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Pathology - Quiz 2 > Wound Healing/Mini CPC > Flashcards

Wound Healing/Mini CPC Flashcards

1
Q

**Name three classes of transmembrane signaling receptors and the intracellular signaling pathways that they usually activate.

A
  1. Kinase-coupled receptors
    - -Most GROWTH FACTORS
    - -Activates PI3, IP3, or MAP kinase pathways
  2. Receptors without kinase activity
    - -CYTOKINES
    - -Act through JAK/STAT pathway
  3. GPCRs
    - -CHEMOKINES
    - -Release Ca and/or generate cAMP
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2
Q

Diagram the cell cycle.

A 
G0 - quiescent, stable cells
G1 - growth
S - DNA replication (cyclin E)
G2 - more growth
M - mitosis (division of nucleus) (cyclin B)
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3
Q

Explain how cyclins and cyclin-dependent kinases regulate the cell cycle.

A

Have checkpoints between every phase

CDKs produced constitutively, activated by cyclins

Cyclins made according to stage of cell cycle, as cell responds to outside stimuli

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4
Q

List the key cellular types involved in wound healing. (4)

A

Leukocytes: neutrophils and **macrophages
Endothelial cells
Epithelial cells
Fibroblasts

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5
Q

State the role of collagen type I as an ECM element.

A

Provide structure and strength, especially in scarring

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6
Q

State the role of collagen type IV as an ECM element.

A

STRUCTURAL NETWORK on which to attach things

–Looks like chain-link fence

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7
Q

State the role of fibronectin as an ECM element.

A

Adhesive glycoprotein
Functions in CELL ATTACHMENT and MIGRATION
–Very sticky
–Binds fibrin, heparan, collagen, integrin

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8
Q

State the role of laminin as an ECM element.

A

Adhesive glycoprotein
Functions in CELL ATTACHMENT
–Binds laminin, heparan, and cell

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9
Q

State the role of proteoglycans as an ECM element.

A

Include heparan, condrotin, dermatan sulfates
Functions in ECM WEAVING
Serves as reservoir for GROWTH FACTORS/CHEMOKINES
—Helps establish gradients of these

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10
Q

Explain the stages of scar formation from initial wound to collagen maturation.

A
  1. Induction of an inflammatory process in response to initial injury -> removal of dead/damaged tissue by neutrophils/macrophages
  2. Proliferation and migration of parenchymal and CT cells
  3. Angiogenesis and granulation tissue
  4. Synthesis of ECM proteins and collagen deposition
  5. Tissue remodeling
  6. Wound contraction
  7. Acquisition of wound strength
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11
Q

List the functions served by macrophages in wound healing. (4)

A

Play an essential role!!

  • Recruitment and maturation
  • Phagocytosis/killing of microorganisms (wound decontamination)
  • Phagocytosis of tissue debris (wound debridement)
  • GF release
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12
Q

Distinguish wound healing by primary vs. secondary intention.

A

Primary: something narrow (cut)

  • Pull edges of wound together
  • Very minimal scar

Secondary: for a larger area (scrape, burn, wide cut)
-Wound heals by deposition of a lot of collagen -> large scar -> contraction

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13
Q

Describe granulation tissue at the gross and histological levels.

A

Gross = watery looking tissue with tiny red dots

Histological =

  • Lots of thin-walled capillaries
  • *-Activated endothelial cells
  • *-Highly activated fibroblasts (big angry purple cells, often with tails)
  • *-Faintly basophilic ECM deposited
  • Scattered neutrophils, macrophages, lymphocytes
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14
Q

List six systemic and four local factors that influence the success of wound healing.

A

Systemic:

  1. Nutrition (scurvy, protein deprivation)
  2. Metabolic status (diabetes is bad)
  3. Circulation (ischemia is bad)
  4. Hormones
  5. Genetic makeup
  6. Medical treatment (steroids are bad)

Local:

  1. Infection
  2. Foreign bodies
  3. Mechanical factors
  4. Size, location, type of wound
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15
Q

List and describe six pathological outcomes/complications of wound healing.

A
  1. Scar formation -> loss of function
  2. Keloid formation
  3. Desmoid (aggressive fibromatosis) - too much collagen deposition
  4. Ulceration, esp. in poor circulation (diabetes)
  5. Wound dehiscence (separation)
  6. Scar contraction - can be like a dense collagenous tether
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16
Q

Define scar. What does a mature scar look like histologically?

A

Collagenous type of tissue repair, whether diffuse or linear

Mature collagen! Very dense, parallel

  • Few fibroblasts
  • Few vessels
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17
Q

Define granulation tissue.

A

New connective tissue and tiny blood vessels that form on the surfaces of a wound during the healing process

The really immature connective tissue that is going to result in scar formation

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18
Q

Define keloid. What does it look like histologically?

A

The piling up of subcutaneous collagen in a way that does not stop

  • Greater in people of African descent
  • Predominately cosmetic problem

TONS of dense collagen with ACTIVE fibroblasts

19
Q

State the role/importance of integrins.

A

Integrins: extend across cell membrane

  • Have long sugars on external surface that associate with collagen, ECM proteins -> give cell something to anchor to and tell cell where it is
  • —Ex. If attached to laminin, know that side is bottom (basement membrane)

-Attach to actin cytoskeletal elements on inside -> signaling

20
Q

Understand how cells “know” what is occurring in their surroundings.

A

Get signals from how they are anchored to the ECM

Receptor signaling as well

21
Q

Know collagen synthesis (5 steps) and four major collagen types.

A
  1. Produced in RER (short capped units)
  2. Trimerized in Golgi
  3. Exported into extracellular space
  4. Caps on ends cleaved -> self-assembly into very long cables
  5. Cross-linking between chains -> strong cables in parallel

Type 1: most abundant, in skin and bone; the basis of scarring
Type 2: major cartilage collagen
Type 3: in stroma of pliable tissues
Type 4: all basement membranes

22
Q

Differential wound healing from regeneration. (3 major points)

A

Regeneration: tissue restored to totally NORMAL state

  • Requires INTACT tissue scaffolding (esp basement membranes)
  • New cells derived from division of stable cells/stem cell

Healing: normal state NEVER totally reestablished

  • Occurs when tissue scaffolding has been altered/destroyed
  • Involves creation of new tissue cells and COLLAGEN deposition (fibrosis/scarring)
23
Q

What tissues have the ability to renew? Regenerate?

A 
Renew = skin
Regenerate = liver, kidney
24
Q

What are three simple mechanisms by which cell proliferation is increased to repair damage?

A

Shortening cell cycle
Pushing stable cells into cell cycle
Simulating stem cells -> parenchymal cells

25
Q

True/false: Wound healing probably evolved from inflammation.

A

TRUE

26
Q

True/false: Chronic inflammation always results in fibrosis.

A

TRUE

27
Q

True/false: Stable cells on their own can enter the cell cycle.

A

FALSE, except in cancer

28
Q

What cell is the main driver of wound contraction?

A

Myofibroblasts

Collagen remodeled, wound constricts

29
Q

True/false: The structure of a basement membrane is the same in all organs.

A

FALSE. It is unique for nearly every organ (except lung and kidney are the same)

30
Q

Define wound.

A

Any area of damage or destruction in a tissue

31
Q

Define scab.

A

Proteins, coagulum, blood, other that overlies an area of recent damage

32
Q

Define cicatrix.

A

Synonymous for scar (British)

33
Q

Describe the four stages of repair by connective tissue (scarring).

A
  1. Angiogenesis
  2. Migration/proliferation of fibroblasts
  3. Deposition of ECM
  4. Maturation of fibrous tissue (remodeling)
34
Q

List the 4 coagulation factors active in wound repair and state their effects.

A
  1. Hageman factor (Factor XII) - vasopermeability
  2. Bradykinin - vasodilation/permeability, pain
  3. Complement - leukocyte recruitment, vasopermeability
  4. Fibrin (clot) - hemostatic plug, reservoir of growth factors, matrix for cell migration
35
Q

List the three roles of platelets in wound repair.

A

Adhesion
Aggregation
Mediator release

36
Q

List the 4 MAIN growth factors active in wound healing and their roles.

A

Fibroblast GF: fibroblast/epidermal cell proliferation; angiogenesis

Platelet-derived GF: fibroblast chemotaxis/proliferation/contraction

Transforming GF beta: fibroblast chemotaxis, ECM deposition, protease inhibitor secretion (protect collagen)

Vascular endothelial GF: vascular permeability, angiogenesis

37
Q

List the functions served by fibroblasts in wound healing. (6)

A
  1. GF production
  2. Proliferation/migration -> formation of granulation tissue
  3. Protease release -> ECM remodeling, fibrin proteolysis
  4. EM production/CT formation
  5. Dynamic linkage between actin/ECM -> tissue contraction
  6. Program cell death: aid in transition from cell-rich gran. tis. to cell-poor scar
38
Q

List the functions served by EPIthelial cells in wound healing. (5)

A
  1. GF production
  2. Migration/proliferation -> reepithelialization
  3. Protease release -> dissection under clot/nonviable tissue
  4. ECM production: provisional matrix/BM formation
  5. Terminal differentiation -> reestablishment of barrier function
39
Q

List the functions served by ENDOthelial cells in wound healing. (9!)

A

Permits blood supply to tissue to remain open/be reestablished

  1. Thrombomodulin/syndecan surface expression -> limits coagulation
  2. Prostacyclin release -> limits platelet thrombi
  3. Plasminogen activator release -> clot lysis
  4. Surface expression of cell adhesion molecules -> leukocyte diapedesis
  5. Metalloproteinase release -> BM degradation -> blood vessel growth
  6. GF production
  7. Migration/proliferation -> angiogenesis
  8. ECM production: provisional matrix/BM formation
  9. Tube formation -> blood flow!
40
Q

Why do endothelial cells release so many anti-clot/thrombus factors in wound healing?

A

Need to prevent thrombosis in new vessels from presence of…

  • Exposed collagen
  • Inflammation
  • Adhesion molecules
41
Q

What does a test for troponin tell you?

A

Risk of imminent MI or probability of acute myocardial damage

42
Q

What does CABG stand for?

A

Coronary Artery Bypass Graft

43
Q

What can lead to global systemic fibrosis, as seen in the CPC? What would clinical symptoms be?

A

ORMOND’S DISEASE (idiopathic retroperitoneal fibrosis): diffuse retroperitoneal process involving chronic inflammation, extensive proliferation of fibroblasts, and widespread ECM deposition

Abdominal pain, ascites/lower body edema, renal/adrenal failure, elevated IVC pressures

Pathology - Quiz 2 (7 decks)

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