Chronic Inflammation 8-5-15

Question 1

What is chronic inflammation characterized by?

Answer 1

• lymphocytes and macrophages
• proliferating blood vessels
• formation of connective tissue

Question 2

What are the differences in onset, cellular infiltrate, tissue injury and fibrosis, local and systemic signs of acute vs chronic inflammation?

Answer 2

Acute
Onset: Fast(minutes or hours)
Cellular Infiltrate: Neutrophils
Tissue injury, fibrosis: mild and self-limited
Local and systemic signs: prominent

Chronic:
Onset: slow(days)
Cellular infiltrate: monocytes/macrophages and lymphocytes and plasma cells
Tissue injury, fibrosis: often severe and progressive
Local and systemic signs: less

Question 3

What is the signature cell of chronic inflammation?

Answer 3

Activated Macroaphages

-M1 macrophage=inflammatory cytokines

Question 4

What do chronic high levels of inflammatory cytokines cause?

Answer 4

1. Increase Hepatic production of defense proteins
2. Increased Hepcidin- sequester Fe
3. Increased growth factors for platelets and monocytes

Question 5

M1 vs M2 macrophages

Answer 5

M1:
IFN-gamma–>phagocytosis (ROS NO lysosomal enzymes) and inflammation (Il1)

M2:
IL 13,4–> tissue repair fibrosis(growth factors, TGF b) and anti-inflammatory effects (IL 10 and TGF B)

Question 6

What is granulomatous inflammation?

Answer 6

T-cell activation

• microbial intracellular infection
• macrophage uptake of a poorly degradable foreign body

found in:
Sarcoidosis and IBD unknown etiology

Question 7

WHat is the morphology of granulomatous inflammation?

Answer 7

1. central portion: necrotic debris
   - caseous: commonly found in TB
2. Activated macrophages and multinucleated giant cells in periphery
3. cuff of T-cells, CD3/CD4 postive
4. entire granuloma is rimmed by proliferating fibroblasts

Question 8

During inflammation what do hepatocytes produce more of?

Answer 8

1. Fibrinogen
2. Ceruloplasmin
3. Complement Components (C3)

Question 9

What happens to albumin synthesis during inflammation?

Answer 9

decreased

-rough correlation between decrease and duration of inflammatory response

Question 10

What does the increased production of hepcidin lead to?

Answer 10

Anemia

Question 11

What do growth factors stimulate the marrow to produce during inflammation?

Answer 11

1. increased leucocyte production
2. increased platelet production
   (leukocytosis and thrombocytosis can be present)

Question 12

What does C-Reactive Protein (CRP) measure? What stimulates it?

Answer 12

CRP is stimulated by inflammation and tightly linked to IL 6 levels
-when normal excludes significant inflammation being present

-obesity false elevation of CRP

Question 13

What does Erythrocyte sedimentation rate indicate?

Answer 13

• chronic inflammation causes increased IgG

- causes IgG and fibrinogen coat erythrocytes and red cells to fall more rapidly