Problem Questions MCELLBI Coscoy

What drug type is available for Hep C?

DAAs

What percent of people die from liver failure assoc. with Hep C?

1-5%

What percent of people clear Hep C in 3 months?

30%

What percent of Hep C is chronic?

70%

What percent of Hep C is acute?

30%

What percent of Hep C are unaware?

80%

How many new Hep C infections /year?

1.5 mil /yr

How many currently infected with Hep C?

70 mil/1% of world population

What is the risk of cirrhosis in 20 years with Hep C?

20-33%

What are the symptoms of Hep C?

Jaundice, nausea, fatigue

What are the assoc diseases of Hep C?

Liver cancer, cirrhosis, liver failure

What is the link between HCV and liver failure/transplant?

Most liver failures and transplants in US are as a result of Hep C infection

Why is there no Hep C vaccine?

Quasispecies

Mutates frequently

Latency

How does a DAA work?

Many drugs in one to target quasispecies of Hep C

How is Hep C diagnosed?

2 blood tests- antibodies then RNA

How is Hep C spread?

Blood contact (organ transplant, needle sharing, blood transfusions)

What are the associated cancers of EBV?

Mono (not cancer), epithelial carcinoma, B-cell lymphoma

What are the symptoms of EBV?

Liver cancer and disease

What is the drug for HSV1/2?

Ganciclovir

What are the symptoms of KSHV?

Spindle cell formation, lesions on internal organs, bleeding into lesions, RBC buildup/stuck in lesions

What are the causes of KSHV?

Organ transplant, body fluid contact, sex

What is the virus most responsible for liver cancer?

HBV

What is the chance to develop liver cancer with HBV?

15-40%

What are the transmission routes for HBV?

Vertical (endemic), blood contact, sex (US), organ transplants

How many liver cancer cases are there?

770k, mostly b/c of HBV

What are the types of HBV particle?

1. Small spheres (antigen)

2. Longer tubular (polypeptide)

3. Dane particle (infectious virion)

What percent of the world has had HBV?

25%

What are the chronicity rates of HBV?

90% if vertical

25-50% if 1-5 y/o

5% if adult

When is PeP given for HBV?

Newborn baby within 12 hours, 85-95% effective

What is PeP for HBV?

1. RBIG

2. Vaccine

What is the HBV vaccine?

Recombinant DNA, first licensed recombinant vaxx ever

How does the HBV vaxx work?

DNA grown in baker’s yeast → spheres purified → spheres purified to code for proteins → proteins picked up by immune system

What are the drugs available for HBV?

1. IFN- direct antiviral, fever effects

2. Nucleoside analogue- oral med, mild, targets replication

What is the Ebola drug?

Monoclonal antibody Remdisivir

What viruses use nucleoside analogues?

CMV, HSV1/2, Hep B

Which viruses have a vaccine?

COVID, Ebola, Rabies, Hep B, HPV

Which viruses use immunoglobulin passive transfer?

Rabies and Hep B

How does mRNA COVID-19 vaccine work once in the body?

mRNA for spike protein is injected and endocytosed

mRNA enters cytosol, translated into a protein via ribosome

Protein stimulates immune system

How does rabies infection work?

Rabies infection → rabies into tissue → rabies into neurons → rabies climbs up spinal cord into brain → replicates in brain → encephalitis → into saliva for transmission

How does EVD work?

Infects macrophages and liver → liver doesn’t produce clotting → macrophages recruited to liver → cytokine storm → blood vessels leak → lack of O2

Which viruses target the liver?

Ebola, CMV, Hep C, Hep B

What is the Ebola immune response?

IgG antibodies

How does WNV work?

Infection → diffusion into visceral organs → into spleen → crosses blood brain barrier → CNS → neuroinvasive

Which viruses are congenital?

CMV, HBV, HCV

What viruses are associated with transplants?

CMV, HBV, HCV, KSHV

Which viruses have an envelope?

All BUT HPV

Which viruses are DNA?

HBV, HPV, and all herpesviruses

How many HPVs are there?

300+

What genetic material is HPV?

DNA

Is HPV enveloped?

No- just capsid

What is the protein associated with HPV?

L1

How big is an HPV?

50 nm, very small

What part of HPV is recognized by the immune system?

L1 Protein

Is HPV specialized or generalized?

Extremely specialized to the point of body localization

What percent of people have had HPV?

50-80%

What is the most common STD?

HPV

What percent of people clear HPV and in how long?

90% in 2 years

How many deaths from cervical cancer yearly?

300k

How many cervical cancers are caused by HPV?

Majority, ~70%

How does HPV enter host?

Microabrasions

What percent of people get cervical HPV cancer in 30 years?

0.8%

What are the cancerous HPVs?

HPV 16 and 18

What are the benign HPVs?

HPV 6 and 11

How can HPV be prevented?

1. Vaccines

2. Protection

How is HPV detected?

Pap smears

Which HPVs are targeted by each HPV vaxx?

1: Cervarix, 16, 18

2. Gardasil, 16, 18, 6, 11

How effective is Gardasil 9?

90% of cervical cancers

Downside to HPV vaccines?

May need adjuvant

How does cancer, in general, work?

During replication, a cell makes a mistake and mutates, then that mutated cell multiplies and its multiplications mutate, etc

Why do old people get more cancers?

Acquire more mutated cells over a lifetime

What are the genes targeted by cancer?

1. Proto-oncogenes

2. Tumor-suppressing genes

What does a proto-oncogene do?

Supports cell proliferation

What happens when a proto-oncogene mutates?

Becomes an oncogene, proliferates rapidly and constantly

What does a tumor suppressor gene do?

Prevent unwanted mutant cell proliferation via apoptosis

What happens when a tumor suppressor cell mutates?

Loses ability to differentiate b etween mutating and non-mutating cells

How does HPV infect?

Basal cells in cervix → microabrasion allows HPV into cervix → HPV attaches to basal cells → HPV circularizes then linearizes its DNA → HPV DNA integrated into basal genome → new basal cells are made with HPV genome → virally infected cells express E6 and E7 → new proteins force cell proliferation > dying → cells proliferate more and more → genome packaging and virion assembly → virion release

What are the proteins E6 and E7?

HPV viral oncogenes

What happens when E6 and E7 are expressed?

E7 → E6 → deregulates cell proliferation → apoptosis blocked → outgrowth of deregulated cells → cancer

How long does cancer take to develop in a normal immune system?

15-20 years

How long does cancer take to develop in an immunocompromised system?

5-10 years

When does rabies become deadly?

Encephalitis once it reaches the brain and cardio-respiratory arrest