Chp. 2 Neutrophil Arrival and Function & Macrophages Flashcards Preview

Pathoma > Chp. 2 Neutrophil Arrival and Function & Macrophages > Flashcards

Flashcards in Chp. 2 Neutrophil Arrival and Function & Macrophages Deck (24):

What are the steps of neutrophil arrival? (7 steps)

The steps are as follows:

1. Margination
2. Rolling
3. Adhesion
4. Transmigration (Diapedesis) & Chemotaxis
5. Phagocytosis
6. Destruction of Phagocytosed Material
7. Resolution


The first step in neutrophil arrival is margination. Describe what happens.

Background: In a blood vessel with laminar flow, everything flows in the very center of the vessel.

With margination, the point is to get the immune cells from the center of the vessel to the periphery. IT BEGINS WITH VASODILATION.

Vasodilation slows blood flow in POSTCAPILLARY VENULES. The blood slowing down allows neutrophils to "settle" on the periphery of the vessel

(Remember, vascular permeability means that things can leak or escape out, so all the fluid and immune cells will leave the vessel at this location.)


Describe "rolling". What molecule on endothelial cells is upregulated. What do these molecules bind with?

Rolling is the process where immune cells, i.e. nuetrophils are rolling along the vessel wall toward the post capillary venule.

The molecules upregulated on endothelial cells are Selectin "speed bumps". There are two types of Selectins:

P selectins are released from Weibel-Palade Bodies. These bodies also release Von Wildebrand Factor

E Selectins are released in response to TNF and IL-1 release.

Selectins bind Sialyl Lewis X on LEUKOCYTES (neuts and macros)


What binds to Sialyl Lewis X bodies? Where is this molecule located?

It binds selectins, and is found on leukocytes


The 3rd step in neutrophil arrival is adhesion. Describe the process, what molecules are involved, and what disease process results from a deficiency in this process.

Cellular adhesion molecules (CAM) are upregulated on ENDOTHELIAL CELLS in response to TNF & IL-1.

At the same time, INTEGRINS are upregulated on leukocytes by C5a & LTB4.

CAMs and Integrins interact and cause the leukocyte to become firmly adhered to the vessel wall.

Disease is LAD


Describe Leukocyte Adhesion Deficiency and what are the clinical features

It is an AR defect of the CD18 SUBUNIT ON INTEGRINS on the neutrophil.

Clinical features are delayed separation of umbilical cord, extremely high levels of circulating neutrophils (6-10x normal), and recurrent bacterial infections W/O PUS FORMATION

Common infections are Omphalitis, Pneumonia, Gingivitis, Peritonits


Describe the process of transmigration and chemotaxis

Leukocytes travel twd the post capillary venule and diapedese out of the vessel into the interstitium. It is then attracted by chemoattractants to the source of infection.

Chemoattractants for Neutrophils are:

Kalikrein, LTB4, C5a, IL-8, and bacterial products


Describe the process of phagocytosis by the neutrophil. What is phagocytosis enhanced by? What is the disease involved with defective phagocytosis?

Phagocytosis is for consumption of pathogens or necrotic tissue. Phagocytosis is enhanced by opsonins C3b and IgG which act as "post it" notes that tags what is supposed to be eaten by the neutrophil

Pseudopods from the leukocyte extend out like arms and grabs the material to be consumed. Once the material is inside, its a phagosome. The vacuole holding the material merges with lysosome. Now its a PHAGOLYSOSOME.

The disease is Chediak Higashi syndrome


What is Chediak-Higashi Syndrome?

It is a protein trafficking defect (AR) that has IMPAIRED PHAGOLYSOSOME FORMATION.

Clinical Presentations:
Increased risk of pyogenic infections

Neutropenia bc the cells can't divide to form new cells

Giant Granules in leukocytes (these are granules that can't be transported out of the cell so they are all stuck at the Golgi forming these large granules

Defective Primary Hemostasis (bc of dense granules in platelets so the clotting factors can't be delivered to the surface so blood can't clot)

Albinism (melanin can't be delivered t/o skin cells)

Peripheral Neuropathy (nerves are long and bc of trafficking defect, proteins can't be delivered to the very bottom of the nerve so it begins to starve


How is the phagocytosed material destroyed?

The material is destroyed via O2 dependent killing which is the most effective way


Describe the process of O2 dependent killing

An Oxidative Burst makes Bleach and it is the end product that is used to kill the pathogen.

O2-->O2- via NADPH oxidase (OXIDATIVE BURST)
O2- --->H2O2 via Superoxide Dismutase
H2O2-->HOCl via MPO (myeloperoxidase)


What disease process is associated with defective O2 dependent killing? What is the defect exactly? What test tests for this deficiency?

Chronic Granulomatous Disease. It is due to a NADPH Oxidase Deficiency (X-Linked or AR)

W/o this enzyme, can't create the oxidative burst. No H2O2 can be formed. But most bacteria make a little H2O2 (those that are catalase - can't get rid of it). So the infected cell can "steal" the bacteria's H2O2 and use it for the final step in the reaction to make bleach.

But...with catalase + bugs, they get rid of their H2O2 so people with this deficiency has an issue with these bacteria. They are the following:

S. Aureas
Pseudomonas Cepacia
Serratia Marcesans

The test is the Nitroblue Tetrazolium test. Leuks are incubated with this dye. If they can make NADPH Oxidase (meaning it can turn O2 to O2-) then the dye will turn BLUE. If no NADPH then the dye will remain COLORLESS IF NO NADPH OXIDASE


What is the respiratory burst?

Conversion of O2 to H2O2


What is MPO deficiency? Is the NBT normal? What are these patients at risk for?

An MPO deficiency is an inability to convert H2O2 to bleach (HOCl).

The NBT is normal bc their NADPH Oxidase is normal. Meaning they can make H2O2 just fine from O2.

Though these patients are asymptomatic, they are at increased risk for Candida infections.


Which is more effective, O2 dependent or independent killing?

O2 dependent killing bc independent uses enzymes in secondary granules that are less effective than bleach. O2 independent is used by macrophages (lysozyme) and eosinophils (major basic protein)


In O2 independent killing, what are the enzymes used in macrophages and eosinophils

Lysozyme and major basic protein, respectively


What are the 5 main microbes that CGD patients have issues with?

All catalase +, esp

S. Aureas
Pseudomonas Cepacia (HIGH YIELD)
Serratia Marcesans


How is neutrophil activity resolved in response to a pathogen?

After phagocytosis and destruction of the pathogen, the neutrophils undergo apoptosis and DISAPPEAR WITHIN 24 HOURS AFTER RESOLUTION of the stimulus.

All neutrophils die in tissue (apoptosis) and form pus.

Pus = Neutrophils in dead tissue


When do macrophages arrive at the scene of acute inflammation? What are they there for?

About 2-3 days after inflammation begins which is right after neutrophils peak. They are there to see if neutrophils have completed the inflammatory process, need to continue it, or if its too much for them.


How do the macrophages arrive at the scene?

Arrive the same way that neutrophils do, via margination, rolling, adhesion, and transmigration sequence.


When macrophages arrive at the scene of infection, what do they do?

They phagocytose material (stuff thats been opsonized) and destroy material using O2 independent killing. (Lysozyme in secondary granules)

They then manage the next step in the inflammatory process


What are the next possible steps that the macrophage takes in the inflammatory process?

If the neutrophils did a good job, then its time for resolution and healing. Macros secrete IL-10 & TGF-B.

IL-10 and TGF-B are anti inflammatory cytokines that end the inflammatory process

If the neutrophils still have work to do, then secrete IL-8 to call more neutrophils in

If the mess just needs to be walled of, then abscess formation takes place and the macrophage induces fibrosis via fibrogenic growth factors and cytokines

If the neutrophils can't handle it...CHRONIC INFLAMMATION!!

The macrophage will ingest some of the pathogen, present it to CD4+ helper T cells. The T cells will start to secrete cytokines to get chronic inflammation party started.

Chronic inflammation is an example of adaptive immunity


Macrophages secrete IL-8; what does this molecule do?

It recruits more neutrophils to assist in the acute inflammatory process. This could go on for weeks to months. As long as its a neutrophil response, its acute inflammation.


When macrophages secrete IL-10 & TGF-B, what is the result?

These are anti-inflammatory cytokines. After macrophages arrive at the scene of acute inflammation, they survey the progress made. If neutrophils did a good job, then its time for healing. These cytokines turns off the inflammatory process.