Inflammation
Inflammation is a complex reaction in tissues that
History
Egyptian papyrus - 3000 B.C.
Celsus (Roman in 1st century A.D.)
Rubor - Tumor - Calor - Dolor
Acute
Rapid in onset, lasting for min/hrs/days
neutrophils
Chronic
Longer duration
necrosis
Etiologies
Microbial infections: bacterial, viral, fungal,parasitic
battery acids
Immunologic reactions: rheumatoid arthritis
Microbial infections
One of the commonest causes of inflammation
Bacteria release specific exotoxins or endotoxins
In parasitic infections hypersensitivity plays an
important role
Physical agents
Tissue damage leading to inflammation may occur
through physical trauma, ultraviolet or other ionizing
radiation, burns or excessive cooling
Irritant and corrosive chemicals
Corrosive chemicals (acids, alkalis, oxidizing agents)
provoke inflammation through tissue damage
Calor vasodilatation
Redness
Rubor vasodilatation
Swelling
Pain
Components of Inflammation
agent that serves to deliver mediators of host defenseleukocytes and plasma proteins- to the site of injury
Alterations in vascular caliber
Structural changes in microvasculature
Emigration and activation of leukocytes
Vascular changes
Transient vasoconstriction
Vasodilation
Exudation of protein rich fluid
Blood stasis
Margination
Transmigration
Vasodilatation
Vascular
permeability
Stasis
Leukocyte
Adhesion
Transmigration
Chemotaxis
Phagocytosis
Termination
Vasodilation
Earliest manifestation
First involves arterioles
Important mediators- Histamine and NO
Histamine
Causes dilatation of arterioles first
Increases the permeability of the venules
Principal mediator of the immediate transient phase
Swelling (tumor)
Swelling result from edema, the accumulation of
fluid(exudate) in the extra vascular space
Exudate
Transudate
debris
Specific gravity >
1.020
permeability
Low protein (mostly
albumin)
Specific gravity <
1.012
Triple response
Slowing
Margination
Concentration
Rolling
Adhesion
Transmigration
Margination
Normal flow - RBCs and
WBCs flow in the center
of the vessel
A cell poor plasma is
flowing adjacent to
endothelium
As blood flow slows,
WBCs collect along the
endothelium
Rolling
Selectins transiently bind to
receptors
Some selectins are present on
endothelial cells (E-Selectin)
Some selectins are present on
leukocytes (L-Selectin)
Some selectins are present on
platelets (P-Selectin)
Weak & transient binding
Results in rolling
Adhesion
Mediated by integrins ICAM-1 and VCAM-1
Transmigration
Mediated by PECAM-1
Primary in venules
Collagenases degrade BM
leukotriene B4 (LTB4)
Phagocytosis
Destroy
Degranulation and the oxidative burst destroy the
engulfed particle
Recognition & attachment
Opsonins coat target and bind to leukocytes
Engulfment
Killing/degradation
O2 dependent
O2 independent
Cell-derived
Sequestered intracellular
Synthesized de novo
Vasodilation
Immediate
Sustained
Chemotaxis
Opsonin
Pain
Histamine
+++
Serotonin (5HT)
Bradykinin
++
Complement 3a
Complement 3b
+++
Complement 5a
+++
Prostaglandins
+++
+?
Leukotrienes
+++
+?
+++
Lysosomal proteases
++1
Oxygen radicals
++1
Injury
Acute inflammation
Abscess
Chronic inflammation
Resolution
Repair
Beneficial effects
Beneficial effects of the fluid exudate are as follows:
Harmful effects
1) Digestion of normal tissue -Enzymes such as
collagenases and proteases may digest normal tissues,
resulting in their destruction
2) Swelling - of cervical lymph nodes may lead to
obstruction of the airway resulting in death;
inflammatory swelling is especially serious when it
occurs in an enclosed space as the cranial cavity
resulting in ischemic damage/herniations
health
If the injurious agent cannot be quickly eliminated,
the result may be chronic inflammation
Complement system
Role in immunity (C5-9 complex)
Membrane Attack Complex (MAC C5-9)
Punches a hole in the membrane
metabolism (c5a)
Leukocyte activation, adhesion and chemotaxis (c5a)
Phagocytosis
Acute-phase proteins
Protein
C-reactive protein
Opsonin on microbes
D-dimer protein
Alpha 1antichymotrypsin
Alpha 2-macroglobulin
Protein
Fibrinogen, prothrombin,
factor VIII, von Willebrand
factor, plasminogen
Coagulation factors
Complement factors
Complement system
Ferritin
Opsonin
Serum amyloid A
Orosomucoid (Alpha-1-acid
glycoprotein, AGP)
Steroids carrier
Ceruloplasmin
Haptoglobin