Inflammation 2

Question 1

WHAT ARE THE CELLULAR EVENTS IN THE INFLAMMATORY RESPONSE?

Answer 1

Movement of leukocytes to site of injury. 
MARGINATION 
ROLLING 
ADHESION 
TRANSMIGRATION 
CHEMOTAXIS

Question 2

MARGINATION

Answer 2

Movement of leukocytes to blood vessel walls. They move out of the central axial column of laminar blood flow between capillaries and post capillary venules.
Blood stasis on inflammation caused by increased intravenous pressure and flow helps margination.

Question 3

ROLLING

Answer 3

Leukocytes ‘tumble’ along endothelial surface and undergo weak and transient adhesion.
Leukocyte and endothelial molecules adhere- see slide 5.

Question 4

ADHESION

Answer 4

Firm adhesion.
Integrins on leukocyte surfaces interact with ligands on endothelial cell surfaces.
Induced by cytokines- they induce expression of endothelial receptors for neutrophils. (ICAM1)
Rolling stops when stable adhesion occurs.
Stable= several receptors binding.

Question 5

TRANSMIGRATION

Answer 5

Leukocyte passes from blood vessel endothelium to tissue via diapedesis (squeezes between endothelial cells at cell junctions).
Driven by chemokines (PECAM1)

Question 6

CHEMOTAXIS

Answer 6

Leukocyte moves from tissue to site of infection down a chemical gradient.
Exogenous and endogenous substances can be chemotactic. eg. Bacterial products, cytokines, complement components (C5a), lipoxygenase pathway of arachidonic acid metabolism products.
Chemotactic agents bind specific cell surface receptors: INCREASED CYTOSOLIC Ca2+
ASSEMBLY OF CYTOSKELETAL CONTRACTILE ELEMENTS
PSEUDOPODIA FORMATION -> MOTILE LEUKOCYTE.

Question 7

LEUKOCYTE ACTIVATION

Answer 7

-Stimuli for activation- Microbial substances
Products of necrotic cells
-These are sensed by various cell surface receptors- Toll like receptors
7-transmembrane G protein receptor family.
-Results in ENHANCED FUNCTION.
-> Phagocytosis
-> Production of lysosomal enzymes and ROS/RNS.
-> Production of mediators to amplify inflammatory response.

Question 8

PHAGOCYTOSIS

Answer 8

Undertaken by macrophages and neutrophils.

• Recognition and attachment of particle.
• Engulfment, formation of phagocytic vacuole.
• Killing and degradation of ingested material.

Question 9

INTRACELLULAR KILILNG/DEGRADATION

Answer 9

Post phagocytosis.
Uses specific cell surface receptors.
Opsonins enhance phagocytosis- IgG, complement C3, lectins.
Microbial substances produced in lysosome.
Phagocytosis stimulates oxidative burst.
ROS free radicals produced.
Phagocytosed particles are degraded by lysosomal acid hydrolases.
Phagocyte oxidase is only activated on phagolysosome fusion.

Question 10

CHRONIC INFLAMMATION

Answer 10

Prolonged inflammation (weeks)
May follow acute inflammation.
Can be an insidious low grade ‘smouldering’ response (eg. Johne’s)
Caused by- persistent infection by certain organisms
- prolonged exposure to toxic agents
- autoimmunity.

Question 11

MORPHOLOGICAL FEATURES OF CHRONIC INFLAMMATION

Answer 11

Infiltration with mononuclear cells. 
LYMPHOCYTES 
MACROPHAGES
PLASMA CELLS
(EOSINOPHILS, MAST CELLS)
Tissue destruction. 
Attempts at healing by connective tissue replacement of damaged tissue- proliferation of small blood vessels and fibrosis.

Question 12

MACROPHAGE ACTIVATION

Answer 12

When in the blood, are called MONOCYTES.
Adhere to vessel endothelium and leave the blood vessels via diapedesis, in response to infectious agent.
In the tissue- MACROPHAGE.
Macrophages are activated by action of activated T cells, which produce cytokines (particularly IFNy).
Activation can also be non immunogenic eg. action of endotoxin, fibronectin, chemical mediators.

ACTIVATED MACROPHAGES then either cause tissue injury or fibrosis.

Question 13

ACTIVATED MACROPHAGES- TISSUE INJURY

Answer 13

Caused due to prolonged inflammation due to activated macrophage products.

• Toxic oxygen metabolites
• Proteases
• Neutrophil chemotactic factors
• Coagulation factors
• Arachidonic acid metabolites
• Nitrous oxide.

Question 14

ACTIVATED MACROPHAGES- FIBROSIS

Answer 14

Caused by:

• Growth factors (Platelet Derived Growth Factor, Fibroblast Growth Factor, Transforming Growth Factor B)
• Fibrogenic cytokines
• Angiogenesis factors
• Remodelling collagenesis.

Question 15

WHAT ACTION DO ACTIVATED MACROPHAGES HAVE ON T LYMPHOCYTES?

Answer 15

Activated macrophages activate T lymphocytes by action of cytokines (eg. IL-12) and by ANTIGEN PRESENTATION to the T lymphocytes.
They also produce TNF, IL-1 and other inflammatory mediators to cause inflammation.

Activated T lymphocytes then produce IFNy to activate more tissue macrophages.
They also produce TNF and other inflammatory mediators to cause inflammation.

Question 16

GRANULOMATOUS INFLAMMATION

Answer 16

Epithelioid macrophages are modified macrophages, forming cohesive sheets.
Multinucleate giant cells- macrophages with fused nuclei.
LANGHAN’S TYPE GIANT CELLS- nuclei form ring round periphery of cell.
eg. Johne’s disease in cattle and sheep.
Granulomatous lymphadenitis, thickened rugal folds in gut, histologically see MN giant cells, lymphocytes, intracellular bacteria (M. avium subspecies paratuberculosis)

Question 17

PYOGRANULOMATOUS INFLAMMATION

Answer 17

Chronic plus acute. Many cells are involved.

eg. Actinobacteria lignieresii. WOODEN TONGUE.
- Neutrophils
- Macrophages
- Epithelioid macrophages
- MN giant cells
- Lymphocytes and plasma cells (mononuclear)

Splendore-Hoeppli material- Club colonies.
‘Sulphur granules’. Precipitated, eosinophilic material (inflammatory cells) is deposited around colonies of intracellular bacteria (A. lignieresii Gram negative)

Fibrosis
Abscessation.