Tutorial 3 - Inflammation, cancer & case studies Flashcards
chronic hepatitis leads to? % probabilities?
- fibrotic liver (fibrous scar tissue),
- liver cirrhosis (25% chance), which can then lead to
- liver cancer (3-5%)
state main causes of chronic liver disease?
hepatitis C 26%
alcohol 24%
hepatitis C with alcohol 14%
hepatitis B 11%
t/f: spontaneous regression of HCC is a rare phenomena where it basically just goes away
true
HCC = hepatocellular carcinoma; liver cancer
possible causes spontaenous regression?
- ischaemia
2. immunologic mechanisms
what is Trans-catheter arterial chemoembolization (TACE)?
- restrictive blood supply tumor
- minimally invasive
- chemotherapy + embolization = chemoembolization
how does TACE work?
small embolic particles coated in therapeutic drugs injected selectively through a catheter into an artery which supplies the tumor
these particles block blood supply and induce cytotoxicity
most tumors in liver supplied by which artery?
hepatic proper
by attacking the hepatic proper artery, how does this fight off the tumor (TACE)?
prevents nutrient delivery over time until neovascularisation can take place
what is (typically) the limiting factor for chemotherapy?
systemic exposure
state the 2 mechanisms by which TACE works?
overall effect of this on physiological level?
- block arterial blood supply until neovascularisation
- focused chemotherapy of higher dose. This effect augmented as chemotherapeutic drug not washed out tumor vascular bed by blood flow (as its blocked). This means a higher contact time of tumor and drug
embolization -> ischaemic necrosis -> failure of transmembrane pump, resulting -> greater absoprtion by tumor cells
how was it proven that TACE targets tumor in liver, not liver overall?
tumor 40x more agent then rest of liver. This proven as if inject into hepatic portal vein, only 1/10 of intra-tumoral concentration
so using hepatic artery proper gives 10x higher [drug]
where does ulcerative colitis start?
starts in rectum, may extend for variable distance along colon
define proctisis
anal canal inflamed
how severe can ulcerative colitis (UC) be - how much of colon can be affected?
all of colon and all colonic mucosa can be affected in highly severe cases
symptoms of UC?
diarrhea, blood/ mucus/ pus in faeces
aetiology of UC?
not clear, several hypothesis:
- psychosomatic - stress induced
- infective - enteropathological form e.coli induce
- autoimmune - lymphoid cells cause inflammation
unified explanation: infection triggers inappropriate immune response leading to destruction colonic mucosa
in active UC, the ulcerated areas are _____
hemorrhagic, leading to bloody diarrhoea
explain histology of active UC?
- in-tact mucosa sits above areas of ulceration as islands
- edema
- increased lymphoid cells & plasma cells in lamina propria
- neutrophils in lamina propria and gland epithelium
- neutrophils migrate through walls of glands forming crypt abscesses in gland lumen
- depletion goblet cells
t/f: UC has only local, no systemic effects
false - both
direct local complications of UC?
blood and fluid loss from extensive ulceration
natural history of patients with UC?
10% develop severe disease, need surgery
10% have persistent active disease despite treatment
80% have chronic quiescent colitis with infrequent episodes
In chronic UC, regeneative changes to colonic mucosa leads to?
dysplasia and risk of carcinoma development in colon
There is more risk of dysplasia/ carcinoma development in chronic UC if?
- disease very severe (total colitis)
2. disease duration long (had for 10 years)
In trying to kill cancer, how are most cancer cells killed?
apoptosis is stimulated by drugs given
necrosis means death by?
O2 deprivation
contrast necrosis and apoptosis in terms of:
cell size change
necrosis - cell swells
apoptosis - cell condense
contrast necrosis and apoptosis in terms of:
membrane
necrosis - membrane broken
apoptosis - membrane in tact
contrast necrosis and apoptosis in terms of:
ATP
necrosis - no ATP needed
apoptosis - ATP needed
contrast necrosis and apoptosis in terms of:
how cell destroyed
necrosis - cell lyses
apoptosis - cell phagocytosed
contrast necrosis and apoptosis in terms of:
DNA
necrosis - random DNA fragmentation/ smearing
apoptosis - ladder-like DNA fragmentation
contrast necrosis and apoptosis in terms of:
in vivo, what area affected?
necrosis - whole areas or tissue
apoptosis - individual cells
contrast necrosis and apoptosis in terms of:
effect on inflammation?
necrosis - inflammation triggered
apoptosis - minimal macrophage activation
contrast necrosis and apoptosis in terms of:
which needs protein function?
necrosis - nil, passive
apoptosis - requires protein use, active
discuss relationship between inflammation and age.
age increases inflammation and inflammatory processes age the body (goes both ways)
describe the relationship between chronic inflammation and cancer?
chronic inflammation contributes toward/ causes cancer, as the chemical mediators released during inflammation stimulate cancerous growth (assumed)
chronic inflammation causing cancer; state the disease (which lead to inflammation) behind the following cancer: colon cancer
chronic ulcerative colitis
chronic inflammation causing cancer; state the disease (which lead to inflammation) behind the following cancer: Liver cancer
chronic hepatitis B or C
chronic inflammation causing cancer; state the disease (which lead to inflammation) behind the following cancer: Lung cancer
COPD, chronic asthma
chronic inflammation causing cancer; state the disease (which lead to inflammation) behind the following cancer: bladder cancer
chronic cystitis
chronic inflammation causing cancer; state the disease (which lead to inflammation) behind the following cancer: lymphoma
chronic thyroiditis, sjorgen syndrome
chronic inflammation causing cancer; state the disease (which lead to inflammation) behind the following cancer: breast cancer
fibrocystic breast disease
chronic inflammation causing cancer; state the disease (which lead to inflammation) behind the following cancer: prostate cancer
benign prostate hyperplasia
expand acronym HCC
hepatocellular carcinoma
main sources infection hepatitis C
inject drug 60%
sexual 15%
transfusion 10%
t/f: gut normal flora can migrate across a degenerated gut mucosa (epithelium) and stimulate inflammation
true
survival factors (cytokines) released by inflammatory cells, promoting tumor growth are?
SOD2
BFL1
BCL-Xl
GADD45beta
describe the relationship between IL-6 and IL-1
they both cause more of each other to be produced (loop)
cirrhosis?
late stage of fibrosis; the progression
hep c (or others) –> fibrosis –> cirrhosis –> cancer development
how would colon of someone with UC in quiescent phase look?
pale and rough
t/f: inflammation triggers regeneration and repair
true (wow)
discuss the relationship between MHC class 1 and natural killer cells?
if a cell does not possess MHC class 1, natural killer cells will attack
(Major Histocompatability protein has protective, ‘self recognising’ effect TO NK CELLS)
non-IgE asthma is driven by which cells (mainly)?
ILC2’s and eosinophils
Consider IgG and IgM, and IgE.
a. ) Which are likely to be present in the early phase of infection?
b. ) Which are likely to be present in the late phase of infection?
a. ) IgM, IgE
b. ) IgG
which antibodies are the “memory antibodies”?
IgG
multiple sclerosis is a type _ hypersensitivity?
4
state the targets of the autoimmune response in multiple sclerosis?
myelin, schwann cells, oligodendrocytes
ulcerative colitis is a major cause of ____ ____.
colon cancer
t/f: apoptosis requires protein synthesis
true
state 3 growth factors which control tissue repair post inflammation?
TFGbeta, VEGF, PDGF
state 3 cancers linked to chronic inflammation?
colon, liver, lung
state cardinal signs of acute inflammation?
heat, swelling, pain, redness
state chemical mediators in the vascular inflammatory response?
serotonin, histamine, prostoglandins, leukotrienes
Th2 cells are (MCQ):
a. ) main player pathogenesis asthma
b. ) main player cytotoxic T cell response
c. ) attract macrophages
d. ) lyse other cells
a.
what type of hypersensitivity is an anaphylactic episode?
type 1
