each works.
- Fusion/entry inhibitors
- Enfuvirtide
- Maraviroc
- Reverse transcriptase inhibitors
-Tenofovir
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- Emtricitabine
- Integrase inhibitors
- Raltegravir
- Protease inhibitors
- Atazanavir
- Indinavir
- Saquinavir

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