Tumor, Transplant,Autoimmunity

• Neoplasia


  Uncontrolled/ Abnormal growth of cells
• Benign


  • Not immortal / Does not invade healthy tissue extensively
  • Benign means non-cancerous
• Malignant


  • Immortal
  • Progressively invasive, it can invade health tissue gradually
  • Hence, it can disseminate/spread in nearby organs
  • Malignant means cancerous
• Carcinoma


  A malignant type which arise from endodermal and ectodermal epithelial tissue
• Sarcoma


  A type of malignancy which arises from mesodermal connective tissue
• Leukemia and Lymphoma


  • Malignant tumors of hematopoietic cells of the bone marrow
  • Involve the precursor cells such as WBC
  • Leukemia→ WBC; in Blood
  • Lymphoma → Lymphocytes; in Lymph nodes
• Metastasis


  • When malignant cells move through the blood or lymph to new sites
  • Small clumps of cells break off and spread where they continue to grow
  • Start of the spread of the cancer cells, they can spread through the circulation or lymph fluid. From one tissue, they can spread to nearby organs
• Proto-oncogenes


  Genes that normally regulate the initiation and execution of normal cell division
• Oncogenes


  • Mutant forms of proto-oncogenes that contribute to various tumor types or malignant transformation
  • We already have oncogenes in our body when we are born. It's up to us kung kailan ma-activate or ma-manifest sa body
  • Cancer is already programmed in our body
  • Oncogenes are inherited and usually activated by external factors
  • Common activators of oncogenes are stress (hormone imbalance), diet, pollution (environmental factor), alcohol, and smoking
  • It can be activated early in life, anytime, or remains inactivated depending on external factors
  • Stress is one of the leading activators of Malignancy
• Tumor-specific antigen


  • Not found in normal somatic cells but results from mutation of genes
  • Directly linked to the tumors
• Tumor-associated antigen


  • Not unique to tumor cells but expression of this antigen has been altered and can be expressed in excess where it would not normally express
  • Not directly linked to tumor but the presence of tumor can alter the expression of this antigen
• Tumor markers


  • Substances that can be found in the body when cancer is present
  • Tumor markers level is high / increased when the tumor is in the last or advanced stage (3rd or 4th stage)
  • In the early stage of the tumor, tumor markers are not significantly increased
  • Hence, tumor markers are not used for early detection of cancer (late na tumataas–gaano kalate?? Last stage na sya paparamdam)
  • Found in blood, urine, and other bodyfluids, tissues, tumors
  • Kung san makikita ung tumor(origin), andun din ung tumor markers
  • E.g if nasa urinary bladder yung tumor, urine gagamitin as marker
• Types of tumor markers

  • Tumor-specific markers— seen in “single type”
  • Tumor non-specific markers — seen in ”many types”
• Use of tumor markers


  • Diagnosing cancer (ex. CA 12-5,AFP )
  • Determining how well treatment is working
  • Seeing if certain treatments are likely to work (ex. HER2, drugs such as Trastuzumab (Herceptin®))
  • Detecting recurrent cancer
• When to check tumor markers


  • At the time of diagnosis
  • Before, during and after treatment
  • Regularly, for many years, to see if the cancer has come back
• Most common tumor markers

  • Carcinoembryonic Antigen (CEA)- GI AND COLORECTAL
  • Alpha-feto Protein (AFP)- HEPATOMA
  • Prostate Specific Antigen- PROSTATE CANCER
  • CA 15-3 – BREAST
  • CA 19-9 – PANCREAS, STOMACH, BILE DUCT
  • CA 125 – OVARIAN
  • CA 72-4 - GASTRIC
  • β-Human Chorionic Gonadotropin (β-HCG) — PREGNANT; F= OVARIAN, UTERINE; M= TESTICULAR
  • Bcr-abl — CHRONIC MYELOGENOUS LEUKEMIA (CML)
• Skin tests


  • Tertiary immunologic reactions that occur on the skin to diagnose/detect infections with certain infectious agents
  • Can be a diagnostic procedure because a certain agent is identified in this procedure
  • In vivo reactions (within the body)
  • Certain antigen (that is specific) to an infectious agent is injected to the body, either through subcutaneous or intramuscular administration, and reactions would occur to signify a positive reaction
  • Positive reaction is called an "induration reaction"
  • Induration reaction - characterized by redness, presence of raised lesions, and pain
• Diseases with skin tests

  • Trichinosis— BACHMAN INTRADERMAL TEST
  • Tuberculosis— TUBERCULIN SKIN TEST; VON PIRQUET; VOLLMER’S PATCH; MENDEL’S; MANTOUX
  • Brucellosis— BRUCELLERGIN SKIN TEST
  • Coccidiomycosis— COCCIDIODIN SKIN TEST
  • Lymphogranuloma venereum— FREI TEST
  • Histoplasmosis- HISTOPLASMIN SKIN TEST
  • Diphtheria— SCHICK TEST
  • Scarlet Fever- DICK TEST
  • Glanders Disease- MALLEIN TEST
  • Toxoplasmosis- TOXOPLASMIN SKIN TEST
  • Anthrax- ASCOLI
  • Ascariasis— MOAN
  • Hydatid Disease- CASONI INTRADERMAL TEST
  • S. pneumoniae infection- FRANCIS SKIN TEST
• Allorecognition


  Transplant of cells or tissues between two individuals is classified by the genetic relatedness of the donor and recipient
• Autograft


  Genetic materials are similar because the tissue or the cell is taken in from the patient body itself
• Syngraft or Isograft


  Origin is from identical twins, therefore genetic material is almost similar but not completely the same
• Allograft


  • From other individuals of the same species
  • Human to Human
• Xenograft or Heterograft


  • Most distant genetic component, from other species
  • Animals to Human
• Organs or body parts that can be transplanted

  • Blood vessels
  • Bone marrow
  • Stem cells
  • Cornea
  • Heart
  • Kidneys
  • Liver
  • Lungs
  • Middle ear
  • Pancreas
  • Skin
• Immunosuppressive drug administration


  • Given to the patient to prevent or suppress immune activation of the patient system when transplanted tissues or cells are given
  • If not given such drugs our immune system will destroy the donor transplant
  • Example: Cyclosporine (Cyclosporin A)
  • When a patient is administered an immunosuppressive drug it will affect the antibody production leading to weak immunity, making them susceptible in opportunistic infections like fungal infections. To cope with this doctors also prescribe probiotics
• Graft / Transplant rejection


  • Organs vary with respect to their susceptibility to rejection based on inherent immunogenicity
  • Influenced by different factors: Vascularity - Pertains to the presence of the blood vessels to the tissue. The more blood vessels in the tissue the more vascular the organ. The more blood flow the more antigen present in the tissue resulting in more immunogenic tissue, the more risk of triggering immune response
• Organs ranked by immunogenicity

  • Most immunogenic: Bone marrow, Skin, Islets of langerhans, Heart, Kidneys, Liver, Bone, Xenogenic valve replacements
  • Least immunogenic: Cornea
• Graft Versus Host Disease

  • Consequence of blood transfusion or transplantation in severely immunocompromised or immunosuppressed patients
  • The degree of immunodeficiency in the host rather than the number of transfused immunocompetent lymphocytes determine whether GVHD will occur
  • To prevent GVHD the donor cells undergo irradiation
  • In irradiation the target cells in the donor are the T cells since it is the most competent to all WBC
  • Occurs when immunocompetent T cells are transfused from a donor to an immunodeficient or immunosuppressed recipient
• Autoimmune disease development


  • Own protein/ DNA are seen as invaders
  • Similar cascade of events begin
  • Damage to own tissue organ
  • Genetic Predisposition → Autoantibody Formation → Medical Intervention
  • Genetic Predisposition - this type of condition is basically inherited
  • Factors that trigger to manifest inherited genes that could start autoimmune disease: Pollution, External stress, Hormone imbalance
• Graft-versus-host disease (GVHD)


  Occurs when immunocompetent T cells are transfused from a donor to an immunodeficient or immunosuppressed recipient
• To prevent GVHD


  The donor cells undergo irradiation
• Target cells in donor irradiation

  T cells, since they are the most competent of all white blood cells
• Cornea


  • The most least immunogenic, since it is avascular (no blood vessels present)
• Kidneys are commonly used as an example for graft rejection since they are the most commonly transplanted organ
• Autoimmune disease


  Condition where the immune system attacks the body's own cells and tissues
• Development of autoimmune disease

  1. Genetic predisposition

  2. Autoantibody formation

  3. Medical intervention
• Genetic predisposition


  Autoimmune condition is inherited
• Factors that trigger autoimmune disease

  • Pollution
  • External stress
  • Hormonal imbalance
• Autoantibody formation


  Start of autoimmune disease, where autoantibodies attack the body's own cells
• Early stage of autoimmune disease


  No manifestations, signs or symptoms detected yet