CCTN Exam Study Guide with Correct Solutions
Antigen-presenting cells - ANSWER dendritic cells, macrophages, B cells
Desensitization protocol to decrease antibody titers - ANSWER plasmapheresis, IVIG, rituximab
Cytotoxic T cells - ANSWER destroy pathogens and release chemicals called cytokines
Helper T cells - ANSWER Activate macrophages, B cells and T cells.
B cells - ANSWER produce antibodies
memory cells - ANSWER a long-lived lymphocyte capable of responding to a particular antigen
on its reintroduction, long after the exposure that prompted its production.
humoral immunity - ANSWER specific immunity produced by B cells/plasma cells that produce
antibodies that circulate in body fluids
cellular immunity - ANSWER Activation of antigen-presenting cells to alert cytotoxic T cells to
release cytokines in response to antigen
Acute cellular rejection - ANSWER cell-mediated lysis of graft tissue by cytotoxic t cells, NK cells,
and or macrophages. Tx is suppression of cytokine (steroids calcineurin inhibitors) prevention is
expanding lymphocytes (cellcept)
Acute antibody-mediated rejection - ANSWER pre sensitized or develop denovo antibodies to
graft HLA. Days to weeks after tx. Dx is biopsy showing presence of c4d activity (not required),
microcapilary injury and serum DSA antibodies. Treatment is ivig, plasmapheresis, polyclonal
and monoclonal antibodies.
, MHC - ANSWER Major Histocompatability complex, a set of proteins found on the plasma
membranes of cells that help display antigen to T cells. MHC I is found on all cells and displays
bits of proteins from within the cell; this allows T cells to monitor cell contents and if abnormal
peptides are displayed on the surface, the cell is destroyed by killer T cells. MHC II is found only
on macrophages and B cells. This class of MHC allows these cells (known as antigen presenting
cells) to display bitts of "eaten" (phagocytosed or internalized) proteins on their surface,
allowing the activation of helper Ts --> thus further activating immune response.
Hyperacute rejection - ANSWER preexisting antibodies against transplanted graft
Chronic rejection - ANSWER T-cell, antibody mediated vascular fibrosis. Months to years after.
Irreversible.
Mycophenolate mofetil - ANSWER anti-proliferation Acts in B and T cells to inhibit inosine
monophosphate (IMP) dehydrogenase-->decreased GMP in de novo purine synth-->decreased
DNA synth in B and T cells-->decreased prolif of B and T cells. Inhibit primary antibody
response. Can cause activated T cell aptotosis
Use = immunosuppressant in transplant pts, also for autoimmune disorders
Tacrolimus - ANSWER isolated from fungus, Calcineurin inhibitor. Calcineurin is involved in the
synthesis of interleukin II and gamma interferon, promotes T cell proliferation . Theraputic
range 5-20 ng/dl. cytochrome p450. tremors, dm, seizures, PRES, htn. Cyp path inhibitor
Sirolimus (rapamycin) - ANSWER MOA: inhibits mTOR to inhibit T cell PROLIFERATION in
response to IL-2
Clinical use: only kidney transplant rejection prophylaxis
-Also used in drug eluting stents
can be used in heart tx > 1 yr posttx
Toxicity: anemia, thrombocytopenia, leukopenia, insulin resistance, hyperlipidemia; *non-
nephrotoxic*. May cause delayed wound healing and contraindicated in hung of liver. may
Antigen-presenting cells - ANSWER dendritic cells, macrophages, B cells
Desensitization protocol to decrease antibody titers - ANSWER plasmapheresis, IVIG, rituximab
Cytotoxic T cells - ANSWER destroy pathogens and release chemicals called cytokines
Helper T cells - ANSWER Activate macrophages, B cells and T cells.
B cells - ANSWER produce antibodies
memory cells - ANSWER a long-lived lymphocyte capable of responding to a particular antigen
on its reintroduction, long after the exposure that prompted its production.
humoral immunity - ANSWER specific immunity produced by B cells/plasma cells that produce
antibodies that circulate in body fluids
cellular immunity - ANSWER Activation of antigen-presenting cells to alert cytotoxic T cells to
release cytokines in response to antigen
Acute cellular rejection - ANSWER cell-mediated lysis of graft tissue by cytotoxic t cells, NK cells,
and or macrophages. Tx is suppression of cytokine (steroids calcineurin inhibitors) prevention is
expanding lymphocytes (cellcept)
Acute antibody-mediated rejection - ANSWER pre sensitized or develop denovo antibodies to
graft HLA. Days to weeks after tx. Dx is biopsy showing presence of c4d activity (not required),
microcapilary injury and serum DSA antibodies. Treatment is ivig, plasmapheresis, polyclonal
and monoclonal antibodies.
, MHC - ANSWER Major Histocompatability complex, a set of proteins found on the plasma
membranes of cells that help display antigen to T cells. MHC I is found on all cells and displays
bits of proteins from within the cell; this allows T cells to monitor cell contents and if abnormal
peptides are displayed on the surface, the cell is destroyed by killer T cells. MHC II is found only
on macrophages and B cells. This class of MHC allows these cells (known as antigen presenting
cells) to display bitts of "eaten" (phagocytosed or internalized) proteins on their surface,
allowing the activation of helper Ts --> thus further activating immune response.
Hyperacute rejection - ANSWER preexisting antibodies against transplanted graft
Chronic rejection - ANSWER T-cell, antibody mediated vascular fibrosis. Months to years after.
Irreversible.
Mycophenolate mofetil - ANSWER anti-proliferation Acts in B and T cells to inhibit inosine
monophosphate (IMP) dehydrogenase-->decreased GMP in de novo purine synth-->decreased
DNA synth in B and T cells-->decreased prolif of B and T cells. Inhibit primary antibody
response. Can cause activated T cell aptotosis
Use = immunosuppressant in transplant pts, also for autoimmune disorders
Tacrolimus - ANSWER isolated from fungus, Calcineurin inhibitor. Calcineurin is involved in the
synthesis of interleukin II and gamma interferon, promotes T cell proliferation . Theraputic
range 5-20 ng/dl. cytochrome p450. tremors, dm, seizures, PRES, htn. Cyp path inhibitor
Sirolimus (rapamycin) - ANSWER MOA: inhibits mTOR to inhibit T cell PROLIFERATION in
response to IL-2
Clinical use: only kidney transplant rejection prophylaxis
-Also used in drug eluting stents
can be used in heart tx > 1 yr posttx
Toxicity: anemia, thrombocytopenia, leukopenia, insulin resistance, hyperlipidemia; *non-
nephrotoxic*. May cause delayed wound healing and contraindicated in hung of liver. may
