18

Basic Principles of Immunology and

Immunotherapy in Urologic

Oncology

Charles G. Drake

Questions

1.Antigen presentation involves both uptake of foreign proteins and processing to form peptide/major histocompatibility complex (MHC) complexes. Each of the following immune-responsive cell types can carry out this function EXCEPT:

a.granulocytes.

b.vascular endothelial cells.

c.monocytes.

d.macrophages.

e.dendritic cells.

2.Transplants between two siblings who are histocompatibility leukocyte antigen (HLA) identical (perfect class I and II match) can be rejected. This is primarily a consequence of:

a.direct antigen presentation.

b.differences in complement proteins.

c.indirect antigen presentation.

d.differences in childhood antimicrobial vaccination.

e.differences in numbers of circulating platelets.

3.Lymphocyte activation depends on complex interactions among many intracellular enzymes, transcription factors, and electrolytes. The influx of which electrolyte is most important for T-cell activation?

a.Sodium

b.Magnesium

c.Potassium

d.Phosphorus

e.Calcium

4.Anergy describes a state of immune nonresponsiveness to antigenic stimulation. The most effective way to induce a state of anergy is by:

a.splenic irradiation.

b.delivery of signal 1 and signal 2.

c.depletion of complement proteins.

d.delivery of signal 1 without signal 2.

e.depletion of helper CD4 + T cells.

5.Each of the following characteristics describes the utility and adaptability of the immune system EXCEPT:

a.memory.

b.rapid amplification.

c.identification of self.

d.antigen restriction.

e.nonspecific defense mechanisms.

6.Innate immune responses are nonspecific and include all of the following EXCEPT:

a.natural killer cells.

b.antibody-dependent cell-mediated cellular cytotoxicity.

c.complement.

d.acute-phase proteins.

e.physical and mucosal barriers.

7.Which cell surface glycoprotein is commonly referred to as the “pan-T-cell marker” because of its presence on all T lymphocytes?

a.CD3

b.CD4

c.CD8

d.CD28

e.CD45

8.The part of an Immunoglobulin (Ig)G antibody molecule that interacts with cell surface receptors on other immune reactive cells such as natural killer (NK) cells is the:

a.hypervariable region.

b.disulfide bonds.

c.amino-terminal end of the antibody.

d.Fc fragment.

e.Fab fragment.

9.The family of transcription factors termed nuclear factor of activated T cells (NFAT) are essential for T-cell activation and clonal expansion through the expression of the gene for:

a.interferon-γ (IF-γ).

b.transferrin.

c.tumor necrosis factor.

d.interleukin-2 (IL-2).

e.IL-10.

.The receptor on B cells that recognizes antigen and transmits signals to the nucleus for gene expression is:

a.the T-cell receptor.

b.the surface IgD molecule.

c.the surface IgM molecule.

d.CD40.

e.CD28.

.The JAK/STAT signaling pathways are critical in regulating cytokine expression. Inborn deficiencies in these pathways may lead to diseases such as:

a.Burkitt lymphoma.

b.Wilms tumor.

c.neuroblastoma.

d.retinoblastoma.

e.severe combined immunodeficiency.

.The initial contact of host immunoresponsive cells with foreign antigen or transplanted donor tissue takes place in the:

a.peripheral lymph nodes.

b.thymus gland.

c.spleen.

d.bursa of Fabricius.

e.bone marrow.

.Programmed cell death, apoptosis, is a mechanism responsible for the elimination of aged, damaged, autoimmune, or redundant cells. Caspase proteins are responsible for executing the suicide program by:

a.release of granzyme B.

b.activating the alternative complement pathway.

c.activating natural killer cells.

d.mediating DNA fragmentation and condensation.

e.release of perforin.

.Tolerance describes the absence of lymphocyte reactivity to specific antigens that have been previously encountered by the immune system. Known mechanisms of tolerance include each of the following EXCEPT:

a.deletion of reactive T cells.

b.deletion of reactive B cells.

c.blocking by antigen-antibody complexes.

d.clonal anergy by delivery of signal 1 without costimulation.

e.suppression of immune responses by regulatory cells.

.Chemokines are chemoattractant cytokines that localize various cell populations to tissue sites of inflammation. Each of the following cell types respond to chemokines EXCEPT:

a.erythrocytes.

b.granulocytes.

c.natural killer cells.

d.dendritic cells.

e.monocytes.

.Although most human tumors are antigenic, the immune system is often not a significant barrier to tumor growth and metastasis. A major reason for the relative weakness of the immune system to eradicate tumors is:

a.absence of costimulation by tumors leading to anergy.

b.tumor-induced alterations of immune function.

c.impaired function of tumor neovasculature.

d.rapid tumor cell proliferation.

e.lack of tumor cell Fc receptors.

.Tumor cell destruction by the immune system often is weak because of tumor cell escape mechanisms, which include all of the following EXCEPT:

a.tumor cell release of IL-2.

b.reduced expression of MHC class I and II molecules on tumor cells.

c.tumor cell and local release of IL-10.

d.ligation of tumor cell FAS by the FAS ligand (FASL) to induce apoptosis of host T cells.

e.tumor cell and local release of transforming growth factor-β (TGF-β).

.Immunotherapy for metastatic renal cell carcinoma in humans has included the use of cytokines such as IFN-γ and IL-2. The objective response rate (both

complete and partial responses) has been demonstrated in what percentage of patients?

a.95%

b.75%

c.55%

d.35%

e.15%

.Extracellular bacteria are susceptible to killing by phagocytosis and complement, but some have developed capsules to block these mechanisms. The most effective immune countermeasure for bacterial encapsulation is the:

a.classical complement pathway.

b.alternative complement pathway.

c.opsonization of bacteria by circulating antibodies.

d.increased secretion of TGF-β in tears.

e.increased beating of bronchial cilia.

.Clearance of intracellular bacteria is most dependent on which immune cell population?

a.Macrophages.

b.Plasma cells.

c.Natural killer cells.

d.Dendritic cells.

e.Primed T lymphocytes.

.Passive immune therapy may be particularly useful for patients with immunodeficiency. Passive therapy is delivered by:

a.attenuated viral organisms.

b.lyophilized vaccines.

c.heterologous serum.

d.live viral organisms.

e.cow's milk.

.Toll-like receptors can be engaged by all of the following EXCEPT:

a.bacterial flagellin.

b.bacterial lipopolysaccharides.

c.calcium.

d.double-stranded viral RNA.

e.paclitaxel.

.Recognition of Toll-like receptors by microbial products can activate all of the following immune mechanisms EXCEPT:

a.adaptive immunity.

b.intracellular microbial killing.

c.innate immunity.

d.IgE antibody formation.

e.expression of costimulatory molecules.

.DNA microarrays depend on the ability of target nucleic acid sequences to:

a.bind to the surface of activated lymphocytes.

b.hybridize to complementary oligonucleotides or polymerase chain reaction (PCR) products.

c.engage the T-cell receptor (TCR).

d.bind to antibody fixed to a glass slide.

e.fix complement.

.Gene expression profiling using DNA microarrays can be used to distinguish the following characteristics of urologic cancers EXCEPT:

a.pathologic stage of the malignancy.

b.diagnosis and classification of the malignancy.

c.monitoring the host response to the malignancy.

d.discovery of targets for treatment of the malignancy.

e.definition of the clinical prognosis of the malignancy.

.Which of the following events do not play a role in the initiation of TCR signaling after engagement with antigen and MHC class II molecules?

a.TCR interaction with CD4 coreceptor

b.TCR interaction with CD8 coreceptor

c.Phosphorylation of TCR and CD3 immunoreceptor tyrosine-based activation motifs (ITAMs) by LCK and FYN kinases

d.Recruitment of ZAP-70 to TCR and its activation

e.Activation of the adaptor molecule, linker of activation in T cells

(LAT)

.Which of the following is a FALSE statement regarding the JANUS family of kinases?

a.The four JAK kinases are not constitutively associated with various cytokine receptors.

b.The JAK kinases regulate different cytokine receptors.

c.The cytokine-receptor binding causes dimerization of receptor chains resulting in JAK activation and phosphorylation of receptors.

d.The STATs are recruited to receptors and phosphorylated by JAK kinases.