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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{Rim}}
|QuestionAuthor= {{SSK}} (Reviewed by Serge Korjian and  {{AJL}})
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Immunology
|MainCategory=Immunology
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|MainCategory=Immunology
|MainCategory=Immunology
|SubCategory=Pulmonology
|SubCategory=Pulmonology
|MainCategory=Immunology
|MainCategory=Immunology
|MainCategory=Immunology
|MainCategory=Immunology
|MainCategory=Immunology
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|MainCategory=Immunology
|MainCategory=Immunology
|SubCategory=Pulmonology
|SubCategory=Pulmonology
|Prompt=A 7-year-old boy was brought to the emergency department for severe cough since three hours. The mother reports that her son woke up from sleep and started coughing non-stop to an extent that she noticed his color became blue.  The mother mentions that this is not the first time it happens with him as he has been having severe bouts of cough at night or following his exercise classes at school. A diagnosis of asthma is suspected.  Which of the following mediators is involved in the class switching of immunoglobulin to IgE which is involved in the pathophysiolohy of the patient's condition?
|Prompt=A 7-year-old boy is brought to the emergency department for several hours of unremitting cough. The mother mentions that this is not the first occurrence, as he has been having severe coughing fits at night and following gym class for several weeks now. Physical examination reveals significant wheezing and decreased air entry bilaterally. Expression of which of the following mediators is likely to be elevated in this patient?
|Explanation=The patient is suffering from symptoms of cough at night and following exercise, which are consistent with a diagnosis of asthma. Both interleukins 4 and 5 are involved in [[asthma]]. Interleukin 4 pronotes class switching of immunoglobulin into [[IgE]] and Interleukin 5 plays a role in the activation and the proliferation of [[eosinophil]]s.
|Explanation=Asthma is an airway disease characterized by reversible bronchial obstruction with chronic underlying airway inflammation. The main pathophysiologic mechanism underlying asthma is Th2-cell mediated inflammation. In vivo, the ratio of Th2/Th1 is markedly elevated in patients with asthma. Consequently, Th2 cytokines, particularly  interleukin 4, 5, and 13 are significantly increased. Interleukin-4 is a major contributor to the disease pathogenesis. It promotes class switching of immunoglobulin into [[IgE]], and stimulates the differentiation of immature T-cells into Th2 cells.
 
Educational objective:
Shown below is an image summarizing the roles of interleukins and the cells that secrete them.


[[File:Interleukin.png]]
The table  below summarizes the roles of interleukins and the main cells that secrete them.
<br>
[[File:Interleukin.png]]<br>
|AnswerA=Interleukin 1
|AnswerA=Interleukin 1
|AnswerAExp=Interleukin 1 affects the activity of [[hypothalamus]], the thermoregulatory center, which leads to a raise of a body temperature, so called [[fever]].  That is why [[IL-1]] is called endogenous [[pyrogen]].  Interleukin 1 is not involved in [[asthma]].
|AnswerAExp=Interleukin 1 impacts the activity of [[hypothalamus]], the thermoregulatory center, which leads to a raise of a body temperature.  Interleukin 1 is not involved in [[asthma]].
|AnswerB=Interleukin 2
|AnswerB=Interleukin 3
|AnswerBExp=Interleukin 2 is necessary for the growth, proliferation, and differentiation of [[T cells]] to become 'effector' T cells.  It is secreted by the T helper cells.  Interleukin 2 is not involved in [[asthma]].
|AnswerBExp=Interleukin 3, secreted by [[basophil]]s and activated [[T cells]], supports growth and differentiation of T cells from [[bone marrow]] in an immune response.  Interleukin 3 is not involved in [[asthma]].
|AnswerC=Interleukin 3
|AnswerC=Interleukin 4
|AnswerCExp=Interleukin 3 is secreted by [[basophil]]s and activated [[T cells]] to support growth and differentiation of T cells from the [[bone marrow]] in an immune response.  Interleukin 3 is not involved in [[asthma]].
|AnswerCExp=Interleukin 4 induces [[B-cell]] class switching to [[IgE]], and up-regulates MHC class II production. IL-4 decreases the production of Th1 cells, macrophages, IFN-gamma, and dendritic cell IL-12.
|AnswerD=Interleukin 4
|AnswerD=Interleukin 10
|AnswerDExp=Interleukin 4 induces [[B-cell]] class switching to [[IgE]], and up-regulates MHC class II production. IL-4 decreases the production of Th1 cells, macrophages, IFN-gamma, and dendritic cell IL-12.
|AnswerDExp=Interleukin 10 is a major regulator of T<sub>reg</sub>-cell activity, and is usually decreased in patients with asthma.
|AnswerE=Interleukin 5
|AnswerE=Interleukin 12
|AnswerEExp=Interleukin 5 is a major regulator of [[eosinophil]] accumulation in tissues, and can modulate eosinophil behavior at every stage from maturation to survival. Interleukin 5 is not involved in [[asthma]].
|AnswerEExp=Interleukin 12 is important for the differentiation of helper T-cells into Th1 cells. Interleukin 12 is not elevated in [[asthma]].
|RightAnswer=D
|EducationalObjectives=Asthma is a Th2-mediated disease with elevated levels of Th2 cytokines, particularly  interleukin 4, 5, and 13.
|WBRKeyword=Interleukin, asthma, immunoglobulin
|References=Martinez FD, Vercelli D. Asthma. Lancet, 2013;382(9901):1360-72.<br>
|Approved=No
Akdis M, Burgler S, Crameri R, Eiwegger T, Fujita H, Gomez E, Klunker S, Meyer N, O'Mahony L, Palomares O, Rhyner C, Ouaked N, Schaffartzik A, Van De Veen W, Zeller S, Zimmermann M, Akdis CA. Interleukins, from 1 to 37, and interferon-γ: receptors, functions, and roles in diseases. J Allergy Clin Immunol. 2011 Mar;127(3):701-21.e1-70.<br>
First Aid 2014 page 205
|RightAnswer=C
|WBRKeyword=Interleukins, Interleukin, Asthma, Immunoglobulin, IgE, Atopy, IL-4, IL-5, IL-13
|Approved=Yes
}}
}}

Latest revision as of 00:45, 28 October 2020
Author [[PageAuthor::Serge Korjian M.D. (Reviewed by Serge Korjian and Alison Leibowitz [1])]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Immunology
Sub Category SubCategory::Pulmonology
Prompt [[Prompt::A 7-year-old boy is brought to the emergency department for several hours of unremitting cough. The mother mentions that this is not the first occurrence, as he has been having severe coughing fits at night and following gym class for several weeks now. Physical examination reveals significant wheezing and decreased air entry bilaterally. Expression of which of the following mediators is likely to be elevated in this patient?]]
Answer A AnswerA::Interleukin 1
Answer A Explanation [[AnswerAExp::Interleukin 1 impacts the activity of hypothalamus, the thermoregulatory center, which leads to a raise of a body temperature. Interleukin 1 is not involved in asthma.]]
Answer B AnswerB::Interleukin 3
Answer B Explanation [[AnswerBExp::Interleukin 3, secreted by basophils and activated T cells, supports growth and differentiation of T cells from bone marrow in an immune response. Interleukin 3 is not involved in asthma.]]
Answer C AnswerC::Interleukin 4
Answer C Explanation [[AnswerCExp::Interleukin 4 induces B-cell class switching to IgE, and up-regulates MHC class II production. IL-4 decreases the production of Th1 cells, macrophages, IFN-gamma, and dendritic cell IL-12.]]
Answer D AnswerD::Interleukin 10
Answer D Explanation [[AnswerDExp::Interleukin 10 is a major regulator of Treg-cell activity, and is usually decreased in patients with asthma.]]
Answer E AnswerE::Interleukin 12
Answer E Explanation [[AnswerEExp::Interleukin 12 is important for the differentiation of helper T-cells into Th1 cells. Interleukin 12 is not elevated in asthma.]]
Right Answer RightAnswer::C
Explanation [[Explanation::Asthma is an airway disease characterized by reversible bronchial obstruction with chronic underlying airway inflammation. The main pathophysiologic mechanism underlying asthma is Th2-cell mediated inflammation. In vivo, the ratio of Th2/Th1 is markedly elevated in patients with asthma. Consequently, Th2 cytokines, particularly interleukin 4, 5, and 13 are significantly increased. Interleukin-4 is a major contributor to the disease pathogenesis. It promotes class switching of immunoglobulin into IgE, and stimulates the differentiation of immature T-cells into Th2 cells.

The table below summarizes the roles of interleukins and the main cells that secrete them.


Educational Objective: Asthma is a Th2-mediated disease with elevated levels of Th2 cytokines, particularly interleukin 4, 5, and 13.
References: Martinez FD, Vercelli D. Asthma. Lancet, 2013;382(9901):1360-72.
Akdis M, Burgler S, Crameri R, Eiwegger T, Fujita H, Gomez E, Klunker S, Meyer N, O'Mahony L, Palomares O, Rhyner C, Ouaked N, Schaffartzik A, Van De Veen W, Zeller S, Zimmermann M, Akdis CA. Interleukins, from 1 to 37, and interferon-γ: receptors, functions, and roles in diseases. J Allergy Clin Immunol. 2011 Mar;127(3):701-21.e1-70.
First Aid 2014 page 205]]

Approved Approved::Yes
Keyword WBRKeyword::Interleukins, WBRKeyword::Interleukin, WBRKeyword::Asthma, WBRKeyword::Immunoglobulin, WBRKeyword::IgE, WBRKeyword::Atopy, WBRKeyword::IL-4, WBRKeyword::IL-5, WBRKeyword::IL-13
Linked Question Linked::
Order in Linked Questions LinkedOrder::
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