MHC Class II basics
The Case of Helen Burns
Diagnosis and Treatment
100

These immune cells recognize peptide antigens presented by MHC class II molecules.

What are CD4+ T cells?


100

At six months old, Helen developed pneumonia caused by this pathogen. 

What is the opportunistic pathogen p. jirovecii?
100

This inheritance pattern characterizes MHC class II deficiency.

What is autosomal recessive inheritance?

200

Name a type of antigen-presenting cells that normally express MHC class II.

What are B cells, dendritic cells, and macrophages?

200

Helen's CD4 T cell count was much lower than this other T cell population, which remained in the normal range.

What are CD8 T cells?

200

Helen's low antibody levels can be explained by impaired activation and function of these immune cells.

What are CD4 T cells (helper T cells)?

300

The 5 HLA class II types.

What are DP, DN, DM, DO, DQ, and DR?

300

Helen had low levels of these antibody classes.

What are IgG, IgA, and IgM? 


300

Impaired T cell function contributes to low antibody levels for this reason.

What is, because CD4 T cells stimulate B cell differentiation, leading to antibody production and secretion? 

400

Despite her impaired antigen-specific response, Helen responded normally to this nonspecific T-cell mitogen.

What is PHA (phytohemagglutinin)? This helped rule out severe combined immunodeficiency (SCID)

400

This treatment restored Helen's immune function.

What is a bone marrow transplant (hematopoietic stem cell transplantation)

500

Defects in these genes cause MHC class II deficiency.

What are the transcription factors CIITA, RFXANK, RFX5, and RFXAP?

500
Helen's B cells and monocytes lacked this MHC class II surface molecule, which established the correct diagnosis.

What is HLA-DR? 

Fluorescent antibody testing also revealed reduced HLA-DQ expression.

500

Explain why a stem cell transplant might not fully restore CD4 T cells in every MHC class II deficient patient.

What is the continued absence of MHC class II expression on the recipient's thymic epithelial cells? These cells are required for the development of CD4 thymocytes, and aren't replaced by the donor's marrow.

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