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Introduction to pathology
Inflammation lecture 1
Dr H Awad
FRCPath
First trimester 2015/16
inflammation
Inflammation
Definition
• Protective response
• involving (1)host cells, (2)blood vessels and
(3)chemical mediators ,
• intended to
• (1)eliminate (a)the initial cause of injury and
the (b)necrotic tissue resulting from the insult
• (2)initiate repair.
Unintended outcomes!
• Inflammation is a protective mechanism…..
Not a disease
• However… cells and mediators that destroy
injurious agents can destroy normal tissue.
Signs of inflammation
• Calor ……. hotness
• Rubor …….. redness
• Tumor…….. swelling
• Dolor……… pain
• Functio laesa.. Loss of function
Causes of inflammation
any cause of cell injury
• Infections
• Trauma
• Physical : thermal injury, burns
• Chemicals
• Tissue necrosis: ischemia or physical insult
• Foreign bodies
• Immune reaction
Infection versus inflammation
• What are the differences????
Acute versus chronic
• Acute: rapid onset, short duration, fluid and
plasma protein exudation, predominantly
neutrophils.
• Chronic: insidious onset, longer duration (
days to years), lymphocytes and macrophages,
vascular proliferation and fibrosis.
Acute versus chronic inflammation
feature acute chronic
onset Fast: Minutes to hours Slow: days
cells neutrophils Lymphocytes &
macrophages
Tissue injury and fibrosis Mild and self limited Severe, progressive
Local and systemic signs prominent May be subtle
mechanisms
• So.. Cells and molecules needed for the
inflammatory response.
• These are present in the blood.
• The goal of the inflammatory reaction is to
bring these cells and mediators to the site of
injury.
Chemical mediators
• Secreted from inflammatory and host cells
(e:g cytokines)
• Derived from plasma proteins (complement)
Self control
• Inflammation is controlled and self limited.
• Inflammatory cells are short lived, and
degraded or become inactive.
• Anti inflammatory mediators.
Recognition of injurious agent
• Receptors on several cells recognize injurious
agents.
• These receptors present on macrophages,
dendritic cells , epithelial cells and others.
• These receptors are called pattern recognition
receptors because they recognize structures
common to many microbes or dead cells.
Pattern recognition receptors
Two families:
• Toll like receptors.
• inflammasomes
Toll like receptors
Toll like receptors
• Microbial sensors.
• 10 mammalian types:
• Can recognize bacterial products : endotoxins
or DNA.
• Can recognize viral products: RNA
Toll like receptors
• Located on plasma membrane and
endosomes.
• So: can recognize extracellular and ingested
microbes.
Toll like receptors
• Once they recognize the microbe…
transcription factors activation… which
stimulate production of chemical agents
(inflammatory mediators)
Inflammasome
• Multi-protein cytoplasmic complex.
• Recognizes products of dead cells… uric acid,
extracellular ATP, crystals, some microbes..
• When stimulated, inflammasome activates
caspase 1.
• Caspase 1.. Cleaves and thus activates IL- 1
which is a potent mediator.
Inflammasome in action
1)Gout
Urate crystals deposited in joints.. Ingested by
macrophages.. Activate inflammasome… IL 1
production… inflammation
2)Inflammasome stimulated by cholesterol crystals..
Possible role of inflammasome in atherosclerosis.
3) Also activated by free fatty acids in obese
people… development of type 2 DM.
???TREATMENT BY blocking IL 1
gout
Uric acid crystals
Acute inflammation
Vascular changes:
*vasodilation and increased vascular
permeability.
*endothelial cell activation to increase leukocyte
adhesion and migration .
Cellular events:
Vascular changes
• 1)Transient vasoconstriction.. Seconds.
• 2)Vasodilation… increased blood flow.
• 3) Increased vascular permeability…
extravascular edema
• 4) loss of fluids from capillaries increases
blood viscosity… slowing of circulation = stasis
• 5) stasis.. Neutrophils accumulate at the
epithelial side = margination (the first step in
leukocyte activation)
Increased vascular permeability
• Results in edema.
• Edema caused by inflammation is usually an
exudate
• Transudate versus exudate???
exudate
• Edema fluid caused usually by inflammation.
• Fluid rich in protein, cell debris and
leukocytes.
• High specific gravity
• Transudate… low protein, low cell debris, no
cells…. Due to changes in hydrostatic or
osmotic pressure….. Here only fluid is lost
Causes of increased vascular
permeability in inflammation
• Endothelial cell contraction.. Increasing the
gaps through which fluid is lost
• Endothelial injury.. Loss of the barrier that
prevents fluid to go out of the vessels.
• Increased transocytosis
• Leakage from new blood vessels.
Endothelial cell contraction
• Most common cause of increased
permeability.
• Rapid response due to histamine, bradykinin
and leukotrienes.
• Short lived.
• A similar response occurs due to cytokines..
Changes to cytoskeleton increasing the gaps..
This is slower but more prolonged.
Endothelial injury
• Damage due to severe injury.. E:g burns or
infections.
• Can start immediately but lasts for several
hours or days till the vessel is thrombosed
• If injury is mild effect (permeability increase)
can be delayed but long lived. E:g in mild
thermal injury or certain bacterial toxins
Increased transocytosis
neovascularization
• New blood vessels formed during repair.
• Leaky till proliferation of endothelial cells
matures adequately to form intracellular
junctions.

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Introduction to pathology.pptx

  • 1. Introduction to pathology Inflammation lecture 1 Dr H Awad FRCPath First trimester 2015/16
  • 3. Inflammation Definition • Protective response • involving (1)host cells, (2)blood vessels and (3)chemical mediators , • intended to • (1)eliminate (a)the initial cause of injury and the (b)necrotic tissue resulting from the insult • (2)initiate repair.
  • 4. Unintended outcomes! • Inflammation is a protective mechanism….. Not a disease • However… cells and mediators that destroy injurious agents can destroy normal tissue.
  • 5. Signs of inflammation • Calor ……. hotness • Rubor …….. redness • Tumor…….. swelling • Dolor……… pain • Functio laesa.. Loss of function
  • 6.
  • 7. Causes of inflammation any cause of cell injury • Infections • Trauma • Physical : thermal injury, burns • Chemicals • Tissue necrosis: ischemia or physical insult • Foreign bodies • Immune reaction
  • 8. Infection versus inflammation • What are the differences????
  • 9. Acute versus chronic • Acute: rapid onset, short duration, fluid and plasma protein exudation, predominantly neutrophils. • Chronic: insidious onset, longer duration ( days to years), lymphocytes and macrophages, vascular proliferation and fibrosis.
  • 10. Acute versus chronic inflammation feature acute chronic onset Fast: Minutes to hours Slow: days cells neutrophils Lymphocytes & macrophages Tissue injury and fibrosis Mild and self limited Severe, progressive Local and systemic signs prominent May be subtle
  • 11. mechanisms • So.. Cells and molecules needed for the inflammatory response. • These are present in the blood. • The goal of the inflammatory reaction is to bring these cells and mediators to the site of injury.
  • 12. Chemical mediators • Secreted from inflammatory and host cells (e:g cytokines) • Derived from plasma proteins (complement)
  • 13. Self control • Inflammation is controlled and self limited. • Inflammatory cells are short lived, and degraded or become inactive. • Anti inflammatory mediators.
  • 14. Recognition of injurious agent • Receptors on several cells recognize injurious agents. • These receptors present on macrophages, dendritic cells , epithelial cells and others. • These receptors are called pattern recognition receptors because they recognize structures common to many microbes or dead cells.
  • 15. Pattern recognition receptors Two families: • Toll like receptors. • inflammasomes
  • 17. Toll like receptors • Microbial sensors. • 10 mammalian types: • Can recognize bacterial products : endotoxins or DNA. • Can recognize viral products: RNA
  • 18. Toll like receptors • Located on plasma membrane and endosomes. • So: can recognize extracellular and ingested microbes.
  • 19. Toll like receptors • Once they recognize the microbe… transcription factors activation… which stimulate production of chemical agents (inflammatory mediators)
  • 20.
  • 21. Inflammasome • Multi-protein cytoplasmic complex. • Recognizes products of dead cells… uric acid, extracellular ATP, crystals, some microbes.. • When stimulated, inflammasome activates caspase 1. • Caspase 1.. Cleaves and thus activates IL- 1 which is a potent mediator.
  • 22. Inflammasome in action 1)Gout Urate crystals deposited in joints.. Ingested by macrophages.. Activate inflammasome… IL 1 production… inflammation 2)Inflammasome stimulated by cholesterol crystals.. Possible role of inflammasome in atherosclerosis. 3) Also activated by free fatty acids in obese people… development of type 2 DM. ???TREATMENT BY blocking IL 1
  • 23. gout
  • 25. Acute inflammation Vascular changes: *vasodilation and increased vascular permeability. *endothelial cell activation to increase leukocyte adhesion and migration . Cellular events:
  • 26. Vascular changes • 1)Transient vasoconstriction.. Seconds. • 2)Vasodilation… increased blood flow. • 3) Increased vascular permeability… extravascular edema • 4) loss of fluids from capillaries increases blood viscosity… slowing of circulation = stasis • 5) stasis.. Neutrophils accumulate at the epithelial side = margination (the first step in leukocyte activation)
  • 27. Increased vascular permeability • Results in edema. • Edema caused by inflammation is usually an exudate • Transudate versus exudate???
  • 28. exudate • Edema fluid caused usually by inflammation. • Fluid rich in protein, cell debris and leukocytes. • High specific gravity • Transudate… low protein, low cell debris, no cells…. Due to changes in hydrostatic or osmotic pressure….. Here only fluid is lost
  • 29. Causes of increased vascular permeability in inflammation • Endothelial cell contraction.. Increasing the gaps through which fluid is lost • Endothelial injury.. Loss of the barrier that prevents fluid to go out of the vessels. • Increased transocytosis • Leakage from new blood vessels.
  • 30. Endothelial cell contraction • Most common cause of increased permeability. • Rapid response due to histamine, bradykinin and leukotrienes. • Short lived. • A similar response occurs due to cytokines.. Changes to cytoskeleton increasing the gaps.. This is slower but more prolonged.
  • 31. Endothelial injury • Damage due to severe injury.. E:g burns or infections. • Can start immediately but lasts for several hours or days till the vessel is thrombosed • If injury is mild effect (permeability increase) can be delayed but long lived. E:g in mild thermal injury or certain bacterial toxins
  • 33. neovascularization • New blood vessels formed during repair. • Leaky till proliferation of endothelial cells matures adequately to form intracellular junctions.