Chapter 13: Inflammation and Cytokines Flashcards
Leads to exposed collagen, platelet-activating factor release and tissue factor release from endothelium
Injury
What happens when platelets bind collagen?
Release growth factors (platelet-derived growth factor [PDGF]); leads to PMN and macrophage recruitment
Dominant role in wound healing; release important growth factors (PDGF) and cytokines (IL-1 and TNF-alpha)
Macrophages
- Chemotactic and activates inflammatory cells (PMNs and macrophages)
- Chemotactic and activates fibroblasts -> collagen and ECM proteins
- Angiogenesis, epithelialization, chemotactic for smooth muscle cells, has been shown to accelerate wound healing
PDGF
- Chemotactic and activates fibroblasts
- Angiogenesis
- Epithelialization
EGF (epidermal growth factor)
- Chemotactic and activates fibroblasts -> collagen and ECM proteins
- Angiogenesis
- Epithelialization
FGF (fibroblastic growth factor)
- Is not stored, generated by phospholipase in endothelium; is a phospholipid
- Chemotactic for inflammatory cells; increase adhesion molecules
PAF (platelet-activating factor)
Chemotactic factors: for inflammatory cells
PDGF, IL-8, LTB-4, C5a and C3a, PAF
Chemotactic factors: for fibroblasts
PDGF, EGF, FGF
Angiogenesis factors
PDGF, EGF, FGF, IL-8, hypoxia
Epithelialization factors
PDGF, EGE, FGF
Last 1-2 days in tissues (7 days in blood)
PMNs
Lasts 7-10 days
Platelets
Involved in chronic inflammation (T cells) and antibody production (B cells)
Lymphocytes
Growth and activating factors
PDGF, EGF, FGF, PAF, (Chemotactic, angiogenesis, epithelialization), PMNs, platelets, lymphocytes, TXA2, PGI2
- Have IgE receptors that bind to allergen
- Release major basic protein, which stimulates basophils and mast cells to release histamine
- Increased in parasitic infections
Eosinophils
What do eosinophils release?
Major basic protein, which stimulates basophils and mast cells to release histamine
Main source of histamine in blood; not found in tissue
Basophils
- Primary cell in type 1 hypersensitivity reactions
- Main source of histamine in tissues
Mast cells
- Vasodilation, tissue edema, postcapillary leakage
- Primary effector in type 1 hypersensitivity reactions (allergic reactions)
Histamine
Peripheral vasodilation, increased permeability, pain, pulmonary vasoconstriction
Bradykinin
Inactivates bradykinin; located in lung
Angiotensin-converting enzyme (ACE)
Cells involved in type 1 hypersensitivity reactions
Eosinophils, basophils, mast cells, histamine, bradykinin
Substrate for nitric oxide synthase
Arginine
Activates gauntlet cyclase and increases cGMP, resulting in vascular smooth muscle dilation
- AKA: endothelium-derived relaxing factor
Nitric Oxide (NO)
Causes vascular smooth muscle constriction (opposite effect of nitric oxide)
Endothelin
Main initial cytokine response to injury and infection
TNF-alpha and IL-1
Largest producers of TNF
Macrophages
- Increases adhesion molecules
- Overall, a procoagulant.
- Causes cachexia in patients with cancer.
- Activates neutrophils and macrophages
TNF-alpha
What can high concentrations of TNF-alpha cause?
Circulatory collapse and multisystem organ failure
- Main source macrophages; effects similar to TNF-alpha and synergizes TNF-alpha
- Responsible for fever (PGE2 mediated in hypothalamus)
IL-1
Cause fever with atelectasis by releasing IL-1
Alveolar macrophages
Increases hepatic acute phase proteins (C-reactive protein, amyloid A)
IL-6
- Released by lymphocytes in response to viral infection or other stimulants
- Active macrophages, natural killer cells, and cytotoxic T cells
- Inhibit viral replication
Interferon
Most potent stimulus for hepatic acute phase response proteins
IL-6
Hepatic acute phase response proteins
- Increased?
- Decreased?
- Increased: CRP, amyloid A and P, fibrinogen, haptoglobin, ceruloplasmin, alpha-1 antitrypsin, and C3 (complement
- Decreased: albumin, pre-albumin, and transferrin
An opsonin, activates complement
C-reactive protein
- On leukocytes
- Bind ICAMs, etc
- Anchoring adhesion
Beta-2 integrins (CD 11/18 molecules)
- On endothelial cells, bind beta-2 integrin molecules located on leukocytes and platelets
- Also involved in transendothelial migration
ICAM, VCAM, PECAM, ELAM
What activates the classic complement pathway (IgG, or IgM)?
Antigen-antibody complex activates
Factors found only in the classic pathway
Factors C1, C2, and C4
What activates the alternative complement pathway?
Endotoxin, bacteria, other stimuli activate
Factors found only in the alternative pathway
Factors B, D, and P (properdin)
Complement: common to and is the convergence point for both pathway (alternative and classic)
C3
Complement: required for both pathways
Magnesium
- Increase vascular permeability, bronchoconstriction
- Activate mast cells and basophils
Anaphylatoxins (C3a, C4a, C5a)
What is the membrane attack complex?
C5b-9b, causes cell lysis (usually bacteria) by creating a hole in the cell membrane
Complement: opsonization (targets antigen for immune response)
C3b and C4b
Complement: chemotaxis for inflammatory cells
C3a and C5a
Produced from arachidonic precursors
Prostaglandins, Leukotrienes
Prostaglandins:
- Vasodilation
- Bronchodilation
- Increased permeability
- Inhibits platelets
PGI-2 and PGE-2
Inhibits cyclooxygenase (reversible)
NSAIDs
Inhibits cyclooxygenase (irreversible), inhibits platelet adhesion by decreasing TXA2
Aspirin
Inhibits phospholipase, which converts phospholipids to arachidonic acid -> inhibits inflammation
Steroids
Leukotrienes: slow-reacting substances of anaphylaxis; bronchoconstriction, vasoconstriction followed by increased permeability (wheal and flare)
LTC-4, LTD-4, LTE-4
Leukotrienes: chemotactic for inflammatory cells
LTB-4
Peaks 24-48 hours after injury
Catecholamines
Released from sympathetic postganglionic neurons
Norepinephrine
Released from the adrenal medulla (neural response to injury)
Epinephrine and norepinephrine
Neuroendocrine response to injury
Afferent nerves from site of injury stimulate CRF, ACTH, ADH, GH, epinephrine, and norepinephrine release
Does not play a major role in injury or inflammation
Thyroid hormone
Function: CXC chemokines
Chemotaxis, angiogenesis, wound healing
What are IL-8 and platelet factor 4?
CXC chemokines (C = cysteine, X = another amino acid)
Generated in inflammation
Oxidants
Main producer: superoxide anion radical (O2-)
NADPH oxidase
Main producer: Hydrogen peroxidase (H2O2)
Xanthine Oxidase
Cellular defense: superoxide anion radical
Superoxide dismutase
Cellular defense: hydrogen peroxidase
Glutathione peroxidase, catalase
Primary mediator of reperfusion injury
PMNs
NADPH-oxidase system enzyme defect in PMNs
- Results in decreased superoxide radical (O2-) formation
Chronic Granulomatous Disease