Download - Inflammation, role and types
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INFLAMMATION
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Dr. Ali YaldrumB.D.S, M.Sc (London)
Faculty of Dentistry, SEGi University
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Survival of all organisms requires they eliminate:
• foreign invaders (infectious pathogens: viruses, bacteria, fungi)
• damaged tissues
• Achieved via a complex mechanism called “inflammation”
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Inflammation is a protective response intended to eliminate the initial cause of cell injury as well as the necrotic cells and tissues resulting from the original insult
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Diluting Destroying/ Neutralising
Heal & Repair
Restoration of Function
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A double edge sword?
Although inflammation helps clear infections and other noxious stimuli and initiates repair, the inflammatory reaction and the subsequent repair process can cause considerable harm.
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Signs of Inflammation
Cardinal signs are
• Heat (calor)
• Redness (rubor)
• Swelling (tumor)
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2 additional signs seen in acute inflammation
• Pain (dolor)
• Loss of function (function laesa)
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Steps of Inflammation
5R’s
1. Recognition of injurious agent 2. Recruitment of leukocytes 3. Removal of agent 4. Regulation of the response 5. Resolution
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Types of Inflammation
• Acute
• Chronic
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Acute Inflammation
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Acute Inflammation
rapid response to injury or microbes and other foreign substances that is designed to deliver leukocytes and plasma proteins to sites of injury
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Stimuli
can be triggered by a variety of stimuli
• Infections
• Trauma
• Physical & chemical agents
• Foreign bodies
• Immune reactions
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Acute inflammat ion has two ma jo r components
• Vascular changes
• Cellular events
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Vascular
• Changes in Vascular Caliber and Flow
• Increased Vascular Permeability
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Changes in Vascular Caliber and Flow
• Changes in blood vessels begin rapidly after infection or injury but may develop at variable rates, depending on the nature and severity of the original inflammatory stimulus.
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transient vasoconstriction
arteriolar vasodilation
increased viscosity & slowing of circulation
stasis
migration
lasting few seconds
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• Endothelial cell contraction leads to intercellular gaps in post capillary venules
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• Histamine, bradykinin, leukotrines
• immediate
• short lived 15 to 30 mins
• called as immediate transient response
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• IL1 and TNF
• prolonged changes in cytoskeleton of endothelial cells
• take 4-6 hours to develop
• lasts for up to 24 hours
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Cellular Events
• an important function of the inflammatory response is to deliver leukocytes to the site of injury and to activate them
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Leukocyte recruitment
Sequence consists of: 1. margination, adhesion to endothelium &
rolling along the vessel wall 2. firm adhesion to endothelium
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3. transmigration between endothelial cells; 4. migration in interstitial tissues toward a
chemotactic stimulus
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Leukocyte activation
• Once leukocytes have been recruited to the site of infection or tissue necrosis, they must be activated to perform their functions
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• Stimuli for activation include microbes, products of necrotic cells, and several mediators
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Phagocytosis
Consists of 3 distinct but interrelated steps
1. recognition and attachment of the particle to the ingesting leukocyte
2. engulfment, with subsequent formation of a phagocytic vacuole
3. killing and degradation of the ingested material.
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Patterns of acute inflammation
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Patterns of acute inflammation
• vascular and cellular reactions that characterize acute inflammation are reflected in the morphologic appearance of the reaction
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• serous inflammation
• fibrinous inflammation
• suppurative inflammation
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serous
characterized by:
• the outpouring of a watery
• re lat ive ly prote in-poor flu id that , depending on the site of injury
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fibrinous
• occurs as a consequence of more severe injuries,
• resulting in greater vascular permeability that allows large molecules (such as fibrinogen) to pass the endothelial barrier
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suppurative
• manifested by the presence of large amounts of purulent exudate (pus) consisting of neutrophils, necrotic cells, and edema fluid
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• Abscesses are focal collections of pus that may be caused by seeding of pyogenic organisms into a tissue or by secondary infections of necrotic foci.
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Chemical mediators of inflammation
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Chemical mediators of inflammation
• Mediators may be produced locally by cells at the site of inflammation,
• or may be circulating in the plasma as inactive precursors that are activated at the site of inflammation
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Chronic Inflammation
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Chronic Inflammation
• is inflammation of prolonged duration (weeks to months to years) in which active inflammation, tissue injury, and healing proceed simultaneously.
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Characterized by:
• infiltration with mononuclear cells
• plasma cells tissue destruction
• repair
• angiogenesis
• fibrosis
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When acute inflammation converts to chronic?
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Chronic inflammation arises in the following settings: 1. T l ymphocy te -med ia ted immune
r e s p o n s e c a l l e d d e l a y e d - t y p e hypersensitivity
2. Immune-mediated inflammatory diseases 3. autoimmune diseases
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Chronic Inflammatory Cells and Mediators
• fundamen ta l f ea tu re o f ch ron i c inflammation is its persistence
• results from complex interactions between the cells that are recruited to the site of inflammation and are activated at this site
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Macrophages
• dominant cell of chronic inflammation
• derived from circulating blood monocytes
• act as filters for particulate matter, microbes, and senescent cells, as well as acting as sentinels
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• scattered in most connective tissues,
• also found in organs such as the liver
• spleen and lymph nodes
• central nervous system
• lungs
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• Together these cells comprise the so-called mononuclear phagocyte system, also known by the older name of reticulo-endothelial system
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Lymphocytes
• mobilized to the setting of any specific immune stimulus
• as wel l as non-immune-mediated inflammation
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Eosinophils
• characteristically found in inflammatory sites around parasitic infections
• or as part of immune reactions mediated by IgE, typically associated with allergies.
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Mast cells
• sentinel cells widely distributed in connective tissues throughout the body,
• participate in both acute and chronic inflammatory responses
• "armed" with IgE antibody specific for certain environmental antigens
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• Neutrophils are the classic hallmarks of acute inflammation, many forms of chronic inflammation may nevertheless continue to show extensive neutrophilic infiltrates
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References
• Robins, Basic Pathology, 8th Edition.