PRC - Lecture 16

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Acute Inflammation II / Mediators of Inflammation
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How does acute inflammation of meningitis appear? Thick exudate - Creamy appearance due to accumulation of neutrophils beneath the arachnoid membrane.
What are the 3 membranes that line the skull and vertebral canal called? Under which of these 3 membranes do neutrophils recruit to during meningitis? - Dura mata - Arachnoid* (middle) - Pia mater
What is meant by 'local' chemical mediators of inflammation? - Mediated by cells at the site of inflammation. - Resident or recruited. - Active over a short range.
What is meant by 'systemic' chemical mediators of inflammation? - Synthesised by the liver and enter the circulation. - e.g. plasma proteins
What 3 components make up the storage granules in mast cells? - Histamine - Serotonin - Lysosomal enzymes
What 5 mediators of inflammation are synthesised by the ER in a mast cell before release at sites of infection? - IL- 8 - Prostaglandins - Leukotrienes - Oxygen radicals - Nitrogen radicals
What is histamine? Chemical released by cells which causes contraction of smooth muscle and dilation of capillaries.
What is Serotonin? - Released from platelets following their aggregation. - Causes vasoconstriction during clotting.
What is the purpose of lysosomal enzymes in mast cells? To help in the breaking down/ degranulation of mast cells.
What is the purpose of IL8 ? - Interleukin-8 is a member of the CXC chemokine family. - Small heparin- binding proteins (pro-inflammatory) - mediate activation of neutrophils into tissue from peripheral blood.
What is the purpose of prostaglandins? Metabolic products of phospholipids. Induce pain and fever during inflammation.
What are leukotrienes? Biologically-active compounds - orginally isolated from leukocytes.
What is the purpose of the release of oxygen/ nitrogen radicals? Free radicals exert their actions via activation of nuclear factors which induce the synthesis of cytokines; promoting synthesis of inflammatory mediator. > Exert their toxic effect at site of inflammation.
Name 4 systems which are systemic mediators of inflammation. - Complement system - Clotting system - Kinin system - Fibrinolysis system
What enzyme catalyses the conversion of fibrinogen (soluble in blood) into fibrin (insoluble)? Thrombin
What is the purpose of fibrin (formed from fibrinogen)? Forms a fibrous mesh that impedes the flow of blood.
Name 2 vasoactive amines. Histamine Serotonin
Name 5 factors which can induce the release of histamine from mast cells. - Physical injury (trauma, heat) - IgE cross-linking with antigens - C3a and C5a - Neuropeptides (substance P) - IL-1 and IL-8
What are the purpose of IL-1 and IL-8? - IL-1 = Cytokine = Activation of vascular endothelium. - IL-8 = Cytokine = Mediates the activation and migration of neutrophils into tissue from the blood.
What is chemotaxis? Movement of an organism in response to chemical stimuli.
Name 3 cell-derived mediators which are recruited to endothelial cells (post-degranulation of mast cells) during inflammation.. - Bradykinin - Thrombin - Histamine
When histamine, bradykinin and thrombin are released from mast cells and recruited to endothelial cells during inflammation, what does this induce? - Causes an increase in Ca2+ conc. - Causing the synthesis of Nitric oxide by Nitric oxide synthase... - Causing the synthesis of Prostaglandin PG12 via Cyclooxygenase... - These cell-derived mediators are secreted... - Induces vasodilation and smooth muscle cell relaxation. - Heat generation.
Describe the formation of prostaglandins. - Stimulation = Bradykinin, C5a and other cell-derived mediators activate Phospholipase A2/ PLA2 at the plasma membrane. - Phospholipid is cleaved from membrane by PLA2 as Arachidonic acid & Lysophospholipids. - Products are divided by enzymes: - Lipoxygenases cleave off Leukotrienes. - Cyclooxygenases/ Cox cleave off prostaglandins.
Other than Prostaglandins, Leukotrienes are also produced from the metabolism of phospholipids, what do they do? Leukotrienes, specifically LTB4, is chemotactic for neutrophils. Able to induce the adhesion and activation of leukocytes.
During the metabolism of Arachidonic acid, what 4 prostaglandins can be generated from the cyclooxygenase pathway? - PGE2 - PGD2 - PGF2-alpha - PGI2
What is the purpose of the prostaglandin PGI2 produced using the cyclooxygenase pathway of arachidonic acid metabolism? Potent vasodilator and inhibitor of platelet aggregation.
What is 5-lipoxgenase enzyme? A major Arachidonic acid metabolizing enzyme in neutrophils.
What leukotrienes are mainly made my neutrophils during the metabolism of Arachidonic acid? LTB4
What is the Leukotriene, LTB4? A potent chemotactic agent produced by neutrophils during the metabolism of Arachidonic acid (used in positive feedback).
What leukotrienes are mainly made my mast cells during the metabolism of Arachidonic acid? LTD4 E4
What are the leukotrienes, LTD4 and E4? Leukotrienes produced by mast cells during the metabolism of Arachidonic acid. Cause broncho-constriction and vascular permeability - hence difficulty in breathing (asthma).
What do steroids do as an anti-inflammatory? Steroids block the pathway which converts Phospholipids into Arachidonic acid & Lysophospholipids by inhibiting Phospholipase A2.
Why are NSAIDs drugs used to control the anti-inflammatory process? NSAIDs block the conversion of Arachidonic acid into Prostaglandins via inhibiting Cyclooxygenases / Cox. Thus, preventing pain and fever.
Why pathway do NSAIDs NOT block when used as a drug to control inflammation? NSAIDs do not block the break down of lysophospholipids into leukotrienes as they cannot inhibit the lipoxygenases.
What are 2 cyclooxygenase enzymes targetted by NSAIDs which go on to inhibit the production of prostaglandins? What is the difference? - Cox-1 and Cox-2 - Cox-1 catalyses the production of mucosal prostaglandins responsible for acid-induced damage in the GI tract. - Cox-2 catalyses the production of prostaglandins responsible for pathogenesis, pain, fever and inflammation.
Why are Pharmaceutical companies trying to develop drugs which only target Cox-1 cycooxygenase? Because it has been found that targetting Cox-2 cyclooxygenase can have serious thrombatic cardiovascular consequences on the patient.
Name 2 cyclooxygenase inhibitor drugs which have been used in anti-inflammation. - Aspirin - Indomethacin
When the body is not undergoing inflammation, are systemic mediators active? No.
What complement from the Complement cascade inserts itself into the membrane of bacteria to puncture their cells? What is this process called? - C6C7C8C9 - Membrane Attack Complex/ MAC
How is the Complement Cascade initiated? When an antigen-antibody complex forms.
When C3a and C5a (?) are produced in the complement cascade, what function do they perform? - Anaphylatoxins: - Induce mast cells to release histamine. - Act directly on blood vessels to increase vascular permeability. - C5a is chemotactic for neutrophils. - C5a also causes a conformational change in integrins.
Explain how anaphylatoxins help to control the adhesion of leukocytes to the vascular endothelium. - C3a and C5a - Alter the conformation of the integrins which allows adhesion to perform.
What is the purpose of Fibrin? Traps platelets and induces clot formation.
What is the purpose of fibrinopeptide released from fibrinogen during the formation of fibrin? - Increases vascular permeability. - Chemotactic for WBC.
What is Bradykinin? - Similar to histamine. - Causes contraction of smooth muscle and vasodilation. - Rapidly inactivated.
What is the purpose of the systemic mediator, the kinin cascade? Generate bradykinin
What is the purpose of the fibrinolytic cascade (systemic mediator)? - Assist in de-coagulation - without fibrinolysis, any injury would result in irreversible clotting..
How is plasmin formed in the fibrinolytic pathway and what does it do? - Plasminogen is converted to plasmin via Kallikrein (from kinin cascade). - Plasmin destroys blood clots by attacking fibrin. - Plasmin also activates C3 > C3a to induce mast degranulation.
How is thrombin formed and what is its function in the clotting cascade? - Thrombin is one of the final products of the clotting cascade. - Thrombin converts fibrinogen to fibrin. - Thus, initiates clotting.
Other than phagocytosis, what else do neutrophils do kill invading pathogens? Produce reactive oxygen radicals.
By what process is phagocytosis of microorganisms facilitated by? By what? Opsonisation Opsonins
Define opsonins. - Serum proteins that bind to the surface of microorganisms - i.e. Immunoglobulins, IgG - i.e. Complement component, C3b
Describe the process of phagocytosis using Opsonins (opsonisation). - IgG and C3b opsonins (on bacteria) bind to Fc receptor and C3b receptors (on phagocyte) respectively. - Phagocytes engulf opsonent pathogen. - Phagosome and lysosome bind. - Lysosomes promote reduction of toxic mediators inside the cell therefore the phagosomes do not do damage to the phagocyte or surrounding cells.
Describe the role of fMet- Leu - Phe receptors in the phagocytosis of pathogens. - Opsonins on pathogens bind to opsonin receptors on phagocytes. - fMLP receptors on the surface of the phagocytes recognise fMet-Leu-Phe peptides from the same pathogen. - This activates Rac2 - Bacteria are taken up in vesicles.
Describe how phagolysosomes are generated/ activated to degrade its components. - Phagosome fuses with primary and secondary granules. - Rac2 makes NADPH oxidase in the phagolysosome membrane; leading to production of oxygen radicals/ O2-. - Ion influx/ Acidification. - Granule proteases released from matrix. - Degradation of microbial components.
Name some oxygen-dependent anti-microbial mechanisms (7). - O* (Superoxide) - OH* (Hydroxyl radical) - H2O2 (Peroxide) - ClO- (Hypochlorite) - NO (Nitric oxide) - NO2 (Nitrogen dioxide) - HNO2 (Nitrous acid)
Name some oxygen-independent anti-microbial mechanisms (7). - Defensins - Lysozyme - Hydrolytic enzymes
What major mediators of acute inflammation initiate the following effects? - Vasodilation - Increased vascular permeability - Chemotaxis - Fever - Pain - Vasodilation = Prostaglandins & Nitric oxide. - Increased vascular permeability = Amines, C3a, C5a, Bradykinin & Leukotrienes. - Chemotaxis = C5a, Leukotriene B4, Bacterial products & Chemokines (e.g. IL-8). - Fever = IL-8, IL-6, TNF & Prostaglandins. - Pain = Prostaglandins & Bradykinin.
What 3 products of acute inflammation cause tissue injury? - Reactive oxygen species - Lysosomal enzymes - Metabolic products of arachidonic acid (leukotrienes).
What are 3 main outcomes of Acute Inflammation? - Resolution - Scarring or fibrosis (abscess formation inevitably leads to this) - Inability to clear damage or eradicate infectious agent > Chronic Inflammation.
What are 3 common features of Chronic inflammation? - Mononuclear cells - Tissue destruction - Angiogenesis & Fibrosis
What is Angiogenesis? Development of new blood vessels.
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