Showing posts with label Mnemonics. Show all posts
Showing posts with label Mnemonics. Show all posts

Mnemonics: Chemokines

Author: V. Dimov, M.D., Allergist/Immunologist and Assistant Professor at University of Chicago
Reviewer: S. Randhawa, M.D., Allergist/Immunologist and Assistant Professor at LSU (Shreveport) Department of Allergy and Immunology

CXC chemokines

P
Positive ELR (glutamic acid-leucine-arginine) chemokine CXC
PMN migration

CXCL10

1 or I
CXCL
10
IP-10
Interferon-induced T migration

Chemokines that guide T and B cell migration within lymph nodes

CXCL13 (BCA-1) - binds to CXCR5 - causes B cell migration into follicles

CCL19 (MIP-3β/ELC) and CCL21 (SLC) - both bind to CCR7 - cause T cell and dendritic cell migration into parafollicular zones of lymph nodes

Mnemonic

CXCL13 binds to CXCR5 - causes B cell migration into follicles
1 + 3 = 4, 5 (binds to CXCR5)

CCL19 and CCL21 bind to CCR7 - cause T cell cell migration into parafollicular zones of lymph nodes
9 - 2 = 7 (bind to CCR7)

What chemokine attracts naïve B cells to lymph nodes?
CXCR5. CXCL13 binds to CXCR5.

What chemokine attracts naïve T cells to lymph nodes?
CCR7. CCL19 and CCL21 bind to CCR7.

Published: 05/20/2010
Updated: 09/02/2010

Mnemonics: Mitogens

Author: V. Dimov, M.D., Allergist/Immunologist and Assistant Professor at University of Chicago
Reviewer: S. Randhawa, M.D., Allergist/Immunologist and Assistant Professor at LSU (Shreveport) Department of Allergy and Immunology

B
Bacterial products - LPS, Staphylococcus aureus Cowan
B cell stimulation

Pokeweed stimulates both T cells and B cells (mnemonic: "weed is everywhere").

Published: 05/05/2010
Updated: 05/28/2010

Mnemonics: Subcutaneous Immunotherapy (SCIT)

Author: V. Dimov, M.D., Allergist/Immunologist and Assistant Professor at University of Chicago
Reviewer: S. Randhawa, M.D., Allergist/Immunologist and Assistant Professor at LSU (Shreveport) Department of Allergy and Immunology

Mixing allergen extracts with high protease content

Mnemonic

M
Mold
Mite - cockroach has even more proteases than mite
Mixing problems - proteases degarade grass extracts in particular and decrease their potency




References

Allergen-specific immunotherapy for respiratory allergies: From meta-analysis to registration and beyond. JACI, 2010.
Allergen immunotherapy practice in the United States: guidelines, measures, and outcomes (2011) http://goo.gl/xHYjG

Published: 05/09/2010
Updated: 09/09/2011

Mnemonics: Hypersensitivity pneumonitis

Author: V. Dimov, M.D., Allergist/Immunologist and Assistant Professor at University of Chicago
Reviewer: S. Randhawa, M.D., Allergist/Immunologist and Assistant Professor at NSU

Mnemonic for Cheese washer's lung

C
Cheese washer's lung (moldy cheese)
Casei, Penicillium casei
Clavatus, Aspergillus clavatus

The relevant antigen to hypersensitivity pneumonitis cannot be identified in up to 20% to 30% of patients http://buff.ly/SJejqa

Published: 05/09/2010
Updated: 05/09/2012

Mnemonics: Complement

Author: V. Dimov, M.D., Allergist/Immunologist and Assistant Professor at University of Chicago
Reviewer: S. Randhawa, M.D., Allergist/Immunologist and Assistant Professor at LSU (Shreveport) Department of Allergy and Immunology

C3
All 3 complement pathways converge at C3 level

There are 3 pathways for activation of complement:

CAM

Classical
Alternative
Mannose-binding lectin (MBL)

CAM leads to MAC

CD59 blocks
C5-9
components of the complement, MAC, from perforating the cell membrane

References

Complement System
Complement Deficiencies

Published: 11/18/2009
Updated: 11/18/2009

Mnemonics: B Lymphocytes

Author: V. Dimov, M.D., Allergist/Immunologist and Assistant Professor at University of Chicago
Reviewer: S. Randhawa, M.D., Allergist/Immunologist and Assistant Professor at LSU (Shreveport) Department of Allergy and Immunology

Mnemonic for mature B cells - 3 types

M
Mature B cells
Main B cell type
Marginal zone B cells

I/1
B1 B cell
Innate
Intestine

Two
B2 B cell
Two
T cell dependent



B Cell Types (click to enlarge the image).

B cell inhibition

2 or II
CD22
Fc gamma RII
ITIM motifs (II)

Published: 10/26/2009
Updated: 08/26/2010

Mnemonics: Drug Allergy

Author: V. Dimov, M.D., Allergist/Immunologist and Assistant Professor at University of Chicago
Reviewer: S. Randhawa, M.D., Allergist/Immunologist and Assistant Professor at LSU (Shreveport) Department of Allergy and Immunology

When drug reactions resembling allergy happen, they are called drug hypersensitivity reactions (DHRs). Drug hypersensitivity reactions may be allergic or nonallergic. Drug allergies are drug hypersensitivity reactions caused by the immune system.

T cell-meditated drug hypersensitivity subclassified as types IVabcd

IVa - 1 = Th1
IVb - 2 = Th2
IVc = cytotoxic CD8 T cells
IVd

Diagnosis of drug allergy

HASTA la vista (Spanish, See you later)

History
Assemble a list of drugs and rank them
Stop all drug candidates
Test
Administer - dose escalation or desensitization

Classification of adverse reactions to drugs: SOAP III

Side effect
Overdose
Allergy
Pseudoallergy

Interaction
Intolerance
Idiosyncrasy



Classification of adverse reactions to drugs: "SOAP III" mnemonic (click to enlarge the image).

Rule of 10s in ADR

10% of patients develop ADR
10% of these are due to allergy
10% of these lead to anaphylaxis
10 % of these lead to death

Mnemonics for penicillin allergy skin testing

Major penicillin determinant test detects
Majority of patients with penicillin allergy

Minor determinant test
Minorizes the risk

Manifestations of beta-lactams hypersensitivity: MAUS

Maculopapular exanthema, 19%
Anaphylaxis without shock, 19%
Urticaria, 36%
Shock, anaphylactic shock, 17%

References: Clinical presentation and time course in hypersensitivity reactions to β-lactams. Allergy, 2007.

Samter's triad include asthma, aspirin sensitivity, and nasal/ethmoidal polyposis:

ASPirin
Asthma
Sensitivity to aspirin
Polyps

T
Toxic epidermal necrosis (TEN)
Thirty percent of the skin (SJS less than 10%)
"Terrible" prognosis

Management of adverse drug reactions: PAD

Premedication with antihistamines and steroids
Avoidance
Desensitization

Published: 10/01/2009
Updated: 03/01/2014

Cluster of differentiation (CD) of leukocytes

Author: V. Dimov, M.D., Allergist/Immunologist and Assistant Professor at University of Chicago
Reviewer: S. Randhawa, M.D., Allergist/Immunologist

The cluster of differentiation (cluster of designation) (abbreviated as CD) is a protocol used for the identification and investigation of cell surface molecules present on leukocytes. There are approximately 300 different CD proteins.

Type of cell CD markers
stem cells CD34+,CD31-
all leukocyte groups CD45+
Granulocyte CD45+,CD15+
Monocyte CD45+,CD14+
T lymphocyte CD45+,CD3+
T helper cell CD45+,CD3+,CD4+
Cytotoxic T cell CD45+,CD3+,CD8+
B lymphocyte CD45+,CD19+ or CD45+,CD20+
Thrombocyte CD45+,CD61+
Natural killer cell CD16+,CD56+,CD3-

List of human clusters of differentiation (CD)

CD1 - an MHC-like molecule that presents lipid molecules. There are 5 subsets - CD1a, b, c, d, e.

CD2 - a cell adhesion molecule on T cells and natural killer (NK) cells. Also called T-cell surface antigen T11/Leu-5, LFA-2, LFA-3 receptor, erythrocyte receptor, rosette receptor. CD2 is a ligand for CD58 and CD59 and is involved in signal transduction and cell adhesion; expressed in T-cell ALL and T-cell NHL. Alefacept (Amevive) is a LFA-3-IgG1 Fc fusion protein against CD2. It is used for treatment of moderate to severe plaque psoriasis.

CD3 - a component of the T cell receptor (TCR) complex, present on all T-lymphocytes. CD3 is not found on NK cells. CD3 defect causes T-B+ SCID.

CD4 - a co-receptor for MHC Class II; also a receptor used by HIV to enter T cells. Present on Th cells.

CD5 - a type I transmembrane protein found on T cells, thymocytes, and some B cells that is a ligand for CD72 and is involved in cellular activation or adhesion; expressed in B-cell CLL and T-cell NHL. A Ligand for CD5 Is CD5 (http://goo.gl/qsjT).

CD6 - adhesion molecule linking developing thymus-cells to thymus epithelial cells; co-stimulator to mature T cells.

CD7 - a type I transmembrane protein found on thymocytes, some T cells, monocytes, natural killer cells, and hemopoietic stem cells; expressed in patients with mycosis fungoides, some patients with T-cell ALL, and a few patients with acute nonlymphocytic lymphoma.

CD8 - a co-receptor for MHC Class I; also found on a subset of myeloid dendritic cells.

CD9 - a member of the Tetraspanin superfamily expressed in a variety of cells, including: pre B cells, eosinophils, basophils and platelets.

CD10 - a type II transmembrane protein found on pre-B cells, germinal-center B cells, some neutrophils, kidney cells, T-cell precursors, and epithelial cells that acts as a zinc metalloprotease cleaving peptide bonds on the amino side of hydrophobic amino acids; expressed in ALL and follicular-center-cell lymphomas.

CD11a - Subunit of LFA-1, a membrane glycoprotein that provides cell-cell adhesion by interaction with ICAM-1. Lymphocyte function-associated antigen 1 (LFA-1) consists of an alpha-chain (CD11a) and beta-chain (CD18). LAD type 1 (CD18 defect) is a problem of PMNs binding to integrins (LAF-1). Integration (tight adhesion) is the second phase of the PMN recruitment (see the "SIP" mnemonic below). LAD type 2 is a problem of PMNs binding to selectins. Selection ("rolling") is the first phase of the PMN recruitment (see the "SIP" mnemonic below). Efalizumab (Raptiva) is a humanized mAb against CD11a (α-subunit of leukocyte function antigen-1 [LFA-1]). It was used to treat moderate to severe plaque psoriasis. Due to the risk of PML, the European Medicines Agency and the FDA recommended suspension from the market in the European Union and the United States, respectively. In April, 2009, Genentech Inc. announced a phased voluntary withdrawal of Raptiva from the U.S. market.

CD11b - Subunit of MAC-1, a complement receptor (CR3). MAC-1 consists of an alpha-chain (CD11b) and beta-chain (CD18).

CD11c - Integrin alphaXbeta2 is a subunit of the complement receptor CR4. CR4 consists of an alpha-chain (CD11c) and beta-chain (CD18). CD11c is expressed in hairy cell leukemias, acute nonlymphocytic leukemias, and some B-cell CLL. CD11c is one of the defining markers for dendritic cells.

CD13 - a zinc metalloproteinase, also known as aminopeptidase N, which is found naturally on myelomonocytic cells from early differentiation through maturity; usually present on AML blasts and rarely found in some forms of lymphoma and lymphocytic leukemia.

CD14 - on macrophages, first described pattern recognition receptor (PRR, PAMP receptor), binds to bacterial LPS. Mnemonic: TLR4 and CD14 recongnize LPS. Monocytes are CD45+ CD14+.

CD15 - a carbohydrate adhesion molecule (not a protein) that mediates phagocytosis and chemotaxis. CD15 is also called Sialyl LewisX (SLeX) and SSEA-1 (stage specific embryonic antigen 1). LAD type 1 is a problem of PMNs binding to integrins (LAF-1). Integration (tight adhesion) is the second phase of the PMN recruitment (see the "SIP" mnemonic below). LAD type 2 (CD15 defect) is a problem of PMNs binding to selectins. Selection ("rolling") is the first phase of the PMN recruitment (see the "SIP" mnemonic below). Granulocytes are CD45+ CD15+.

CD16 - FcγRIII, a low-affinity Fc receptor for IgG. Found on NK cells, macrophages, and neutrophils. CD16 is the most common IgG Fc receptor. NK cells are CD45+ CD3- CD16+ or CD56+. NKT cells are CD45+ CD3+ CD16+ or CD56+.

CD18 - CD18 is the beta subunit of 3 different structures (paired with CD11 a, b, c): LFA-1 (paired with CD11a), Macrophage-1 antigen, MAC-1 (paired with CD11b), Integrin alphaXbeta2 (paired with CD11c). CD18 helps neutrophils make their way from the blood stream into the infected areas of the body. LAD type 1 (CD18 defect) is a problem of PMNs binding to integrins (LAF-1). Integration (tight adhesion) is the second phase of the PMN recruitment (see the "SIP" mnemonic below). LAD type 2 is a problem of PMNs binding to selectins. Selection ("rolling") is the first phase of the PMN recruitment (see the "SIP" mnemonic below).

CD19 - B-lymphocyte surface antigen. Probably the best marker of B-lymphocytes. CD19 is a co-receptor with CD21. Complement receptor CD21 (CR2) activates BCR if the antigen is opsonized by C3b component of the complement. CR2-CD19-CD81 complex is expressed on the surface of B lymphocytes. When CD21 (CR2) interacts with C3d, the complex is brought into the BCR. CD19 has an ITAM that is phosphorylated, thus recruiting Lyn to enhance phosphorylation.

CD20 - found on B cells, forms a calcium channel for influx of calcium required for cell activation; expressed in B-cell lymphomas, hairy cell leukemia, and B-cell CLL. Rituximab is an antibody against CD20, used for treatment of CLL. Anti-CD20 monoclonal antibody ocrelizumab helps patients with relapsing-remitting multiple sclerosis (MS) (Lancet, 2011).

CD21 (CR2) - found on B cells and follicular dendritic cells, plays a role in signal transduction. CD19 is a co-receptor with CD21. Complement receptor CD21 (CR2) activates BCR if the antigen is opsonized by C3b component of the complement. CR2-CD19-CD81 complex is expressed on the surface of B lymphocytes. CD21 is receptor for complement (CD21(CR2) binds C3d) and Epstein-Barr virus (EBV). CD21 (CR2) binds EBV, HHV8, C3d, and CD23 (low affinity IgE receptor (FceRII). CD21(CR2) is expressed in hairy cell leukemia, B-cell lymphoma, and some T-cell ALL.

CD22 is a B-lymphocyte cell adhesion molecule (BL-CAM)that binds sialic acid with an immunoglobulin (Ig) domain. CD22 is a member of Ig superfamily and SIGLEC family. CD22 is an inhibitory receptor for B cell receptor (BCR) signalling.

CD23 is the low affinity IgE receptor (FceRII). CD21 (CR2) binds EBV, HHV8, C3d, and CD23 (low affinity IgE receptor (FceRII).

CD24 - a glycoprotein expressed on the surface of most B lymphocytes and differentiating neuroblasts.

CD25 - a transmembrane protein present on activated T and B cells, myeloid precursors, and oligodendrocytes. CD25 associates with CD122 to form a heterodimer that acts as a high-affinity receptor for IL-2. CD15 is IL-2R-alpha chain. CD25 is expressed in most B-cell neoplasms, some acute nonlymphocytic leukemias, and neuroblastomas. Daclizumab is an antibody against CD25. CD 25 is one the defining markerks of T-reg cells (CD4+/CD25+/Foxp3+).

CD26 - membrane-bound protease. T-cell costimulatory molecule. Cell adhesion molecule.

CD27 - TNF-receptor and a marker of memory B cells. CD27 is the defining marker of B memory cells, just like CD25 is one of the defining markers of T-reg cells (CD4+/CD25+/Foxp3+). CD27 is a member of the TNFRSF (TNF receptor superfamily). TNFRSF includes CD27, CD30, CD40, FAS, CD120, CD134, CD137. Memory B cells are CD19+ CD27+ sIgM+. Switched memory B cells are CD19+ CD27+ sIgM-.

CD28 - present on all T-cells, and when matched with the appropriate ligand (CD80 or CD86), it has co-stimulatory effect on T-cells. CD28 is also expressed on eosinophil granulocytes, especially after tissue infiltration.

CD29 - integrin beta-1 - a cell adhesion molecule.

CD30 - present on activated T and B cells. CD30 is expressed in Hodgkin disease, some T-cell lymphomas, and anaplastic large cell lymphomas. CD30 is a member of the TNFRSF. TNFRSF includes CD27, CD30, CD40, FAS, CD120, CD134, CD137.

CD31 - PECAM-1, a cell adhesion molecule on platelets and endothelial cells. CD31 is from Ig superfamily, it binds CD38.

CD32 - FcγRII, a receptor for the Fc (constant) region of immunoglobulin G (IgG). CD32 down-regulates IgG. Binding of FcγRIIb is the proposed mechanism of action of IVIG.

CD33 - found on immature myeloid cells, including acute myeloid leukemia blasts and mature monocytes.

CD34 - stem cell marker and adhesion molecule. CD34 is found on hematopoietic precursors (high concentrations in umbilical cord blood) and embryonic fibroblasts. CD34 is the defining marker of stem cells. CD34 binds CD62L (L selectin).

CD35 - complement receptor 1 (C3b/C4b receptor). Complement receptor (CR2) is CD21 - it activates BCR if the antigen is opsonized by C3b component of the complement. CR2-CD19-CD81 complex is expressed on the surface of B lymphocytes.

CD36 - Platelet glycoprotein IV or IIIb (GP IV / GP IIIb).

CD37 - A leucocyte restricted tetraspanin expressed primarily in B cells, but also found on T cells, monocytes and granulocytes.

CD38 - involved in ecto-ADP-ribosyl cyclase and cell activation on many hematopoietic, plasma, and B and T activated cells; marker increases with HIV seroconversion, coexpression with CD8 associated with progression (indicates persistent viral stimulation).

CD40 - a co-stimulatory protein found on antigen presenting cells. CD40 combines with CD154 (CD40L) on T cells to induce antibody isotype switching in B cells. CD40 and CD40L (CD154) defect leads to hyperIgM syndrome (HIGM3). TNFRSF includes CD27, CD30, CD40, FAS, CD120, CD134, CD137.

CD41 - platelet glycoprotein (GPIIb/IIIa) integrin acts as a receptor for fibrinogen and several other extracellular matrix molecules. Its absence causes Glanzmann's thrombasthenia.

CD42 - platelet glycoprotein Ib/V/IX complex(GPIb/V/IX). Expressed on platelets and is a late, specific marker of megakaryocyte differentiation. The glycoprotein Ib/V/IX complex is essential for normal haemostasis; deficiency results in Bernard-Soulier Syndrome, a syndrome of thrombocytopenia and giant platelets.

CD43 - a sialomucin.

CD44 - a cell-surface glycoprotein involved in cell-cell interactions, cell adhesion and migration. PMN adhesion to the endothelium is mediated through CD44.

CD45 - leukocyte common antigen (LCA), protein tyrosine phosphatase, receptor type, C (PTPRC). CD45 is a type I transmembrane protein present on all hematopoietic cells, except erythrocytes. Various isoforms of CD45 exist, memory T lymphocytes express the shortest CD45 isoform, CD45RO. CD45RA is present on naïve T cells. CD45RO is present on memory T cells. CD45 is defective in T-B+NK+ SCID.

CD46 - inhibitory complement receptor which is ubiquitously expressed on human cells. CD46 is a membrane cofactor protein (MCP).

CD47 - Membrane protein, which is involved in the increase in intracellular calcium concentration that occurs upon cell adhesion to extracellular matrix.

CD49a-f - Very late antigen (VLA). CD49 (VLA) is present on WBCs. VLA participates in cell adhesion.

CD53 - A leucocyte restricted tetraspanin expressed by B cells, T cells, dendritic cells, monocytes, NK cells and granulocytes.

CD54 - Intercellular adhesion molecule -1 (ICAM-1). CD54 (ICAM-1) binds LFA-1 (CD50) and is a receptor for rhinovirus.

CD55 - complement Decay-Accelerating Factor (DAF). CD55 (DAF) prevents the assembly of the C3bBb complex (the C3-convertase of the alternative pathway) or accelerates the disassembly of preformed convertase, thus blocking the formation of the membrane attack complex (MAC). CD55 is deficient in paroxysmal nocturnal hemoglobinuria (PNH). CD59 absence also leads to PNH.

CD56 - NCAM (neural cell adhesion molecule), a marker for natural killer (NK) cells and some T-lymphocytes. NK cells are CD45+ CD3- CD16+ or CD56+. NKT cells are CD45+ CD3+ CD16+ or CD56+.

CD58 (LFA-3) - a membrane protein present on many hemopoietic cells and fibroblasts that acts as a ligand for CD2 and may be involved in T-cell function.

CD59 - Protectin or Membrane attack complex inhibition factor (MACIF); MAC-inhibitory protein (MAC-IP). CD59 inhibits MAC which consists of C5-9 (mnemonic). CD59 or CD55 absence leads to paroxysmal nocturnal hemoglobinuria (PNH).

CD61 - Integrin beta 3 (Itgb3); Glycoprotein IIIa (GPIIIa): fibrinogen receptor; major role is in platelet aggregation. Defects in Itgb3 cause Glanzmann's thrombasthenia. Platelets are CD45+ CD61+.

CD62E - E-selectin is a cell adhesion molecule expressed on Endothelial cells activated by cytokines. CD62E is a ligand for CD15, CD44, and CD162. CD62E and CD15 are defective in LAD2.

CD62L - L-selectin is a cell adhesion molecule found on Leukocytes. CD62L binds CD34, CD15 and MADCAM. Central memory T cells are CD27+, CCR7+, CD62L+.

CD62P - P-selectin is a cell adhesion molecule (CAM) found in granules in endothelial cells and activated Platelets. CD62P binds CD162.

CD64 is a is a high affinity IgG receptor, FcγRI.

CD66 - CEA, a cell adhesion molecule (CAM) of Ig superfamily.

CD68 - highly glycosylated transmembrane protein which is mainly located in lysosomes. Present in macrophages in many human tissues including Kupffer’s cells and macrophages in the red pulp of the spleen, in lung alveoli, in lamina propria of the gut, and in the bone marrow. Used as immunocytochemical marker for staining of monocytes/macrophages.

CD69 - An early activation marker on T cells and NK cells.

CD71 - Transferrin receptor, mediates cellular uptake of iron.

CD72 - Mediator of B- and T-cell interactions.

CD80 - when bound to CD28 on T-cells, can provide the costimulatory effect; also referred to as B7.1, one of the B7 molecules. Causes up-regulation of a high affinity IL-2 receptor allowing T cells to proliferate. Abatacept (Orencia) is CTLA4-human IgG1 fusion protein against B7-1 (CD80) and B7-2 (CD86). It us used for treatment of rheumatoid arthritis and juvenile rheumatoid arthritis.

CD81 - A tetraspanin expressed in a wide variety of tissues, which plays an important role in B cells as part of the B cell co-receptor complex with CD19, Leu 13 and CD21. Also expressed in T cells, NK cells, Dendritic cells, Monocytes and blood progenitors.

CD82 - Member of the tetraspanin family of transmembrane proteins. Broad tissue distribution including B cells, T cells, Granulocytes, Monocytes and CD34+ progenitors.

CD83 - a transmembrane glycoprotein of the Ig superfamily. Expressed on cultured dendritic cells, interdigitating, follicular, and circulating dendritic cells as well as some proliferating lymphocyte of all human cell lines.

CD86 - when bound to CD28 on T-cells, can provide the costimulatory effect; also referred to as B7.2, one of the B7 molecules. Causes up-regulation of a high affinity IL-2 receptor allowing T cells to proliferate. Abatacept (Orencia) is CTLA4-human IgG1 fusion protein against B7-1 (CD80) and B7-2 (CD86). It us used for treatment of rheumatoid arthritis and juvenile rheumatoid arthritis.

CD87 - also referred to as the urokinase type plasminogen activator receptor, provides a binding point for urokinase type plasminogen activator.

CD88 - C5a receptor.

CD89 - FcalphaRI - receptor for IgA.

CD90 Thy-1 - Thymus cell antigen.

CD91 - Low density lipoprotein (LDL) receptor-related protein 1 (LRP1) (also known as α2-macroglobulin receptor), a major endocytotic receptor with over 35 known ligands including amyloid precursor protein (APP), ApoE, and many proteins involved with protease regulation.

CD95 - Fas Receptor, a receptor for Fas ligand, an extrinsic apoptotic signal. Its aliases include CD95/FasR, Apo-1, and tumor necrosis factor receptor superfamily, member 6 (TNFRSF6). CD95 (Fas) causes apoptosis when ligated by FasL. CD178 is Fas ligand. CD178 (FasL) binds CD95 (Fas) and causes apoptosis. CD95 (Fas) is defective in ALPS.

CD99 - CD44 and CD99 - both participate in leukocyte migration. CD99 is expressed on all leukocytes but highest on thymocytes and augments T-cell adhesion, apoptosis of double positive T cells, and participates in migration and activation.

CD103 - a type I transmembrane protein present on intestinal intraepithelial lymphocytes, some circulating leukocytes, and some T cells that facilitates adhesion to epithelia; expressed in hairy cell leukemia and some B-cell CLL.

CD105 - Endoglin, a regulatory component of the TGF-beta receptor-cell complex. Mediates cellular response to TGFbeta.

CD106 - VCAM-1 is an adhesion molecule involved in white blood cell migration.

CD117 (C-kit) is required for mast cell survival and is the ligand for stem cell factor (SCF).

CD120 - a member of the TNFRSF (like CD27, CD30, CD40, FAS).

CD127 - IL-7 receptor alpha chain. Thymic stromal lymphopoietin (TSLP) signals through a heterodimeric receptor complex composed of the TSLP receptor and the IL-7R alpha chain. Some researchers have classified TSLP as a "master regulator" of the Th2 response due to overexpression of the cytokine in pulmonary tissue and skin cells result in Th2-induced asthma and dermatitis. A defect in IL-7RA leads to SCID (T-/B+/NK+). Anti-TSLP is a potential new therapeutic target in asthma.

CD142 - Tissue factor, a major initiator of blood-clotting.

CD143 - Angiotensin-converting enzyme.

CD144 - Cadherin, a calcium-dependent adhesion molecule at intercellular junctions, found mainly in the vascular endothelium. Recent research indicates that CD144 may be present on some leucocytes as well.

CD152 - Cytotoxic T-lymphocyte antigen-4 (CTLA-4). CTLA-4 binds to CD80 and CD86 receptors with a higher affinity than CD28, and inhibits T cell activation.

CD154 (CD40L) - ligand for CD40. CD154 is a co-stimulatory molecule that plays many roles, best known for activating B cells but it also activates APCs in association with T cell receptor stimulation by MHC molecules.

CD158 - KIR expressed on NK and T cells. CD158 binds HLA class I and inhibits NK or T cell cytotoxicity.

CD159 is expressed on NK cells and modulates NK killing.

CD162 is a P-selectin glycoprotein ligand-1 (PSGL-1). CD162 binds to CD62P.

CD163 - M130; HbSR; RM3/1 antigen. A glycoprotein endocytic scavenger receptor for haptoglobin-hemoglobin complexes. Found specifically on monocytes/macrophages and some dendritic cells. Involved in anti-iflammatory processes. Soluble form shed upon Toll-like receptor activation.

CD166 - activated leukocyte cell adhesion molecule (ALCAM).

CD178 is Fas ligand. CD178 (FasL) binds CD95 (Fas) and causes apoptosis.

CD209 - DC-SIGN, C-type lectin receptor found on dendritic cell subsets.

CD303 - BDCA-2, a type II transmembrane C-type lectin which is involved in endocytosis of antigens for processing in plasmacytoid dendritic cells. Activation decreases type I interferon production.

References and related reading

Cluster of differentiation, Wikipedia.
List of human clusters of differentiation (CD), Wikipedia.
TSLP calms inflammation. The Journal of Experimental Medicine, Vol. 206, No. 3, 493, 2009.
Immunomodulatory Receptor CD300a  http://goo.gl/36OCR - In other news, there are now officially more than 300 CD markers!

Published: 12/15/2007
Updated: 04/17/2012

Mnemonics: Primary Immunodeficiency

Author: V. Dimov, M.D., Allergist/Immunologist and Assistant Professor at University of Chicago
Reviewer: S. Randhawa, M.D., Allergist/Immunologist and Assistant Professor at LSU (Shreveport) Department of Allergy and Immunology

Which PIDD is most common? 

Antibody (50%), T cell defects (20%), phagocyte def (20%), Complement (2%). Mnemonic: 50-20-20-2

Primary Immunodeficiency (PIDD): pH CCC

Phagocyte
Humoral

Cellular
Combined
Complement

CGD mnemonic: 3

3 letters - CGD
3 stages of testing: DHR, immunoblot, genotyping
3 prophylaxis modalities: TMP-SMX, antifungal, INF-gamma

JAK3 Deficiency

JAK3 defect causes a form of SCID.
Janus
"Just fine" B cells (T-/B+/NK-)


Key steps of the JAK-STAT pathway. Image source: Wikpedia, public domain.


Cytokine Signaling. This video is from: Janeway's Immunobiology, 7th Edition Murphy, Travers, & Walport. Source: Garland Science.

Type I cytokine receptors are mediated through JAK/STAT and bind: IL-2, 3, 4, 5, 6, 7, 9, 10, 12, 13, 15, GM-CSF.

LAD type 2

CD15
F
Fifteen
Fucose, Sialyl LewisX (SLeX)
FucT-1 gene

Surface Markers

Stem cell CD 34+
Plasma cell CD 38+

Stem cell CD 34
Wiskott-Aldrich CD 43 defect

L
Ligands on
Lymphocytes

CD40L on T helpers (CD4+)
FAS-L on CTL 9CD8+)

CD40 on B cells
FAS ("death signal") on cells to be killed by CTLs

CD40 and CD40L defects are among the causes of HyperIgM syndrome.

Four - CXCR4 (CD4) - also involved in WHIM syndrome (PIDD)

A mutation of CXCR4 causes a phagocytic defect called WHIM syndrome (Warts, Hypogammaglobulinemia, Infection, and Myelokathexis). Myelokathexis refers to retention (kathexis) of neutrophils in the bone marrow (myelo). Myelokathexis causes severe chronic leukopenia and neutropenia.

ZAP70

ZAP 70 binds to the Zeta chain (CD247) of the T-cell receptor.

Z
ZAP-70
Zeta-chain-associated protein kinase 70 (70 is the molecular weight in kDa)

ZAP70 deficiency is a form of SCID (T-/B+/NK+), one of the few SCID forms with palpable LN.


T-cell receptor complex with TCR-α and TCR-β chains. Image source: Wikipedia.

Dose of IVIG in PIDD

400-600 mg/kg/month
4 letter words:
IVIG
CVID
SCID

All of the following are causes of hyper-IgM syndrome except:

A. CD40L deficiency on B cells
B. AID defect (activation-induced cytidine deaminase gene)
C. CD40 deficiency on B cells
D. CD40L deficiency on T cells
E. UNG defect

Answer: A. There is no CD40L on B cells. CD40L is on T cells.

Published: 03/01/2009
Updated: 01/19/2012

Mnemonics: Eosinophilic Esophagitis

Author: V. Dimov, M.D.
Reviewer: S. Randhawa, M.D.

Treatment for eosinophilic esophagitis: SADD

Steroids
Acid suppression
Diet
Dilatation of esophagus

Published: 08/09/2008

Mnemonics: Other Pulmonary Disorders

Author: V. Dimov, M.D., Allergist/Immunologist and Assistant Professor at University of Chicago
Reviewer: S. Randhawa, M.D., Allergist/Immunologist and Assistant Professor at LSU (Shreveport) Department of Allergy and Immunology

Cystic Fibrosis

C
CF
Caucasians
Children
CFTR gene mutation
Chronic lung infections
Cirrhosis
Chloride in sweat
Chest physiotherapy

Alpha-1 Antitrypsin Deficiency

Over 95% of cases of pulmonary and hepatic disease are due to to the Pi-ZZ phenotype.

Z means
Zig-zagged A1AT in the endoplasmic reticulum

Interstitial Lung Diseases (ILD)

I
ILD
IPF 30%
Idiopathic
Ineffective CS

There are 4 histology patterns in ILD -- BLUD:

BIP, bronchiolitis with interstitial pneumonia
LIP, lymphocytic interstitial pneumonia
UIP, usual interstitial pneumonia, this is IPF
DIP, desquamative interstitial pneumonia

R
Reticular pattern, more than 25% of lung involved
Resistance to CS

Chronic Obstructive Pulmonary Disease (COPD)

Treatment -- B CAOS:

Bronchodilators
Corticosteroids
Antibiotics and Vaccinations
Oxygen
Smoking cessation

Allergic Bronchopulmonary Aspergillosis (ABPA)

A
ABPA
Asthma
Aspergillus

Created: 02/08/2008
Updated: 02/09/2008

Mnemonics: Diagnosing Allergies

Author: V. Dimov, M.D., Allergist/Immunologist and Assistant Professor at University of Chicago
Reviewer: S. Randhawa, M.D., Allergist/Immunologist and Assistant Professor at LSU (Shreveport) Department of Allergy and Immunology

Allergen solutions for skin prick testing: PONI F

Positive control (histamine)
Occupational allergens (ammonium persulphate, platinum salts, antibiotics, and latex)
Negative control (diluent)
Inhaled allergens (house dust mite (HDM), grass pollen, cat dander, dog hair)
Food allergens

References: Diagnosing allergy. Clinical review: ABC of allergies. BMJ 1998;316:686.

Disadvantages of skin prick test: FISH

Food allergens (less standardized), less reliable than inhaled allergens
Itching
Skin conditions (eczema or dermatographism) interfere with interpretation
Histamine antagonists (antihistamines) suppress skin reaction

References: Diagnosing allergy. Clinical review: ABC of allergies. BMJ 1998;316:686.

RAST and ImmunoCAP advantages: MSSS

Medications (antihistamines) do not influence the test
Skin conditions do not interfere with the test
Safe
Specificity 90% for inhaled allergens

References: Diagnosing allergy. Clinical review: ABC of allergies. BMJ 1998;316:686.

Published: 01/24/2008
Updated: 02/26/2009

Mnemonics: Allergic Conjunctivitis

Author: V. Dimov, M.D., Allergist/Immunologist and Assistant Professor at University of Chicago
Reviewer: S. Randhawa, M.D., Allergist/Immunologist and Assistant Professor at LSU (Shreveport) Department of Allergy and Immunology

Classification of Ocular Allergy: A SPA VGC

Allergic Conjunctivitis – 3:

AAC
SAC
PAC

Keratoconjunctivitis:

Atopic Keratoconjunctivitis (AKC), atopic dermatitis-related, lower eyelid
Vernal Keratoconjunctivitis (VKC), upper eyelid

Giant Papillary Conjunctivitis (GPC), contact lenses-related, upper eyelid
Contact dermatoconjunctivitis

Medications for SAC and PAC

5 classes of topical drugs:

1. antihistamines
2. mast cell stabilizers, e.g. cromolyn
3. antihistamine/mast cell stabilizer combinations, e.g. olopatadine, ketotifen
4. steroids
5. non-steroidal anti-inflammatory agents (NSAIDs), e.g. ketorolac

Mnemonic for medications for SAC and PAC: MD VANS

Mast cell stabilizers
Dual-acting: antihistamine/mast cell stabilizer

Vasoconstrictors, not recommended
Antihistamines
NSAIDs, only ketorolac, not recommended
Steroids, only loteprednol, by ophthalmologist



Ocular antihistamines (eye drops) (click to enlarge the image).

Related reading

Vernal Keratoconjunctivitis - NEJM images, 2012.

Published: 09/25/2008
Updated: 01/26/2012

Mnemonics: Asthma

Author: V. Dimov, M.D., Allergist/Immunologist and Assistant Professor at University of Chicago
Reviewer: S. Randhawa, M.D., Allergist/Immunologist and Assistant Professor at LSU (Shreveport) Department of Allergy and Immunology

Asthma is the most common chronic respiratory disease, affecting up to 10% of adults and 30% of children (JACI, 2011). Prevalence of asthma is 8%, prevalence of AR is 3 times higher (24%). 40% of patients with AR have asthma, 80% of patients with asthma have AR.

Classification of asthma - mnemonic

I'M MS ("I'm a Master of Science")

Intermittent
Mild persistent
Moderate persistent
Severe persistent

Number of controllers used in each stage of the classification of asthma - mnemonic:

I'M MS
0 1 2 3

0 - SABA PRN (albuterol) only
1 - ICS or LTRA
2 - ICS/LABA or ICS plus LTRA
3 - ICS/LABA and LTRA, consider omalizumab (anti-IgE mAb)

Allergic Rhinitis and its Impact on Asthma (ARIA): Achievements in 10 years and future needs. ARIA has reclassified AR as mild/moderate-severe and intermittent/persistent. This classification closely reflects patients' needs and underlines the close relationship between rhinitis and asthma. http://buff.ly/QL1eYI

Pathogenesis of Asthma

Lymphocytes

CD4, Th2
Central effector cells
Cytokine release

Overview of adhesion molecules, 3 groups remembered by the mnemonic SIS:
Selectins
Integrins
Superfamily Ig

Mast cells are subdivided into 2 types based on proteinase content:
TC mast cells -- Tryptase and Chymase in granules
T mast cells -- Tryptase only granules

Mast cells
Mediator release
Mucosal inflammation

Mediators from eosinophils are remembered by the mnemonic CML EEE:

Cytokines
MBP
Lipid Mediators

EDN
ECP
EPO

Eosinophils
Emit
Eight mediators (at least 8, the first C in the mnemonic covers cytokines, chemokines and growth factors)

Overview of adhesion molecules, 3 groups remembered by the mnemonic SIS:
Selectins
Integrins
Superfamily Ig

There are 4 families of eicosanoids (PP-LT): prostaglandins (PG), prostacyclins (PGI), leukotrienes (LT) and thromboxanes (TX).

Diagnosis of Asthma

A mnemonic to remember the different PFTs is SPIROMEtry:

Spirometry
PEFR
Inhalation tests:
Reversibilty of
Obstruction with beta-agonist
Metacholine challenge
Exhaled NO

The phases of spirometry can be remembered by the mnemonic BEIF:
Breath normally x 6 times
Exhale fully
Inhalation (deep)
Forceful exhalation for 6 seconds

FEV1/FVC
FEF 25-75
R
Regular (normal) or
Raised in
Restriction

FEV1
1ow in both obstructive and restrictive disease

Bronchodilation test: BB RR
Baseline spirometry
Beta-agonist
Repeat spirometry
Reversibilty of obstruction

Methacholine challenge test, remember the numbers: 5-25-20-5:
5 breaths
25 mg/mL metacholine
20% FEV1 reduction
5% of patients with asthma have a negative test, 95% react to the challenge

Test for Respiratory and Asthma Control in Kids (TRACK)

5
5 questions
5 year-old or younger (2-5 years)

Test for respiratory and asthma control in kids (TRACK) - mnemonic: 3S

Symptoms (3 questions)
SABA use
Steroid use

Test for respiratory and asthma control in kids (TRACK) - complete mnemonic: 3S

Symptoms - SPA: Symptoms - how often, Play, At night, past 4 weeks
SABA use, past 12 weeks (3 months)
Steroid use, past 12 months (1 year)

Time frame of TRACK:

Symptoms - 4 weeks (1 month)
SABA use - 12 weeks (3 months), quarter
Steroid use - 12 months (1 year)

References:
Test for Respiratory and Asthma Control in Kids (TRACK): A caregiver-completed questionnaire for preschool-aged children. Kevin R. Murphy et al. JACI. Volume 123, Issue 4, Pages 833-839.e9 (April 2009).

Differential Diagnosis of Asthma

C
Children
Congenital conditions
CF

A
Adults
Acquired conditions

Asthma Classification: M MMS

M
ild intermittent

Mild persistent
Moderate persistent
Severe persistent

Treatment

One can remember the stages by the number of controller medications a patient would need at each stage:

I'M MS
0 1 2 3

"Rule of 2s” is used to determine level of control. If any of these are positive, consider a daily controller medication:

- daytime symptoms more than 2 days/wk
- rescue β2 -agonist use more than 2 times per week
- nighttime symptoms more than 2 nights/mo
- more than 2 asthma exacerbations per year
- more than 2 rescue β2-agonist canisters/yr

Reference for rule of 2's: Audio: Asthma, noon conference. Muthiah Pugazhenthi. Podcasting Project for the UT Internal Medicine Residency Program, 12/2006.

If asthma treatment is not working, check DAT:

Diagnosis - not asthma at all (VCD, CF, FBA), asthma plus AR, GERD
Adherence - compliance with medication
Technique - NEB, HFA with spacer, DPI, etc.

3 C's of care - communication, continuity, concordance (finding common ground) are critical for asthma management (http://goo.gl/8gJM6).

Medications

S
Singulair
Single daily dose
Suicude risk (potential)

LABA
M
Monotherapy
Masks inflammation
Mortality increase

Corticosteroids
C category during pregnancy

Budesonide
B category during pregnancy

Exercise-induced asthma treatment: CLIMB

Cromolyn
Leukotriene receptor antagonist
Inhaled steroids
Mast cell stabilizers other than cromolyn
Beta agonists

Leukotriene receptors

Leukotriene
B4
BLT 1, 2 receptors

Leukotriene
C4, D4, E4
CysLT 1, 2 receptors

Ciclesonide mnemonic

C
Ciclesonide
Converted to active form (des-CIC)
Carboxyl-esterases in bronchial epithelial cells
Clearance by liver

Published: 01/24/2008
Updated: 11/27/2012

Mnemonics: T Lymphocytes

Author: V. Dimov, M.D., Allergist/Immunologist and Assistant Professor at University of Chicago
Reviewer: S. Randhawa, M.D., Allergist/Immunologist and Assistant Professor at NSU

Th
I
Infection
Intracellular pathogens
Immune diseases, i.e. autoimmune diseases
Inflammatory bowel disease (IBD)

Th2
Antibodies, i.e. humoral immunity
Allergy
Asthma
Allergic rhinitis

The mnemonic for different T-cell subtypes is FERMNN G ("pheromon G"):

Four, CD4, helper cells (Th1 and Th2)
Eight, CD8, killer cells
Regulatory, formerly known as suppressors
Memory
Naïve T cells
Natural Killer T cells (NKT)

Gamma/delta T cells (γδ)

CDs on Different Cells

T cells have CD 3, 4 and 8 (double, 4 x 2)
B cells have CD 19, 20 and 40 (double 20 x 2)

There are 3 types of interferons -- ABG:
Alpha, IFN-α
Beta, IFN-β
Gamma, IFN-γ

IFN
α
αlba (white blood cells)

IFN-β
fibroβlasts

Interleukins: Hot T-Bone stEAk

IL-1: fever (Hot)
IL-2: stimulates T cells
IL-3: stimulates Bone marrow
IL-4: stimulates IgE
IL-5: stimulates IgA

MHC

MHC class II molecules bind to CD4+/CD8- T cells. MHC class I molecules bind to CD8+/CD4- T cells. This relationship is remembered by the mnemonic 2 x 4=8 and 1 X 8 = 8, the final result is always 8, 2 is MHC II, 1 is MHC II, 4 is CD4, 8 is CD8.

MHC numbers: 2, 4, 8, 16

MHC2 x CD4 = 8 - MHC2 binds best 16 amino acid-long peptides (11-30)

MHC1 x CD8 = 8 - MHC2 binds best 8 amino acid-long peptides (8-10)

Transduction pathways

ITAM
Activates transduction pathways

ITIM
Inhibits transduction pathways

3 sequential Ts:
Transduction - MHC and TCR, CD28-CD80/86
Transcription - nuclear factors - NFkB
Translation - IL-2

MHC Genes

MHC I - genes ABC
MHC II - genes D, again alphabetical - DP, DQ, DR
Both on chromosome 6

I......II
ABCD PQR

MHC

I
1 letter HLA: ABC
1 polypeptide chain MHC (alpha and beta-2 microgobulin)

II
2 letters HLA: DP, DQ, DR
2 polypeptide chains MHC (alpha and beta)

Surface Markers

L
Ligands on
Lymphocytes

CD40L on T helpers (CD4+)
FAS-L on CTL 9CD8+)

CD40 on B cells
FAS ("death signal") on cells to be killed by CTLs

ZAP70

ZAP 70 binds to the Zeta chain (CD247) of the T-cell receptor.

Z
ZAP-70
Zeta-chain-associated protein kinase 70 (70 is the molecular weight in kDa)

ZAP70 deficiency is a form of SCID (T-/B+/NK+), one of the few SCID forms with palpable LN. ZAP-70 deficiency is a form of SCID with no CD8 cells and no T cell function, but with normal B and NK cells.


T-cell receptor complex with TCR-α and TCR-β chains. Image source: Wikipedia.

This video describes the process by which apoptosis is activated by T cells. This video is from: Janeway's Immunobiology, 7th Edition Murphy, Travers, & Walport. Source: Garland Science. Severe combined immunodeficiency (SCID) - 4 groups according to T/B/NK cells (click to enlarge the image). Discovery of T-cell Receptors (video) National Jewish Health scientists John Kappler, PhD, and Philippa Marrack, PhD, discuss their discovery of the T-cell receptor - the protein found on the surface of T Cells that helps detect specific antigens, or foreign invaders, in the body:
Published: 01/24/2008
Updated: 08/03/2012

Mnemonics: Eosinophils

Author: V. Dimov, M.D., Allergist/Immunologist and Assistant Professor at University of Chicago
Reviewer: S. Randhawa, M.D., Allergist/Immunologist and Assistant Professor at LSU (Shreveport) Department of Allergy and Immunology

Mediators from eosinophils are remembered by the mnemonic CML EEE:

Cytokines
MBP
Lipid Mediators

EDN
ECP
EPO

Published: 01/24/2008
Updated: 11/29/2008

Mnemonics: Mast Cells and Basophils

Author: V. Dimov, M.D., Allergist/Immunologist and Assistant Professor at University of Chicago
Reviewer: S. Randhawa, M.D., Allergist/Immunologist and Assistant Professor at LSU (Shreveport) Department of Allergy and Immunology

Mast cells are subdivided into 2 types based on proteinase content:

TC mast cells -- Tryptase and Chymase in granules
T mast cells -- Tryptase only granules

TC
Tryptase/Chymase, Kit+/CD88+

T
Tryptase only, Kit+/CD88-

D
Dermis
Dual granules - Tryptase/Chymase
Dual surface markers - Kit+/CD88+

M
Mast cells
Major cell (10 µm) -- 2 times bigger than basophils (5 µm)
Minute granules (0.2 µm)
More granules (1000) than basophils (80)
Monophorm (round) nucleus

B
Basophils
Blood circulation
Bigger granules (1.2 µm)
Bilobar nucleus

Mast Cell Mediators

The mediators fall into 3 groups remembered by the mnemonic ONC.

ONC:
Old
New
Cytokines

Leukotriene receptors

Leukotriene
B
B4
BLT 1, 2 receptors

Leukotriene
C
C4, D4, E4
CysLT 1, 2 receptors

What is the most potent bronchoconstrictor?

(A) LTB4
(B) LTC4
(C) acetylcholine
(D) histamine
(E) thromboxane A2 (TXA2)
(F) methacholine

Answer: B

CysLTs are the most potent bronchoconstrictor agents yet discovered, about 100-1000 times more potent than histamine. The second most potent bronchoconstrictor is thromboxane A2 (TXA2).

Cysteinyl‐LTs and LTB4 are, respectively, the most potent bronchoconstrictor agents and one of the most effective leukocyte chemotaxins yet.

Mast Cell Disorders (presentation on Google drive):



Published: 01/24/2008
Updated: 05/12/2009

Mnemonics: Adaptive Humoral Immunity: B-cells and Immunoglobulins

Author: V. Dimov, M.D., Allergist/Immunologist and Assistant Professor at University of Chicago
Reviewer: S. Randhawa, M.D., Allergist/Immunologist and Assistant Professor at LSU (Shreveport) Department of Allergy and Immunology

Antibodies (immunoglobulins, Ig)

There are 5 immunoglobulin classes remembered by the mnemonic GAMED: Ig G, A, M, E, D.

Ig
G
Greatest serum concentration, half-life and number of sub-classes

Ig
M
Macro -- largest Ig

Ig
A
Adhesion prevention
Aggregates -- 2 units linked together
Alternative pathway of complement
Activation

Fc gamma receptors for IgG: CD 16, 32, 64 (double).

Fc gamma receptors for IgG (CD 16, 32, 64) are labeled in "reverse" order:

CD 16 - FcR III - low-affinity
CD 32 - FcR II - intermediate-affinity
CD 64 - FcR I - high-affinity

CD 16 and CD 56 are present on NK cells.

Fc II receptors:
CD 32 - Fc gamma II
CD 23 - Fc epsilon II, Fc receptors for IgE

CD32 down-regulates IgG. Binding of FcγRIIb is the proposed mechanism of action of IVIG.

Downregulation of IgG

T
Thirty-two, CD 32
Two, FcR gamma II
Turns downs (down regulates) IgG

CDs on Different Cells

T cells have CD 3, 4 and 8 (double, 4 x 2)
B cells have CD 19, 20 and 40 (double 20 x 2)

Stem cell CD 34+
Plasma cell CD 38+

Stem cell CD 34
Wiskott-Aldrich CD 43 defect

Interleukins: Hot T-Bone stEAk

IL-1: fever (Hot)
IL-2: stimulates T cells
IL-3: stimulates Bone marrow
IL-4: stimulates IgE
IL-5: stimulates IgA




B Cell Types (click to enlarge the image).

Published: 01/24/2008
Updated: 05/14/2010

Mnemonics: Innate Immune System

Author: V. Dimov, M.D., Allergist/Immunologist and Assistant Professor at University of Chicago
Reviewer: S. Randhawa, M.D., Allergist/Immunologist and Assistant Professor at LSU (Shreveport) Department of Allergy and Immunology

I
Innate immunity (natural or native immunity)
Instant
Immediate
Initial response
Induces adaptive immunity
Integrates with adaptive immunity

A
Adaptive immune system
Acquired
Await days = no immediate response
Accurate = specific
Autoregulation
Autoimmunity

Intraepithelial lymphocytes

B
B1-B cells
Bowel

PAMPs Recognition Receptors

4 PAMPs receptors: T-CNS

Toll-like receptors
C-type lectins
N-formyl Met-Leu-Phe receptors
Scavenger receptors

C
C-type lectins
Calcium-dependent
Carbohydrate-binding molecules

N
NF MLP
Neutrophil chemoattractant

Pattern-recognition receptors (molecules) are divided into 3 groups:

SES

S
ecreted
Endocytic
Signaling

Macrophages differentiate into specialized forms in different tissues:

KOMA:
Kupffer cells (liver)
Osteoclasts (bone)
Microglia (CNS)
Alveolar macrophages (lung)

There are 3 pathways for activation of complement:

CAM

Classical
Alternative
Mannose-binding lectin (MBL)

C
Classical pathway
C1
Cleaves
C4
Covalent bond to bacterial surface
Cleaves
C2
Complex C4b2a
C3
Convertase to MAC

Classical pathway
Complex Ag-Ab (IgG/M)

Alternative pathway
Adhesive cell walls

Recruitment of Leukocytes to Sites of Infection

SIP of wine:
Selectins
Integrins
Penetration of BM by PMN

Selectins are first in the chain of events. Integrins cause release of VCAM and VLA.

Adhesion molecules, 3 groups = SIS
Selectins
Integrins
Superfamily Ig

There are 3 groups of selectins = LEP
L-selectins
Leukocytes

E-selectins
Endothelial cells

P-selectins
Platelets

Ig Superfamily - cell adhesion molecules (CAM)

VIP:
VCAM (vascular cell adhesion molecule)
ICAM (intercellular adhesion molecule)
PECAM (platelet-endothelial cell adhesion molecule)

NK Cells

NK
Natural Killers, "born to kill"
Not lymphocytes

MHC I
I
Inhibits cell killing by NK

IL 15
Increases number of NK cells
IL 12 stimulation
INF gamma stimulation of NK cells

Published: 01/24/2008
Updated: 08/05/2008

Mnemonics: Drug Hypersensitivity

Author: V. Dimov, M.D.
Reviewer: S. Randhawa, M.D.

Classification of adverse reactions to drugs: SOAP III

Side effect
Overdose
Allergy
Pseudoallergy

Interaction
Intolerance
Idiosyncrasy



Classification of adverse reactions to drugs: "SOAP III" mnemonic (click to enlarge the image).

Rule of 10s in ADR

10% of patients develop ADR
10% of these are due to allergy
10% of these lead to anaphylaxis
10 % of these lead to death

Manifestations of beta-lactams hypersensitivity: MAUS

Maculopapular exanthema, 19%
Anaphylaxis without shock, 19%
Urticaria, 36%
Shock, anaphylactic shock, 17%

References: Clinical presentation and time course in hypersensitivity reactions to β-lactams. Allergy, 2007.



Hypersensitivity reactions to beta-lactam antibiotics: MAUS mnemonic 20-20-40-20%. Click here to enlarge the image.

Samter's triad include asthma, aspirin sensitivity, and nasal/ethmoidal polyposis:

ASPirin
Asthma
Sensitivity to aspirin
Polyps

T
Toxic epidermal necrosis (TEN)
Thirty percent of the skin (SJS less than 10%)
"Terrible" prognosis

Management of adverse drug reactions: PAD

Premedication with antihistamines and steroids
Avoidance
Desensitization

Multiple choice questions

Chapter 57: Drug Allergy. Allergy and Immunology Review Corner: Chapter 57 of Pediatric Allergy: Principles & Practices, edited by Donald Y.M. Leung, et al.

Published: 01/24/2008
Updated: 01/24/2012