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NancyMEDSCI203 > Lecture 11: Chronic Inflammation > Flashcards

Lecture 11: Chronic Inflammation Flashcards

1
Q

How can chronic inflammation arise?

A
  1. From prior acute inflammation which failed to resolve

2. From prior acute inflammation which may have had distinctive properties of chronic inflammation almost from the onset

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2
Q

Name the three different types of causes of chronic inflammation

A
  1. Persistent exposures
  2. Abnormal immune responses
  3. Novel tissue
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3
Q

What are two examples of persistent exposures which can cause chronic inflammation

A

Irritants like bronchitis, emphysema (smoke)

Infections like HBV, H. Pylori, M. Tuberculosis

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4
Q

What are three examples of abnormal immune redness that can cause chronic infection

A

Harmless environmental agents like allergies

Commensal microbes like in inflammatory bowel disease: Crohn’s

Components of the body like autoimmune diseases

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5
Q

What are two examples of novel tissue that can cause chronic inflammation

A

Wounds that do not heal, like cancers

Grafts, like rejection of organ transplants

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6
Q

What is acute inflammation mediated by?

A

Cells of the innate immune system

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7
Q

What does chronic inflammation also require?

A

Cells of the adaptive immune system

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8
Q

How are circulating monocytes recruited into tissues?

A

By chemotactic stimuli

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9
Q

What happens after monocytes are recruited into tissues?

A

They differentiate into macrophages

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10
Q

What happens to macrophages in innate immunity?

A

They phagocytose unwanted tissue (debris, oxidised lipoprotein) or microbes

They kill bacteria

They regulate inflammation, angiogenesis and repair

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11
Q

How do macrophages regulate inflammation angiogenesis and repair?

A

They release

ROS, cytokines(IL-1β, TNF, IL-6) and chemokines

They release proteases like MMPs that remodel ECM

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12
Q

How do macrophages regulate adaptive immunity?

A

Acting as antigen presenting cells

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13
Q

Macrophages may also sustain what?

A

Chronic inflammation

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14
Q

What can antigen presenting cells do?

A

Engulf microbes or their products
Process them to peptide fragments
Present peptides to lymphocytes

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15
Q

Lymphocytes have a vast repertoire of receptors that recognise what?

A

Epitopes on macromolecules

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16
Q

What are epitopes

A

Specific molecular shapes

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17
Q

What happens when epitopes are recognised as foreign?

A

Lymphocytes will generate immune response

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18
Q

Helper cell populations are a part of what class of lymphocytes?

A

T lymphocytes

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19
Q

What do T helper cells do?

A

Secrete cytokines to regulate cells of innate and adaptive immunity

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20
Q

What type of cytokine does TH-1 cell secrete?

A

Interferon-γ

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21
Q

What does interferon -γ do?

A

Stimulates TH1 development and activates macrophage responses to intracellular pathogens

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22
Q

Abnormal responses of activated by IFN-γ mediate what?

A

Autoimmunity

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23
Q

What type of cytokine do TH2 cells secrete?

A

IL-4 and IL-21

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24
Q

What does IL-21 do?

A

Stimulates TH17 development

Activates epithelial responses to microbes

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25
Q

What are some epithelial responses to microbes which are activated by TH-17 development?

A

Secretion of anti microbial peptides (AMPs) like defensins and GM-CSF which recruits neutrophils

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26
Q

What do abnormal responses mediate?

A

autoimmunity

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27
Q

What do Treg cells secrete?

A

cytokines such as TGFβ

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28
Q

What does TGFβ stimulate?

A 
Treg development
suppresses inflammation (i.e. as a fire extinguisher of other T helper activities)
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29
Q

What does deficient Treg function lead to?

A

excessive inflammation

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30
Q

What are some epithelial responses to microbes which are activated by TH-17 development?

A

Secretion of anti microbial peptides (AMPs) like defensins and GM-CSF which recruits neutrophils

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31
Q

What do abnormal responses mediate?

A

autoimmunity

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32
Q

What do Treg cells secrete?

A

cytokines such as TGFβ

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33
Q

What does TGFβ stimulate?

A 
Treg development
suppresses inflammation (i.e. as a fire extinguisher of other T helper activities)
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34
Q

What does deficient Treg function lead to?

A

excessive inflammation

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35
Q

What do B cells differentiate into?

A

Plasma cells

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36
Q

What do plasma cells produce?

A

Antibodies

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37
Q

What are antibodies?

A

Proteins that bind to particular epitopes on target molecules

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38
Q

What are particular epitopes on target molecules also known as?

A

Antigens

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39
Q

What is GERD?

A

Gastroesophageal reflex disease

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40
Q

What is GERD marked by?

A

Chronic mucosal inflammation

41
Q

How many adults in western countries does GERD affect?

A

20-30%

42
Q

What are some symptoms of GERD

A

Heart burn
Regurgitation of stomach contents
Dyspepsia (upper abdominal pain)

43
Q

GERD arises from regurgitation of stomach fluid containing what things?

A

Acid, proteases, bile acids

44
Q

What is regurgitation of stomach acid treated with?

A

Proton pump inhibitors like omeprazole

45
Q

What are two examples of proteases that can be found in regurgitation of stomach fluid?

A

Pepsin and trypsin

46
Q

What can bile acids in regurgitation of stomach fluid cause?

A

Mitochondrial damage,

Oxidative stress

DNA breaks

47
Q

What condition may GERD progress to

A

Barrett’s oesophagus

48
Q

What is the progression from GERD to barrett’s oesophagus caused by?

A

Squamous, to columnar, to intestinal (goblet cell) metaplasia

Native epithelial cell types can’t cope with stressful conditions caused by regurgitation of stomach acid, so they are replaced with intestinal cells which produce mucin

49
Q

What do mice express, in the transgenic mice model which outlines the steps involved in barrett’s oesophagus condition?

A

The human IL-1β from an oesophagus specific promotor

50
Q

What does expression of IL-1β lead to?

A

Inflammation with erythema and oedema

Immature myeloid cell, neutrophil, TH1 cells and macrophage recruitment

Barrett’s oesophagus with columnar epithelium- inflammatory environment requires epithelial stem cells from stomach

Dysplasia and cancer

51
Q

What do immature myeloid cells secrete

A

IL-6

52
Q

What does secretion of IL-6 from immature myeloid cells promote?

A

Survival and proliferation of epithelial cells

53
Q

Along with columnar epithelium, what else is secreted in metaplastic barrett’s oesophagus

A

Intestinal epithelial homeobox protein CDX2

Mucin

Microvilli

54
Q

What are the changes which occur due to expression of IL-1β potentiated by?

A

Bile acids,

DNA alkylators like N-nitroso compounds

55
Q

Where do N-nitroso compounds originate from?

A

Dietary nitrate is reduced to NO by gastric fluid, forming N-nitroso compounds

56
Q

What is barrett’s oesophagus a risk for?

A

Oesophageal cancer

57
Q

What is the conversion rate of barrett’s oesophagus to oesophageal cancer?

A

0.5-1.0%

58
Q

How much has the incidence of oesophageal cancer increased in western countries in the last 50 years?

A

Incidence has increased five fold

59
Q

What are the five spectrum of pathologies associated with chronic gastritis

A

Chronic superficial gastritis

Peptic ulcers

Atrophic gastritis

Intestinal metaplasia

Dysplasia

60
Q

What is chronic superficial gastritis

A

When the are presence of inflammatory cells and products

61
Q

What are peptic ulcers

A

The occurrence of the destruction of the epithelium and underlying stroma

62
Q

What is atrophic gastritis

A

The loss of gastric glandular epithelium with goblet cells

63
Q

What is intestinal metaplasia

A

The replacement of intestinal epithelium with goblet cells

64
Q

What is dysplasia

A

The loss of normal tissue differentiation that may proceed to cancer

65
Q

Which microorganism is the cause of the pathological spectrum of diseases associated with chronic gastritis

A

Helicobacter pylori

66
Q

How did Warren and Marshall illustrate the cause of those diseases?

A

-observed spiral bacteria assoc. with inflamed epithelium as a new species and named: H. pylori
-hypothesised as cause of ulcers despite other assumptions of H. pylori being incidental contaminants
-discovered H. pylori grew slowly (from cultures left over an Easter weekend)
- Marshall drank a flask full of pylori to prove its cause of gastritis.
Discovered bacteria turned off acid secretion he did not taste acid in his vomit
- proved that disease was from bacterial infection. However gastroenterologists initially resist evidence of successful treatment by antibiotics

67
Q

What percentage of humanity do H. pylori infect?

A

50%

68
Q

Where do H. pylori live?

A

Under mucus layer or inside epithelial cells

69
Q

Which toxins do H. pylori inject into cells?

A

cagA and peptidoglycan

70
Q

What else do H. pylori release?

A

H. pylori-neutrophil activating protein (HP-NAP)

71
Q

What does cagA do?

A

Disassembles tight junctions, leading to

  1. loss of cell polarity,
  2. motile behaviour, and
  3. disruption of epithelial integrity
72
Q

What do cagA and PG do?

A

Induce gastric epithelial cells to secrete IL-8 , which recruits neutrohils

73
Q

How does cagA and PG induce GE cells to secrete IL-8?

A

They act through pattern recognition receptors and transcription factor NF-κB

74
Q

What does HP-NAP do?

A

Induces neutrophils to release damaging ROS and myeloperoxidase

75
Q

What other inflammatory cell does HP-NAP recruit?

A

Macrophages

76
Q

What do the recruitment of macrophages by HP-NAP release?

A

IL-8 and IL-1β

77
Q

How are parietal cells maintained?

A

By secreting acid,

This increases intracellular Ca2+ and sustains the expression of sonic hedgehog

78
Q

What type of protein is sonic hedgehog?

A

Morphogenic protein

79
Q

What does IL-1β do?

A

It suppresses acid secretion, intracellular Ca2+ and sonic hedgehog expression with loss of parietal cells with metaplasia

80
Q

What is loss of cells known as?

A

Atrophy

81
Q

Which two diseases fall in the category of inflammatory bowel disease?.

A

Crohn’s disease

Ulcerative colitis

82
Q

When does Crohn’s disease first appear?

A

Adolescents or young adults

83
Q

Where does Crohn’s disease mainly occur

A

In the end of the ileum, or beginning of the colon, but it can occur anywhere in the gut

84
Q

What happens in Crohn’s disease?

A
  1. Affected areas become inflammaed
  2. Epithelial lining ulcerated
  3. Wall of bowel may undergo extensive damage and fibrotic thickening
  4. Lumen narrows with obstruction
  5. Fissures develop through bowel wall and drain into pus filled cavities or form channels into nearby loops of bowel
  6. Immune system is activated, lymphocytes and macrophages aggregate and lymph nodes are enlarged
  7. Probability of developing cancer is increased
85
Q

What are the effects of areas of inflammation in Crohn’s disease?

A

Redness, swelling, pain, leukocyte infiltrate

86
Q

What are fissures?

A

Cracks

87
Q

What are abscesses.

A

Pus filled cavities

88
Q

What are fistulas?

A

Channels formed from abscesses

89
Q

What are follicles?

A

Aggregated lymphocytes

90
Q

What are granulomas?

A

Aggregated macrophages

91
Q

List the aetiological factors implicated in Crohn’s disease

A

Family history
Environmental factors
Microbial factors
Immune responses

92
Q

How has family history been known to implicate Crohn’s disease?

A

Concordance in twins & siblings suggests genetic contribution

30% of Caucasians with Crohn’s have a CARD15 gene mutation

93
Q

What is the CARD15 protein?

A

It is a astern recognition receptor for bacterial products

It helps innate immune system to eliminate bacteria

94
Q

What are some environmental factors which have contributed to Crohn’s disease

A

Diet, NSAIDs, tobaccos, increased hygiene

95
Q

How is increased hygiene an environmental factor that may result in Crohn’s?

A

Increased hygiene alters the balance of commensal microbes

96
Q

How are microbial factors implicated in Crohn’s disease?

A

Microbial factors include pathogenic infections as triggers

Altered communities of commensal Bactria may alter ecology of gut

97
Q

How are uncontrolled immune responses an implication in Crohn’s?

A

Over active TH1 cells or under active Treg cells can result in uncontrolled immune responses which towards commensal bacteria

This damages the bowel

98
Q

What is the suggested outline of the pathogenesis of Crohn’s

A
  • environmental trigger damages mucosa
  • damage (with bacterial invasion of the wu mucosa) induces inflammatory response and repair
  • those with genetic deficiency in innate immunity or barrier function unable to repair damage or eliminate microbes from wu mucosa
  • uncontrolled T cell responses develop against commensal bacteria and long term damage occurs to the colon wall

NancyMEDSCI203 (12 decks)

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