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INFLAMMATION LECTURE
DR HEYAM AWAD, FRCPATH
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INFLAMMATORY REACTION
• RECOGNITION.• RECRUITMENT.• REMOVAL OF THE AGENT.• REGULATION.• RESOLUTION/ REPAIR.
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RECOGNITION
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RECEPTORS
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CELULAR RECEPTORS FOR MICROBES
• TOLL-LIKE RECEPTORS (TLRs).
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WHICH CELLS?
• EPITHELIAL.• DENDRITIC CELLS.• MACROPHAGES.• WBCs.
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SENSORS OF CELL DAMAGE.
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SENSORS OF CELL DAMAGE
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SENSORS OF CELL DAMAGE
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SENSORS OF CELL DAMAGE
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• SENSORS OF CELL DAMAGE ACTIVATE A PROTEIN CYTOSOLIC COMPLEX CALLES INFLAMMASOME.
• INFLAMMASOME INDUCES PRODUCTION OF IL-1.
• IL-1 RECRUITS LEUKOCYTES.
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• WHICH CELLS?
• WHERE IN THE CELLS?
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OTHER CELLULAR RECEPTORS
• WBCs EXPRESS RECEPTORS FOR Fc TAIL OF ANTIBODIES AND COMPLEMENT...............SO THEY RECOGNISE MICROBES COATED WITH ANTIBODIES AND COMPLEMENT
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CIRCULATING PROTEINS
• COMPLEMENT SYSTEM REACTS AGAINST MICROBES.
• MANNOSE- BINDING LECTIN RECOGNISES MICROBIAL SUGARS.
• COLLECTINS BIND MICROBES.
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RECRUITMENT
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MARGINATION
• NORMALLY RBCs ARE CONFINED TO A CENTRAL COLUMN DISPLACING WBCs TO THE PERIPHERY.
• STASIS CAUSES DECREASE WALL SHEAR STRESS SO MORE WBCs TAKE A PERIPHERAL POSITION.
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ROLLING
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• ROLLING IS FOLLOWED BY ADHESION.
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• ROLLING AND ADHESION ARE CAUSED BY COMLEMENTARY ADHESION MOLECULES IN BOTH WBC AND ENDOTHELIAL CELLS.
• ADHESION MOLECULES: SELECTINS AND INTEGRINS.....A LONG STORY!!!
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• SELECTINS CAUSE ROLLING....WEAK ADHESION.
• ROLLING SLAWS DOWN WBCs....CHANCE FOR FIRM ADHESION.
• FIRM ADHESION BY INTEGRING...VCAM AND ICAM
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MIGRATION
• TRANSMIGRATION OR DIAPEDESIS.• OCCURS MAINLY IN POSTCAPILLARY VENULES.• ADHESION MOLECULES...PECAM (PLATELET
ENDOTHELIAL CELL ASHESION MOLECULE).• THROUGH THE BASEMENT MEMBRANE?
COLLAGENASE.
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CHEMOTAXIS
CHEMOATTRACTANTS:• BACTERIAL PRODUCTS; PEPTIDES AND LIPIDS.• CYTOKINES, ESPECIALLY CHEMOKINES( IL8 ).• COMPLEMENT C5a.• ARACHIDONIC ACID METABOLITES,
LEUKOTRIENE B4.
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REMOVAL OF INSULT
• PHAGOCYTOSIS AND INTRACELLULAR KILLING.• THREE STEPS : RECOGNITION AND
ATTACHMENT, ENGULFMENT, KILLING OR DERGRADATION.
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RECEPTORS FOR RECOGNITION
• MANNOSE RECEPTORS.• RECOGNISE MANNOSE AND FUCOSE ON
GLYCOPROTEINS AND GLYCOLIPIDS .
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RECEPTORS
• SCAVENGER RECEPTOR.• RECOGNISE MODIFIED LDL....OXIDISED OR
ACETYLATED.
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RECEPTORS
• RECEPTORS FOR OPSONINS.• OPSONINS ARE PROTEINS THAT BIND
MICROBES.• OPSONINS: IgG, C3b, LECTINS.
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ENGULFMENT
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INTRACELLULAR DESTRUCTION
• LYSOSOMAL ENZYMES.• REACTIVE OXYGEN SPECIES.• REACTIVE NITROGEN SPECIES.
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LYSOSOMAL ENZYMES
• WHICH CELLS?
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NEUTROPHIL GRANULES
• 1. PRIMARY, LARGE, AZUROPHIL GRANULES. MYLOPEROXIDASE, BACTERIOCIDAL
FACTORS, HYDROLASES.2. SECONDARY, SMALL, SPECIFIC GRANULES. LYSOZYME, COLLAGENASE, GELATINASE,
ALKALINE PHOSPHATASE, HISTAMINASE.
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PROTEASES.
• ACID PROTEASES....DEGRADE ACIDIFIED DEBRIS .
• NEUTRAL PROTEASES... CAN DEGRADE COLLAGEN, ELASTIN, FIBRIN, CARTILAGE, BASEMENT MEMBRANE
• NEUTRAL PROTEASES CAN CAUSE TISSUE DESTRUCTION.
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MACROPHAGES
• CONTAIN: HYDROLASES, COLLAGENASE, ELASTASE, PHOSPHOLIPASE.
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ANTIPROTEASES
• LYSOSOMAL PROTEASES ARE HARMFUL TO OUR TISSUE.
• CONTROLLED BY ANTIPROTEASES.• ALPHA 1 ANTITRYPSIN INHIBITS NEUTROPHIL
ELASTASE.
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REACTIVE OXYGEN SPECIES
• OXIDASES CAN PRODUCE ROS, e.g: SUPEROXIDE ANION.
• OXIDASE CONSISTS OF 7 PROTEINS!! • COMPONENTS IN PLASMA MEMBRANE AND
CYTOPLASM.• ROS PRODUCED IN PHAGOLYSOSOMES.
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• SUPEROXIDE IS CONVERTED TO HYDROGEN PEROXIDE (H2O2)
• H2O2 CONVERTED BY MYELOPEROXIDASE TO HYPOCHLORITE (OCL2-)
• HYPOCHLORITE DESTROYS MICROBES BY HALOGENATION OR OXIDATION.
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NITROGEN RADICALS
• NITRIC OXIDE (NO) PRODUCED BY NITRIC OXIDE SYNTHASE (NOS)
• NOS...eNOS, nNOS,iNOS.• NO RECTS WITH SUPEROXIDE TO FORM
PEROXINITRITE(ONOO-)