Unit 17 Question Bank
The five tabs are the five sections of the real paper. Items tagged
Past Paper 2019 or 2020 are the genuine questions, reproduced verbatim.
Items tagged Slide come from the TMU lecture; items tagged Janeway's are built
from the textbook to cover examinable ground. Nothing is invented. Janeway's 10e is a reflowed
edition with no printed page numbers, so it is cited by numbered section (§1-14), not by page.
0 / 28 answered
1Immunotherapy is best defined as:
Answer: A
Note the word inhibit — immunotherapy is not only about strengthening immunity. Anti-lymphocyte serum for graft rejection is immunotherapy just as much as a vaccine is. Adoptive cell transfer is one form of it, not the definition.Past Papers 2019 & 2020, Section I · TMU Lecture 13 — Immunotherapy (Yu Chunyan) Slide 4
2Which classification correctly divides immunotherapy?
Answer: B
One of the three stated classifications, and it is Unit 1's active/passive distinction applied. The others are potentiation vs suppression, and specific vs non-specific.TMU Lecture 13 — Immunotherapy (Yu Chunyan) Slide 4
3A toxoid is:
Answer: C
Chemical modification destroys the toxin moiety while leaving the antigenic determinants intact — so the antibody produced still neutralises the real toxin. An antibody against a toxin is an antitoxin, which is passive rather than active immunisation.Past Papers 2019 & 2020, Section IV Q8 · TMU Lecture 13 — Immunotherapy (Yu Chunyan) Slide 11
4Which are the four features of an effective vaccine?
Answer: D
Directly from the lecture, and the content of True/False Q9. 'Practical considerations' is why the DNA vaccine's freedom from a cold chain matters so much in the field.Past Papers 2019 & 2020, Section IV Q9 · TMU Lecture 13 — Immunotherapy (Yu Chunyan)
5What was the first recombinant vaccine produced?
Answer: A
The gene encoding HBsAg was overexpressed in yeast and the antigen purified biochemically. Pneumococcal polysaccharide is a purified antigen vaccine, and BCG is a live attenuated organism.TMU Lecture 13 — Immunotherapy (Yu Chunyan) Slide 9
6Why does a recombinant protein vaccine generate primarily a humoral response?
Answer: B
This is Unit 11's rule deciding vaccine design. Injected protein is exogenous → endocytosis → MHC class II → CD4⁺ → antibody. Because it never enters the cytosol, no MHC class I presentation and therefore no cell-mediated response occurs.TMU Lecture 13 — Immunotherapy (Yu Chunyan) Slide 10
7Why can a DNA vaccine elicit BOTH humoral and cellular immunity?
Answer: C
The genes are expressed inside the host's own cells, making the antigen endogenous — proteasome, TAP, MHC class I, CD8⁺ CTL — while secreted protein also enters the class II route. This is why DNA vaccines are attractive against viruses and tumours, where antibody alone is insufficient.TMU Lecture 13 — Immunotherapy (Yu Chunyan) Slides 13–15
8Which is a stated disadvantage of DNA vaccines?
Answer: D
Integration is the safety concern, along with the risk of anti-DNA antibodies and autoimmune disease. The other three options are stated advantages: DNA vaccines are heat-stable (no cold chain), can be given to neonates despite maternal antibody, and elicit both arms of immunity.TMU Lecture 13 — Immunotherapy (Yu Chunyan) Slides 15–16
9Which adjuvant is used in human vaccines?
Answer: A
Alum is essentially the only adjuvant used in human vaccines. Freund's complete adjuvant is far too inflammatory for humans and is restricted to research animals. Modern adjuvants under development are TLR agonists such as CpG — deliberately triggering Unit 9's PRR–PAMP system to supply signal 2.TMU Lecture 13 — Immunotherapy (Yu Chunyan) Slide 18
10How does an adjuvant enhance the immune response?
Answer: B
Three mechanisms: prolonging antigen persistence through slow release; enhancing co-stimulatory signals by raising MHC and B7 expression and cytokine secretion; and inducing granuloma formation and lymphocyte proliferation. Raising B7 is literally supplying signal 2 from Unit 7.TMU Lecture 13 — Immunotherapy (Yu Chunyan) Slide 18
11Anti-lymphocyte serum is used for:
Answer: C
This is immunotherapy in the inhibit direction — the half of the definition students forget. Antitoxins treat exotoxin diseases; gamma globulin prevents viral infection and treats hypogammaglobulinaemia.TMU Lecture 13 — Immunotherapy (Yu Chunyan) Slide 19
12Monoclonal antibodies to which cytokines are used in rheumatoid arthritis?
Answer: D
Anti-IL-1 and anti-TNF monoclonal antibodies are used in rheumatoid arthritis and chronic inflammation — blocking the cytokines that drive the inflammatory damage.TMU Lecture 13 — Immunotherapy (Yu Chunyan) Slide 20
13A chimeric therapeutic antibody consists of:
Answer: A
The engineering ladder is a retreat from mouse protein, which would otherwise be a xenogeneic antigen. Chimeric keeps mouse V + human C; humanized keeps only the mouse CDRs; single-chain is VH–linker–VL; bi-specific has two specificities.TMU Lecture 13 — Immunotherapy (Yu Chunyan) Slide 22
14Which molecules are the main targets of immune checkpoint blockade?
Answer: B
These are the brakes from Unit 7, blocked to release T-cell activity against tumours. Newer targets are BTLA, VISTA, TIM3 and LAG3. CD28, ICOS and CD40L are the accelerators — you would not block those.TMU Lecture 13 — Immunotherapy (Yu Chunyan) Slides 23–24
15What is the characteristic toxicity of checkpoint inhibitors, and why?
Answer: C
If CTLA-4 exists to restrain T-cell activation and maintain homeostasis, blocking it should produce exactly what it was preventing. It does: colitis, thyroiditis, hepatitis, pneumonitis. The side effects are the drug working, in tissues where you did not want it to.TMU Lecture 13 — Immunotherapy (Yu Chunyan) Slides 23–24 · Unit 7
16Which interferon is approved for multiple sclerosis?
Answer: D
IFN-β for multiple sclerosis; IFN-α for viral infections such as hepatitis and herpes zoster (and hairy cell leukaemia, melanoma); IFN-γ for rheumatoid arthritis and chronic granulomatous disease.TMU Lecture 13 — Immunotherapy (Yu Chunyan) Slide 28
1 Immunotherapy — 3 marks+
The treatment of a disease with therapeutic agents that potentiate or inhibit the immune response. Classified three ways: immunopotentiation vs immunosuppression; specific vs non-specific; and active immunotherapy (giving antigen) vs passive/adoptive immunotherapy (giving immune response products).Past Papers 2019 AND 2020, Section I · TMU Lecture 13 — Immunotherapy (Yu Chunyan) Slide 4
2 Toxoid — 3 marks+
A bacterial exotoxin which has been treated, usually with formaldehyde, so that it loses its toxic properties but retains its ability to stimulate an immune response against the toxin. Chemical modification destroys the toxin moiety while preserving the antigenic determinants — the basis of the tetanus and diphtheria vaccines.Past Papers 2019 & 2020, Section IV Q8 · TMU Lecture 13 — Immunotherapy (Yu Chunyan) Slides 11–12
3 Features of an effective vaccine — 3 marks+
Safe — the vaccine must not itself cause disease. Protective — it must protect against the real pathogen. Sustained protection — protection must last, which requires immunological memory. Practical considerations — cost, stability, storage and ease of administration.Past Papers 2019 & 2020, Section IV Q9
4 DNA (genetic) vaccine — 3 marks+
A vaccine in which the gene encoding an immunogenic antigen is inserted into a plasmid under a promoter and delivered — for example on gold particles by 'gene gun' — so that the host's own cells synthesise the antigen. Because the antigen is made endogenously it enters the MHC class I pathway as well as class II, and so elicits both humoral and cellular immunity. Also heat-stable (no cold chain), cheap, and usable in neonates. Risk: integration of foreign DNA, and anti-DNA antibodies.TMU Lecture 13 — Immunotherapy (Yu Chunyan) Slides 13–16
5 Engineered monoclonal antibodies — 3 marks+
Monoclonal antibodies prepared by recombinant DNA technology to reduce their mouse content, which would otherwise act as a xenogeneic antigen: chimeric (mouse V domain + human C domain), humanized, single-chain (VH–linker–VL) and bi-specific.TMU Lecture 13 — Immunotherapy (Yu Chunyan) Slide 22
6 Immune checkpoint blockade — 3 marks+
Therapy using monoclonal antibodies against inhibitory checkpoint molecules — CTLA-4, PD-1 and PD-L1 (also BTLA, VISTA, TIM3, LAG3) — to release the brake on T-cell activity against tumours. Many tumours over-express PD-L1 to inactivate infiltrating T cells; blocking that interaction restores the response. Characteristic toxicity is autoimmune.TMU Lecture 13 — Immunotherapy (Yu Chunyan) Slides 23–24
1Immunotherapy is the treatment of disease with agents that ? or ? the immune response.2 mark(s)
Both directions count — anti-lymphocyte serum for graft rejection is immunotherapy just as much as a vaccine is.
Past Papers 2019 & 2020, Section I2 ? immunotherapy gives antigen, whereas ? or ? immunotherapy gives immune response products.3 mark(s)
Unit 1's active/passive distinction, applied therapeutically.
TMU Lecture 13 — Immunotherapy (Yu Chunyan) Slide 43A toxoid is an exotoxin treated with ? so that it loses its ? properties but retains its ability to stimulate an ? against the toxin.3 mark(s)
The exam statement in True/False Q8 is this definition, word for word.
Past Papers 2019 & 2020, Section IV Q84The four features of an effective vaccine are ? , ? , ? and ? .4 mark(s)
This is True/False Q9, and it is true.
Past Papers 2019 & 2020, Section IV Q95The four types of engineered monoclonal antibody are ? , ? , ? and ? .4 mark(s)
Each step down the list removes more mouse protein while preserving the binding site — which is why drug names end in -ximab (chimeric) or -zumab (humanized).
TMU Lecture 13 — Immunotherapy (Yu Chunyan) Slide 226The main immune checkpoint molecules targeted therapeutically are ? , ? and ? .3 mark(s)
These are Unit 7's brakes; blocking them releases T-cell activity against tumours.
TMU Lecture 13 — Immunotherapy (Yu Chunyan) Slide 231Toxoid is a bacterial exotoxin which has been treated usually with formaldehyde so that it has lost its toxic properties but retains its ability to stimulate an immune response against the toxin.
TRUE
TRUE — the lecture's definition verbatim. The exam statement is the slide, so learning the definition answers the question exactly.Past Papers 2019 & 2020, Section IV Q8 — verbatim, both years
2Features of effective vaccines include safe, protective, sustained protection and practical considerations.
TRUE
TRUE — the four stated criteria. 'Practical considerations' covers cost, stability and ease of administration, which is why the DNA vaccine's freedom from a cold chain is such an advantage in the field.Past Papers 2019 & 2020, Section IV Q9 — verbatim, both years
3Recombinant protein vaccines elicit a strong cell-mediated immune response.
FALSE
False. The response is primarily humoral, because the injected protein is exogenous antigen processed by the MHC class II pathway. It never reaches the cytosol, so no MHC class I presentation and no CTL response occurs — which is exactly the gap DNA vaccines were designed to fill.TMU Lecture 13 — Immunotherapy (Yu Chunyan) Slide 10
4DNA vaccines require a cold chain for storage and transport.
FALSE
False — one of their principal advantages is that they are highly stable and resistant to high temperature, so no cold chain is necessary. That is a decisive practical benefit in field conditions.TMU Lecture 13 — Immunotherapy (Yu Chunyan) Slide 14
5Alum is the main adjuvant used in human vaccines.
TRUE
True. Freund's complete adjuvant is far too inflammatory for human use and is restricted to research animals. Modern adjuvants under development are TLR agonists such as CpG.TMU Lecture 13 — Immunotherapy (Yu Chunyan) Slide 18
6Checkpoint inhibitors work by directly killing tumour cells.
FALSE
False. They kill nothing. They remove an inhibitory signal — typically PD-L1 on the tumour engaging PD-1 on infiltrating T cells — restoring a T-cell response the patient already had. That is also why the toxicity is autoimmune rather than cytotoxic.TMU Lecture 13 — Immunotherapy (Yu Chunyan) Slides 23–24
1
Classify immunotherapy and give examples of each category.
6 marks
Definition. The treatment of a disease with therapeutic agents that potentiate or inhibit the immune response.
| Classification | Categories | Examples |
|---|---|---|
| By direction | Immunopotentiation / immunosuppression | Vaccines and cytokines / anti-lymphocyte serum, anti-CD3 mAb |
| By specificity | Specific / non-specific | Vaccine against one pathogen / adjuvants, BCG |
| By what is given | Active (antigen) / passive or adoptive (immune response products) | Toxoid, recombinant and DNA vaccines / antitoxin, gamma globulin, monoclonal antibody |
Antigen-based (active): purified antigen, synthetic peptide–carrier conjugate, recombinant antigen (HBsAg in yeast), DNA vaccine, recombinant virus vector.
Antibody-based (passive): antitoxin, gamma globulin, anti-viral serum, anti-lymphocyte serum; monoclonal antibodies including engineered (chimeric, humanized, single-chain, bi-specific) and checkpoint blockade (CTLA-4, PD-1, PD-L1).
Cytokine-related: supplementation (IFN-α, IFN-β, IL-2, CSF, EPO) and antagonism (anti-TNF mAb, IL-1ra).
Marking guide: 2 marks for the three classifications, 4 for examples across the antigen-, antibody- and cytokine-based groups. Noting that immunotherapy includes suppression is expected.
2
Compare recombinant protein vaccines and DNA vaccines.
6 marks
| Recombinant protein vaccine | DNA vaccine | |
|---|---|---|
| What is given | Purified antigen protein made in bacteria or yeast | Plasmid carrying the gene for the antigen |
| Where antigen appears | Outside the cell — exogenous | Inside the host's own cells — endogenous |
| Presentation pathway | MHC class II only | MHC class I (and class II) |
| Immunity generated | Primarily humoral; no cell-mediated response | Both humoral and cellular |
| Advantages | Large amounts cheaply; exotoxins can be genetically inactivated; antigen can be made more immunodominant | Heat-stable, no cold chain; cheap; long duration; usable in neonates despite maternal antibody; multiple vaccines together |
| Disadvantages | Humoral memory needs several doses | Foreign DNA might integrate and transform the cell; anti-DNA antibodies and autoimmunity |
The organising point: the compartment in which the antigen appears determines the presentation pathway, which determines the kind of immunity you get. That is why DNA vaccines are pursued for viruses and tumours, where CTLs are needed.
Marking guide: 1 mark per row. The class I / class II contrast and its consequence for cell-mediated immunity is the discriminating point.
3
Describe antibody-based immunotherapy.
6 marks
1 · Immune serum (antiserum). Antitoxins for exotoxin-induced disease (tetanus, diphtheria); serum or placental gamma globulin to prevent viral infection (measles, hepatitis) and treat hypogammaglobulinaemia; anti-viral serum for measles and rabies; anti-lymphocyte serum to inhibit graft rejection and treat autoimmune disease.
2 · Monoclonal antibodies. Anti-CD3 and anti-CD4 to prevent graft rejection and GVHD; anti-IL-1 and anti-TNF for rheumatoid arthritis and chronic inflammation; antibody-guided therapy — radioimmunotherapy (¹³¹I, ¹²⁵I), chemotherapy conjugates, and immunotoxins (ricin, diphtheria toxin).
3 · Engineered monoclonal antibodies. Chimeric (mouse V + human C), humanized, single-chain (VH–linker–VL) and bi-specific — each step reducing the mouse content that would otherwise act as a xenogeneic antigen.
4 · Immune checkpoint blockade. Monoclonal antibodies against CTLA-4, PD-1 and PD-L1 (also BTLA, VISTA, TIM3, LAG3), used in tumour immunotherapy to release the brake on T cells. Characteristic toxicity is autoimmune, because checkpoints normally prevent autoimmunity.
Marking guide: 1.5 marks per group. Naming the engineered-antibody types and the checkpoint targets secures full marks; explaining why antibodies are engineered is the discriminating detail.