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Pathology and Immunity > Healing and Repair > Flashcards

Healing and Repair Flashcards

1
Q

what are the four stages of soft tissue healing

A

coagulation
inflammation
proliferative
maturation

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2
Q

what occurs in the proliferative phase

A

angiogenesis and fibrosis

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3
Q

what are the stages of hard tissue healing

A

bone remodelling
fracture healing

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4
Q

what type of inflammation leads to healing and repair

A

both acute and chronic

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5
Q

what is regeneration

A

replacement with functional, differentiated cells

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6
Q

what is repair

A

production of a fibrous scar and changes in tissue structure

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7
Q

what determines if there will regeneration or repair

A

this depends on the severity or location of tissue damage

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8
Q

how does a fibrous scar arise

A

from fibrosis by fibroblasts which produce collagen
scar will remain in tissue and change its struture and function

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9
Q

which form of inflammation is associated with a fibrous scar

A

chronic inflammatory diseases

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10
Q

what are the three cell types involved in healing and repair

A

labile cells
stable cells
permanent cells

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11
Q

what are labile cells

A

these are cells that have active cell division and rapid regeneration

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12
Q

what is an example of labile cells

A

oral keratinocytes

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13
Q

what is an example of stable cells

A

fibroblasts

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14
Q

what characterises stable cells

A

these have variable rates of regeneration and proliferation in response to injury

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15
Q

what is an example of permanent cells

A

nerve fibres

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16
Q

what characterises permanent cells

A

unable to divide and unable to regenerate

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17
Q

why is nerve damage permanent

A

nerve cells cannot regenerate or divide

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18
Q

where are oral keratinocytes found

A

in the periphery of gingival tissue

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19
Q

what happens in the coagulation phase of healing

A
  • clot formation through coagulation cascade
  • in parallel with the fibrinolytic system
  • platelets are weaved together by fibrin
  • mitosis of labile and stable cells
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20
Q

are the stages of healing and repair isolated

A

no they all occur at the same time

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21
Q

describe the inflammation stage of healing and repair

A

innate immune cell recruitment to site
immune cells will phagocytose and degrade infectious agents or damaged cells
stimulation of cells to start tissue repair and regeneration
fibroblasts drive fibrosis

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22
Q

what are the main points of inflammation phase

A

cell recruitment and fibrosis

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23
Q

what occurs in the proliferation phase

A

this has an early and late phase
forms granulation tissue
growth factors
fibroblasts
angiogenesis
myofibroblasts

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24
Q

what is angiogenesis

A

the formation of new blood vessels

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25
what is granulation tissue rich in
collagen
26
why are myofibroblasts involved in healing
they aid in the closure of a wound
27
why are wounds bright red
there are new blood vessels being formed during proliferation phase
28
what is the first phase of proliferation
this phase is rich in vasculature and is a mix of newly formed capillaries, immune cells, fibroblasts and leaky capillaries
29
what occurs in the second phase of proliferation
this stage is rich in collagen as there is fibrous granulation tissue the capillaries will regress and mature fibroblasts will create collagen
30
when is granulation tissue first formed
during proliferation phase
31
how does granulation tissue appear histologically
circular cells that are macrophages to control fibroblast action new capillaries appear as red dots fibroblasts are long and spindle shaped cells
32
what are matrix metalloproteinases
these are produced by different immune cells and that remodel the extracellular matrix, help with cellular migration and aid the process of angiogenesis
33
how do MMPs work
they target collagen to help cellular migration, getting the cells out of circulation itno the tissue and then aiding angiogenesis create a way into the tissue to the new capillaries can be formed produce cytokine growth factors and these enzymes will aid in cellular migration and angiogenesis
34
what are growth factors
these are signalling molecules that promote or inhibit cell growth and differentiation. they bind receptors on the cell surface they are normally produced but if there is an alteration in the balance of their production then there is dysregulated cellular proliferation
35
when are growth factors released as effector responses
following microbial recognition and cytokine signalling
36
what are the two growth factors to notr
TGF VEGF
37
what is TGF
transforming growth factor functions in driving the formation of new tissue and stimulates fibroblasts to produce collagen
38
what is VEGF
this is vascular endothelial factor that functions in driving angiogenesis
39
what is angiogenesis in healing
formation of new capillaries formed by existing vasculature by sprouting or splitting the process is driven by VEGF
40
what is sprouting
VEGF will produce a gradient and endothelial cells lining existing vasculature will move toward the gradient and as they move they will form a new capillary stemming from the original vasculature
41
what does splitting mean
this is intersusception of existing vasculature this is when there is no VEGF gradient and the endothelial cells will move and increase the size of the lumen of the existing vasculature until it forms new vasculature through splitting
42
how are new blood vessels formed when there is a VEGF gradient
sprouting
43
how are new blood vessels formed when there is no VEGF gradient
splitting
44
what is fibrosis
this is the deposition of collagen and the formation of fibrous connective tissue it is driven by fibroblasts during substantial or repeated damage ie in chronic inflammation
45
what controls fibroblasts function
M1 and M2 macrophages
46
where are fibroblasts found
within the connective tissue underlying the epidermis and epithelial tissue
47
which macrophages are the main drivers of fibrosis and angiogenesis
M2
48
which macrophage is antiinflammatory
m2
49
which macrophages are pro inflammatory
m1
50
what does the balance between the m1 and m2 subsets of macrophages lead to
tissue injury or tissue repair
51
which molecule drives tissue remodelling
prostaglandins
52
do prostaglandins increase or decrease the activity of fibroblasts
they decrease it
53
what is the maturation phase of healing
this is when disorganised granulation tissue is remodelled by remaining cells collagen fibres are cross linked and there is repeithelialisation they regain tensile strength fibrous scar will remain tissue remodelling is required
54
which molecules reduce fibroblast activity
prostaglandins
55
what is osteoblastogenesis
the formation of bone
56
what is osteoclastogenesis
the resorption of bone
57
how often do we get a new skeleton
every ten years
58
is there net loss of bone during normal formation and resorption
no
59
what is bone resorption mediated by
osteoclasts
60
what do osteoclasts differentiate from
macrophages
61
what is RANKL
receptor activator of nuclear factor Kappa-B Ligand
62
what produces RANKL
osteoblasts
63
what does RANKL activate
RANK on osteoclasts
64
why is there not normally unbalanced bone resorption
the production of RANKL is normally controlled
65
what mediates bone formation
osteoblasts
66
what do osteoblasts secrete alongside RANKL
OPG - osteoprotogerin
67
what inhibits RANKL
osteoprotogerin
68
what is the RANKL/OPG ratio important for
modulating processes in health
69
what is an excessie immune respone associated with
an increase in the RANKL/OPG ratio
70
what is an example of a disease that leads to an imbalance in RANKL/OPG ratio
periodontal disease
71
what is the keystone pathogen for periodontal disease
p gingivails
72
how does p gingivalis cause periodontal disease
they target osteoblasts and stimulate the production of RANKL which leads to an imbalance in the ratio to cause excessive bone resorption
73
what is the periosteum
this is the sheath outside the bone that supplies it with blood immune cells and plasma proteins
74
what are the stages of fracture healing
hematoma to callus to the original shape
75
what occurs in the coagulation phase for fracture healing
formation of a hematoma
76
what is a hematoma
blood clot within tissue/bone
77
what occurs in the inflammatio phase of fracture healing
recruitment of immune cells and removal of debris and dying tissue cells produce soluble mediators to drive later healing responses
78
describe the proliferation phase of fracture healing
formation of granulation tissue that is similar to soft tissue this granulation tissue becomes the fibrocartilage callus and is comopsed of osteoblasts, fibroblasts and chondrocytes it is then ossified
79
what does woven bone do during fracture healing
forms a tempoary scaffold for new bone development
80
describe the maturation phase of fracture healing
osteoclasts and osteoblasts will remodel the bone callus cortical replaces woven bone can take between months and years angiogenesis is essential for bone regeneration and repair
81
why does bone remodelling occur
to restructure the bone back to its original shape
82
describe the steps to sprouting
- tip vs stalk selection - abluminal sprouting - elongation and bridging - sprout fusion and lumenisation (ie formation of a lumen)
83
describe the steps to splitting
- vascular enlargement - protrusion of opposing capillary walls, intraluminal sprouting - intraluminar pillar formation - splitting
84
what is another name for capillary splitting
intussusception

Pathology and Immunity (16 decks)

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