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Inflammation Flashcards

1
Q

What are the four cardinal features of inflammation?

A

Rubor - redness
Calor - heat
Tumor - swelling
Dolor - pain

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2
Q

What causes rubor?

A

Vascular leakage leads to an accumulation of blood contents, including red blood cells which causes the redness

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3
Q

What causes calor at a site of inflammation?

A

High metabolism of infiltrating immune cells all generate heat. Also the increased presence of fluid at core body temperature at a site that usually has limited exposure

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4
Q

What is inflammation?

A

A non specific immune response to cellular injury which is designed to remove damaged cells and clear threats such as infections and pathogens

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5
Q

What are the causes of inflammation?

A

Pathogens, allergens, physical damage, extreme temperatures, autoantigens

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6
Q

Where can inflammation occur?

A

Any vascularised tissue

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7
Q

When is inflammation initiated?

A

When cellular damage leads to the release of Damage Associated Molecular Pathogens (DAMPs) or Pathogen Associated Molecular Pathogens (PAMPs)

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8
Q

What causes swelling at a site of inflammation?

A

Vascular leakage increases blood flow into the inflamed tissue, leading to tissue buildup

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9
Q

What causes pain in an inflamed area?

A

Many of the mediators (e.g. prostaglandins) that signal to endothelial and immune cells during inflammation also signal on local nerve cells

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10
Q

What is meant by acute inflammation?

A

A short term process occuring in response to tissue injury, normally associated with rapid onset and resolution

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11
Q

What is acute inflammation characterised by?

A

Neutrophil recruitment

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12
Q

What triggers the release of DAMPs and PAMPs?

A

Non-apoptotic cell death eg due to a wound for example

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13
Q

What vasodilators do mast cells release?

A

Nitric oxide and histamine

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14
Q

What are the vascular changes associated with the release of histamine and nitric oxide?

A
  • Increase permeability of blood vessel wall
  • Dilation
  • Plasma leakage
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15
Q

What 4 benefits does increased vascular permeability and leakage into an inflamed site bring?

A

BALP

forms a BARRIER
more ANTIBODIES
more LEUKOCYTE migration
more PROTEINS to the site

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16
Q

How do neutrophils move to areas of damage?

A

Via chemotaxis, following a concentration gradient of chemotoxins including C5a, LTB4 and bacterial peptides

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17
Q

What is exudate?

A

Fluid, protein and cells that have seeped out a blood vessel

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18
Q

What does the exudate form?

A

A separation between healthy tissue and the inflamed tissue - acts as a physical barrier

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19
Q

How are neutrophils able to migrate towards the chemokine source?

A

They express complementary chemokine receptors which allow them to migrate towards the course

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20
Q

What is meant by neutrophil extravasation?

A

The movement of neutrophils from the vasculature into the surrounding tissue to reach the site of inflammation

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21
Q

What are the four steps of neutrophil extravasation?

A
  1. Chemo-attraction
  2. Rolling adhesion
  3. Tight Adhesion
  4. Transmigration
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22
Q

What are the two adhesion molecules which are upregulated by cytokines?

A

P-selectin and E-selectin

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23
Q

How do neutrophils recognise selectin molecules on the endothelium?

A

They have complementary carbohydrate ligands which bind to the selectin molecules

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24
Q

What is rolling adhesion?

A

When there is gentle interaction between the selectin molecules and the surface ligands which bind, causing the neutrophils to roll along the endothelium

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25
What is the name of the P selectin ligand?
PSGL1
26
What promotes the low to high affinity switch in integrins?
Chemokines
27
What is meant by transmigration?
The movement of the neutrophil through the endothelial wall which involves the cytoskeleton of the neutrophil to be rearranged
28
What molecule mediates the transmigration of the neutrophil molecule?
PECAM
29
What are the three functions of neutrophils at the site of inflammation?
1. Pathogen recognition 2. Pathogen clearance 3. Cytokine secretion
30
How do neutrophils recognise pathogens?
They use the TLR4 receptor to identify lipopolysaccharides that are present in gram negative bacteria for example
31
How do neutrophils clear pathogens?
By phagocytosis
32
Describe the process of phagocytosis?
1. Pathogen is engulfed into phagosome 2. Phagosome fuses with enzyme containing vesicles forming a phagolysosome 3. This is degraded by enzymes through acidifcation
33
What is released during phagocytosis which causes oxidative damage?
ROS - reactive oxygen species
34
Give 3 reasons why the release of exudate is helpful?
Leads to increased lymphatic drainage and also allows plasma proteins like fibrin to be directly delivered to site of inflammation. Also helps to form a physical barrier between inflamed and healthy tissue
35
Why are histamine molecules turned over rapidly?
They are small molecules and therefore are rapidly degraded
36
What produces anti-inflammatory mediators to resolve acute inflammation?
Macrophages
37
How can acute inflammation be resolved through repair?
Infiltrating WBC clear the wound of dead cells and pathogens and release growth factors which stimulate tissue repair - ECM deposition
38
How do macrophages clear apoptotic cells?
They engulf them
39
When does chronic inflammation occur?
When the acute response cannot clear the stimuli
40
What does chronic inflammation result in?
Scarring and loss of tissue function
41
What drives continual inflammation in chronic inflammation?
Antigens
42
Why is persistent neutrophil activation bad?
It is highly toxic and leads to rapid tissue destruction
43
What is a foreign antigen?
an antigen derived from molecules not found in the body
44
What is a self antigen?
An antigen derived from molecules produced by our bodies
45
What is an immunogen?
An antigen independantly capable of driving an immune response in absence to additional substances
46
What is a hapten?
A small molecule that alone does not act as an antigen but when bound to a larger molecule it can create an antigen
47
What is granulomatous inflammation?
Chronic inflammation with distinct patterns of granuloma formation
48
Name some diseases characterised by chronic inflammation?
Rhuematoid Arthritis Asthma Inflammatory Bowel Disease Hepatitis Psoriasis
49
Name some diseases associated with granulomatous inflammation?
TB Leprosy Tumour reactions Crohn's Disease
50
What are some persistent inflammatory stimuli found in chronic inflammation?
Persistent/prolonger infection Persistent toxic stimuli like allergens and pollutants Unclearable particulates Self-antigens
51
What does the distinct immune cell infiltrate found in chronic inflammation consist of?
Inflammatory macrophages T cells Plasma Cells
52
How are macrophages recruited to the site of inflammation?
As monocytes
53
What are the benefits of macrophages being recruited to the site of inflammation?
Phagocytosis Cytotoxic Anti-inflammatory Help repair wound by building ECM
54
What are the bad things associated with macrophages being recruited to the area?
They can cause damage to healthy surrounding tissue Inflammatory Pro-fibrotic, deposit excess collagen
55
What pro-inflammatory signals do T cells release?
TNF, IL-17 and IFN-gamma
56
How do T cells promote remodelling and suppression of the immune system?
TGF-beta
57
How do T cells act in a cytotoxic manner?
through the release of perforin and granzymes
58
What do B cells do in an chronic inflammatory response?
Generate antibodies that help to clear infection
59
Which white blood cell can act remotely during chronic inflammation?
B cells
60
What are granulomas?
Aggregation of activated macrophages
61
What triggers granuloma formation?
Strong T cell responses
62
What is the job of the granulomas?
To form a physical barrier to prevent pathogenic material from leaking out granuloma, thus allowing macrophages to clear the material
63
What are the differences between acute and chronic inflammation?
Acute: - Rapid onset - Lasts days - Vasodilation - Neutrophils predominate - Histamine release - Scarring - Either resolved or moves on to chronic inflammation Chronic: - Delayed onset - Lasts years - Ongoing tissue injury and attempts at healing - Monocytes and macrophages dominate - Prominent scarring
64
What type of cell dominates during chronic inflammation?
Monocytes / Macrophages
65
How long may a chronic inflammatory reaction last for?
Weeks, months or even years
66
What is continually released during chronic inflammation?
Cytokine release
67
What are the long term consequences of inflammation called?
The sequelae
68
What are the three possible outcomes of injury?
1. Regeneration 2. Repair / scar formation 3. Tissue scarring categorized by chronic inflammation
69
What does resolution after injury involve?
The clearance of injurious stimuli, and inflammatory mediators, replace injured cells and return to normal function
70
What does fibrosis involve as an sequalae of inflammation?
the deposition of collagen leading to excess tissue scarring and therefore the inability of the tissue to carry out its function
71
What is deposited when wounds heal?
ECM deposited
72
How do scars form?
When the collagen is unable to be removed from the site of endothelial repair
73
What are the positive outcomes of inflammation?
Clear inflammatory agent. Remove damaged cells Restore normal tissue function
74
What are the negative outcomes of inflammation?
Excess tissue damage Scarring Loss of organ function -> organ failure
75
What does a histopathologist do?
Deals with tissues, examines them and notes the architecture of the tissue and identify what it tells us about a particular condition
76
Describe how neutrophils are able to emigrate through the blood vessel walls?
Through the relaxation of inter-endothelial cell junctions and digestion of vascular basement membrane
77
Which chemokines released by macrophages cause chemo-attraction of neutrophils to the site of injury?
TNF and IL-1
78
Which chemokines cause the switch from low affinity ligands to high affinity ligands?
LFA-1 and MAC-1

POM CELLS (15 decks)

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