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*MOD Exam 1 > Ch 3 Lect: Inflammation and Repair (Dobson) > Flashcards

Ch 3 Lect: Inflammation and Repair (Dobson) Flashcards

1
Q

Define:

Inflammation

A

“Inflammation is a protective response of vascularized tissues to infections and damaged tissues that brings cells and molecules of host defense from the circulation to the sites where they are needed, in order to eliminate the offending agents”

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2
Q

What are the “5 R’s” of acute inflammation?

A
  1. Recognized
  2. Recruited
  3. Removed
  4. Regulated
  5. Repaired
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3
Q

What are the 5 hallmark signs of acute inflammation?

A

Rubor (redness)

Calor (heat)

Tumor (swelling)

Dolor (pain)

Loss of function

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4
Q

Features of Acute Inflammation

Onset?

A

Fast!!!

Minuites or hours

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5
Q

Features of Acute Inflammation

What is the Cellular Infiltrate?

A

NEUTROPHILS

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6
Q

Features of Acute Inflammation

Feature: Tissue injury, fibrosis?

A

Usually mild and self-limited

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7
Q

Features of Acute Inflammation

Feature: Local and systemic signs?

A

Prominent

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8
Q

Features of Chronic Inflammation

Feature: Onset?

A

Slow!!!

Days

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9
Q

Features of Chronic Inflammation

Feature: Cellular infiltrate?

A

Monocytes

Macrophages

Lymphocytes

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10
Q

Features of Chronic Inflammation

Feature: Tissue injury/fibrosis?

A

Otften severe and progressive

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11
Q

Features of Chronic Inflammation

Feature: Local and systemic signs?

A

Less than acute

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12
Q

Acute inflammation is one of the reactions of the type of host defense known as _______ immunity

A

Innate

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13
Q

Chronic inflammation is more prominent in the reactions of ________ immunity

A

Adaptive

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14
Q

What are the primary cells involved in recognition of foreign bodies?

A

Macrophages

Dendritic cells

Mast cells

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15
Q

What are dendritic cells?

A

Antigen presenting cells (APCs) that process antigen material and present it on the cell surface to the T Cells of the immune system.

They act as messengers between the innate and the adaptive immune systems.

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16
Q

Gain-of-function mutations in the sensor are the cause of rare diseases known as _______________

A

Autoinflammatory syndromes

–> Characterized by spontaneous inflammation

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17
Q

What is an effective treatment for autoinflammatory syndromes?

A

IL-1 antagonists

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18
Q

The inflammasome has been implicated in inflammatory reactions to?

A
  • Urate crystals
  • Lipids
  • Cholesterol crystals
  • Amyloid deposits in alzheimers
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19
Q

What are the three major components of an acute inflammation response?

A
  1. Dilation of small vessels leading to an increase in blood flow
  2. Increased permeability of the microvasculature enabling plasma proteins and leukocytes to leave the circulation
  3. Emigration of leukocytes from the microcirculation, their accumulation in the focus of injury, and their activation to eliminate the offending agent
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20
Q

What is exudate?

A

High protein and cellular content

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21
Q

What is transudate?

A

Low protein content, few cells

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22
Q

Inflammatory reactions are initiated, maintained and terminated by ___________

A

Mediators of inflammation

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23
Q

Table 3-4

Principal mediators of Inflammation

Mediator: Histamine

Source? Action?

A

Source: Mast cells, basophils, platelets

Action: Vasodilation, increased vascular permeability, endothelial activation

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24
Q

Table 3-4

Principal mediators of Inflammation

Mediator: Prostaglandins

Source? Action?

A

Source: Mast cells, leukocytes

Action: Vasodilation, pain, fever

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25
Table 3-4 Principal mediators of Inflammation Mediator: _Leukotrienes_ Source? Action?
Source: Mast cells, leukocytes Action: Increased vascular permeability, chemotaxis, leukocyte adhesion and activation
26
Table 3-4 Principal mediators of Inflammation Mediator: _Cytokines (TNF, IL-1, IL-6)_ Source? Action?
Source: Macrophages, endothelial cells, mast cells Action: Local [endothelial activation] Systemic [fever, metabolic abnormalities, hypotension (shock)]
27
Table 3-4 Principal mediators of Inflammation Mediator: _Chemokines_ Source? Action?
Source: Leukocytes, activated macrophages Action: Chemotaxis, leukocyte activation
28
Table 3-4 Principal mediators of Inflammation Mediator: _Platelet-activating factor_ Source? Action?
Source: Leukocytes, mast cells Action: Vasodilation, increased vascular permeability, leukocyte adhesion, chemotaxis, **degranulation, oxidative burst**
29
Table 3-4 Principal mediators of Inflammation Mediator: _Complement_ Source? Action?
Source: Plasma (produced in liver) Action: Leukocyte chemotaxis and activation, direct target killing, vasodilation
30
Table 3-4 Principal mediators of Inflammation Mediator: **Kinins** Source? Action?
Source: Plasma (produced in liver) Action: Increased vascular permeability, smooth muscle contraction, vasodilation, pain
31
Process of inflammation more prodominantly occurs in which of the following? A) Arterioles B) Venules C) Lymphatics
A) Arterioles **_B) Venules_** C) Lymphatics \*Post capillary venules are the primary site where exudation occurs. Very thin layer allow materials to diffuse accross
32
What does this image reveal?
Lymphangitis
33
What are the 4 overarching steps of getting a leukocyte to travel from the circulation to the site of infection?
1. Margination 2. Rolling 3. Adhesion to endothelium 4. Diapedesis (transmigration)
34
What are the first two selections to become expressed by TNF and IL-1?
P-selectin E-selectin
35
What is the major player involved in diapedesis/transmigration of the leukocyte across the endothelium?
PECAM-1 (CD31)
36
After the leukocyte has entered the tissue, what does it do to move toward the site of injury?
Utilizes **chemotaxis**
37
What is the major **exogenous** agent for chemotaxis?
N-formylmethionine
38
What are the major **endogenous agents** (3) for chemotaxis?
1. Cyokines (eg. IL-8) 2. Complement (C5a) 3. Arachidonic acid (AA), mainly LTB4
39
What are the functions of **integrins?**
- Focal attachment - Trigger signaling cascades - Influence cell locomotion, proliferation, shape and differentiation
40
What are the different receptors involved in leukocyte activation?
- GPCRs - Toll-like receptors - Cytokine receptor - Phagocytic receptor
41
The macrophage mannose receptor is a lectin that binds...
Terminal mannose and fructose residues of glycoproteins and glycolipids. \*These sugars are typically part of molecules found on **microbial cell walls**
42
The efficienty of phagocytosis is greatly enhanced when microbes are \_\_\_\_\_\_\_\_\_\_
Oponized
43
What are the major **opsonins?**
IgG Antibodies C3b breakdown product of complement Mannose-binding lectin
44
Killing of microbes is accomplished by \_\_\_\_\_\_\_\_\_\_\_\_\_\_
Reactive oxygen species (ROS)
45
Primary granules contain? Aka? Large or small?
MPO Azurophil granules Large
46
What is this slide revealing?
**Toxic granulation** --\> Seen in patients with **sepsis** --\> Toxic granulations are dark coarse granules found in granulocytes, particularly _neutrophils_
47
What is an alternative way that infections are **contained?**
Use of **Neutrophil extracellular traps (NETs)** These NETs prevent the spreading of microbes by trapping them in _fibrils_
48
Prostaglandins and leukotrienes are produced from?
Arachidonic acid (AA)
49
What is the mechanism of **aspirin?**
Functions to inhibit **cyclooxygenase** enzyme so that _prostaglandins are not produced_
50
What do COX inhibitors inhibit?
Cyclooxygenase (prostaglandin production)
51
What are the major cytokines involved in **acute inflammation?**
TNF IL-1 IL-6 Chemokines IL-17
52
Acute Inflammation What is the source and action of **TNF?**
Source: **Macrophages (primarily)**, mast cells, T lymphocytes Action: Stimulates expression of _endothelial adhesion_ molecules and secretion of other cytokines (systemic effects)
53
Acute Inflammation What is the source and action of **IL-1?**
Source: **Macrophages (primarily)**, endothelial cells and some epithelial cells Actions: Similar to TNF; endothelial activation (initiation of P and E selectin release) and greater role in **fever**
54
Acute Inflammation What is the source and action of **IL-6?**
Source: **Macrophages**, other cells Actions: Systemic effects (acute phase response)
55
Acute Inflammation What is the source and action of **Chemokines?**
Source: Macrophages, endothelial cells, T lymphocytes, mast cells and others Actions: Recruitment of leukocytes to sites of inflammation; migration of cells in normal tissues
56
Acute Inflammation What is the source and action of IL-17?
Source: T lymphocytes Action: **Recruitment** of neutrophils and monocytes
57
What are the primary cytokines involved in **chronic inflammation?**
IL-12 IFN-gamma IL-17
58
Chronic Inflammation What is the source and action of **IL-12?**
Source: ANTIGEN PRESENTING CELLS!!! Dendritic cells, macrophages Actions: Increased production of IFN-gamma
59
Chronic Inflammation What is the source and action of **IFN-gamma?**
Source: T lympocytes, NK cells Action: Activation of macrophages
60
Chronic Inflammation What is the source and action of **IL-17?**
Source: T lymphocytes Actions: Recruitment of neutrophils and monocytes
61
\_\_\_ and ___ serve critical roles in leukocyte recruitment by promoting adhesion of leukocytes to endothelium and their migration through vessels
TNF IL-1
62
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ have been remarkably effective in the treatment of chronic inflammatory diseases; particularly rheumatoid arthritis
TNF antagonists
63
What do complement proteins C5a, C3a and C3b do?
C5a and C3a = Add to the inflammatory response C3b=Phagocytosis, acts as an opsonin
64
What disease is associated with inhibiting C1 in the complement pathway?
C1 inhibitor blocks the activation of C1 that leads to **hereditary angioedema**
65
What is **paroxysmal nocturnal hemoglobinuria (PNH)** associated with?
Decary accelerating factor (DAF)
66
What are the principal mediators of: *Vasodilation?*
Histamine Prostaglandins
67
What are the principal mediators of: *Increased vascular permeability?*
Histamine Serotonin C3a C5a Leukotrienes C4, D4, E4
68
What are the principal mediators of: *Chemotaxis, leukocyte recruitment* and *activation?*
TNF IL-1 Chemokines C3a, C5a Leukotriene B4
69
What are the principal mediators of: *Fever?*
IL-1 TNF Prostaglandins
70
What are the principal mediators of: *Pain?*
Prostaglandins Bradykinin
71
What are the principal mediators of: *Tissue damage?*
Lysosomal enzymes of leukocytes Reactive oxygen species (ROS)
72
What are the **morphologic patterns** of acute inflammation?
1. Serous inflammation 2. Fibrinous inflammation 3. Purulent (suppurative) inflammation/abscess 4. Ulcer
73
Serous inflammation is marked by exudation of ___________ into spaces created by cell injury or into body cavities lined by the peritoneum, pleura or pericardium. This is termed an: \_\_\_\_\_\_\_\_
Cell-poor fluid Effusion
74
When does a **fibrinous exudate** develop?
When vascular permeability allows **large molecules** such as **fibrin** to pass out of the blood or There is a local **procoagulant stimulus** (malignant cells)
75
Where is **fibrinous exudate** characteristically found?
Lining body cavities
76
What is **purulent inflammation?**
Produces **pus**; an exudate consisting of neutrophils, the liquefied debris of necrotic cells and edema fluid
77
What is an **ulcer?**
A local defect, or excavation, of the surface of an organ or tissue that is produced by the sloughing of inflamed necrotic tissue
78
What is the Onset, Cellular infiltrate, Tissue injury and local/systemic signs of **Chronic inflammation?**
Onset: ***Slow/days*** Cellular infiltrate: _Monocytes/macrophages and lymphocytes_ Tissue injury: ***Often severe and progressive*** Local/systemic signs: _less than acute_
79
Monocytes have MANY names based on where they are: State the name based on the location: Circulating in blood = In tissue= Liver macrophages= Spleen/lymph node= CNS= Lungs= Skin=
Circulating in blood = **Monocytes** In tissue= **Macrophages** Liver macrophages= **Kupffer cells** Spleen/lymph node= **Sinus histiocytes** CNS= **Microglial cells** Lungs= **Alveolar macrophages** Skin= **Langerhans cells**
80
Identify the labeled cells
81
**Classically activated Macrophage (M1)** What are the activated by? What are they inhibited by? What are the downstream events upon activation?
Activated: Microbes, IFN-gamma Inhibited: IL-13, IL-4 Downstream: Inflammation, phagocytosis
82
Alternatively activated Macrophage (M2) What are the activated by? What are they inhibited by? What are the downstream events upon activation?
Active: IL-13, IL-4 Inhibited: Microbes, IFN-gamma Downstream: Tissue repair, fibrosis, Anti-inflammatory effects
83
Eosinophils
84
Eosinophils have granules that contain \_\_\_\_\_\_\_\_\_\_\_\_\_
Major basic protein
85
What is this and what are the components?
Necrotizing granuloma
86
Name examples of diseases with granulmatous inflammation:
1. Tuberculosis 2. Leprosy 3. Syphilis 4. Cat-scratch disease 5. Sarcoidosis 6. Crohn disease
87
What are **acute-phase** reactants?
"Plasma proteins, mostly synthesized in the liver, whose plasma concentrations may **increase several hundred-fold** as a part of the response to inflammatory stimuli"
88
What are 4 examples of **acute-phase reactants?**
1. C reactive protein (CRP) 2. Fibrinogen 3. Serum amyloid associated protein (SAA) 4. Hepcidin
89
What is the most abundant cell type in the blood?
**Neutrophils** (40-70%) of blood composition
90
What is the least abundant cell type in the blood?
Basophils (0-1%)
91
What does a **left-shift** refer to?
A left shift is related to an **accelerated release** of cells from the bone marrow post mitotic reserve pool and is therefore associated with a **rise in the number of more immature neutrophils** in the blood = left shift
92
\_\_\_\_\_\_\_\_\_\_\_\_\_ is the process of new blood vessel development from existing vessels. It is critical in healing at sites of injury.
Angiogenesis
93
What is the major player in the deposition of connective tissue?
TGF-beta
94
Which method of "intention" allows for the best healing?
First intention
95

*MOD Exam 1 (15 decks)

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