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Malnourishment and Obesity > Immunological Response to Injury Sepsis > Flashcards

Immunological Response to Injury Sepsis Flashcards

1
Q

Name the types of dysfunctional inflammation (un-controlled):

A

Acute
Chronic
Contributory

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2
Q

Name some anti-inflammation foods:

A 
Tomatoes
Fruits
Nuts
Olive Oil
Leafy greens
Fatty fish
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3
Q

What is inflammation?

A

A protective tissue response to tissue damage or microbes, which serve to destroy, dilute, or wall-off both the injurious agent and the injured tissues.

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4
Q

What pathways can develop from acute inflammation?

A
  1. Resolution - Infection clearance and tissue homeostasis
  2. Persistance
    - chronic inflammation
    - chronic inflammatory diseases
    - pre-cancer and cancer
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5
Q

Cardinal signs of inflammation are:

A
  • Heat
  • Redness
  • Swelling
  • Pain
  • Loss of function
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6
Q

Explain the cycle process when there’s a new damage, involving both innate and adaptive response:

A
  1. Stimulus cause sentinel activation
  2. Vascular - dilation, increased blood flow/permeability
  3. Leukocyte migration
  4. Cellular - antimicrobial, phagocytosis, antigen presentation
  5. Induction phase - Antigen presenting, clonal expansion and maturation
  6. Leukocyte migration
  7. Effect phase - lymphocyte recruitment, cellular/tissue activation
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7
Q

What happens vessels during acute inflammation?

A
  • vascular changes
  • neutrophil recruitment
  • mediators
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8
Q

What happens in vessels during resolution?

A
  • clearance of injurious stimuli
  • clearance of mediators and acute inflammatory cells
  • replacement of injured cells
  • normal function
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9
Q

what is abscess?

A

pus formation

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10
Q

If acute inflammation progresses, it becomes chronic inflammation. What happens in vessels during chronic inflammation?

A
  • angiogenesis
  • mononuclear cell infiltrate
  • fibrosis (scar)
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11
Q

What was used in the Wheal and Flair reaction (Lewis triple response)?

A
  • Bradykinin
  • Histamine
  • Capsaicin (Ralgex)
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12
Q

What are some inflammatory mediators for heat and redness (increases blood flow)?

A
  • Histamine
  • PGE2/PGI2
  • 5-hydroxytryptamine
  • Platelet activating factor
  • nitric oxide
  • bradykinin
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13
Q

What are some inflammatory mediators for swelling (increases vascular permeability/cellular infiltration)?

A
  • anaphylatoxins
  • C3a/C5a
  • LTB4/PGE2/VEGF
  • TNFalpha/IL-1/IL-8
  • Platelet activating factor
  • Bradykinin
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14
Q

What are some inflammatory mediators for pain?

A
  • Substance P
  • Calcitonin gene-related peptide
  • Bradykinin
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15
Q

What are some inflammatory mediators for loss of function)?

A
  • Lipases
  • Proteases
  • Free Radicals
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16
Q

What are some inflammatory mediators for spasm of bronchial muscle?

A
  • Bradykinin
  • LTD4/LTC4
  • Histamine
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17
Q

Name the cellular components of inflammation:

A
  • Mast cells
  • Neutrophils
  • Eosinophils
  • Macrophages
  • Lymphocytes
  • Neurons
  • Platelets
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18
Q

Which are the first cells to migrate during inflammation?

A

Neutrophils

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19
Q

How do you distinguish between neutrophils and eosinophils?

A

Eosinophils have more granules

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20
Q

Which cell released during inflammation have antigen presenting feature?

A

macrophages

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21
Q

What are the divisions and subdivisions of lymphocytes?

A

B and T cells

subdivided to CD4+ and CD8+ cells

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22
Q

What is PRR?

A

Pattern Recognition Receptors

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23
Q

What are the pattern recognition receptors? (PRR)

A

Signalling:

  • TLR (Toll-like)
  • NOD-like receptors/NLR

Endocytic:

  • Pentaxins
  • CLR (c-type lectin)
  • Complement receptors
  • Scavenger receptors
  • N-formyl met-leu-phe receptors
  • RIG-like receptors
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24
Q

Name the cascades in PRR?

A

Kinins cascade

Coagulation cascade

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25
Q

What are the stimulus in PRR?

A

DAMPs (damage-associated molecular patterns)

PAMPs (pathogen-associated)

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26
Q

Where can Toll-like receptors be found on?

A
  • Macrophages
  • Neutrophils
  • Dendritic cells
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27
Q

Name an antagonist for acute and chronic inflammation:

A

TLR-2, 4

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28
Q

Name an agonist for asthma:

A

TLR-9

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29
Q

Name a component involved in the coagulation cascade:

A

Thrombin

30
Q

Name a component involved in the Kinin cascade:

A

Kallikrein

31
Q

Name a component involved in the complement cascade:

A

C3

32
Q

Name a component involved in the fibrinolytic cascade

A

Plasmin

33
Q

What are the 3 pathways that stimulate complement pathways?

A
  • Classical
  • Lectin
  • Alternative
34
Q

How is the classical pathway stimulated?

A

antigen-antibody complexes fix C1

35
Q

How is the alternative pathway stimulated?

A

contact with bacterial polysaccharide or other cell wall component

36
Q

How is the lectin-mannose pathway stimulated?

A

plasma lectin binds mannose component in a microbe

37
Q

Explain the processes of the 3 complement pathways:

A
  1. All 3 pathways lead to formation C3 convertase that plays a central role in complement effects
  2. C3 convertase cleaves to C3a and C3b
  3. C3b deposits on surgace of microbe - binds C3 convertase and forms C5 convertase
  4. C5 convertase cleaves C5 to C5a and C5b
  5. Assembly of C6-C9 - membrane attack complex
38
Q

How does one develop angioedema?

A
  • Drug induced

- Hereditary

39
Q

What could lead to increased systemic levels of C3?

A
  • Adiposity
  • Inflammation
  • Immune activation
  • Insulin resistance
  • hypetriglyceridaemia
  • hyperglycaemia
40
Q

What are the potent vasodilator mediators in microcirculation?

A
  • prostaglandins, nitric oxide (from endothelial/inflammatory cells)
  • neuropeptides (from sensory nerves)
41
Q

What are the oedema producing mediators that increases microvascular permeability?

A

Direct-acting:

  • histamine
  • bradykinin
  • leukotrienes
  • PAF
  • Substance P
  • VEGF

Neutrophil dependent:
- agents that stimulate neutrophil activation

42
Q

Where is histadine found?

A
  • mast cells
  • basophils
  • histaminergic neurons
43
Q

Histadine is released by?

A
  • IgE
  • C5a, C3a
  • Substance P, VIP
44
Q

Histadine metabolism includes the following 3:

A
  • oxidation
  • n-methylation
  • acetylation
45
Q

What does an increase in cAMP do to histamine?

A
  • inhibits histamine release
46
Q

What are cytokines?

A

Simple polypetides or glycoproteins with a molecular weight <30kD

47
Q

Explain the general cytokine production:

A
  • regulated by including stimuli at the level of transcription and translation
  • transient and action of radius is usually short
48
Q

Explain the general cytokine action:

A
  • act by binding to high-affinity cell-surface receptors

- actions are attributed to altered gene expression in the target cells

49
Q

Name the steps of leukocyte emigration:

A
  • Rolling
  • Activation
  • Tight Adhesion
  • Transmigration
50
Q

Name an inflammatory mediator that is an omega-6 polyunsaturated fatty acid

A

AA (free arachidonic acid)

51
Q

Name an ANTI-inflammatory mediator that is an omega-6 polyunsaturated fatty acid

A 
DHA (docosahexaenoic acid)
and EPA (eicosapentaenoic acid)
52
Q

What are the antigen presenting cells?

A
  • Dendritic cells
  • Macrophages
  • B cells
53
Q

What do the antibody domains consist of?

A

beta-pleated sheet ‘sandwich” with hydrophobic centre

54
Q

Describe the Class I MHC antigens:

A
  1. Glycoproteins of ~43kDa
  2. On surface of all nucleated somatic cells
  3. Has a peptide binding groove
  4. Recognised by Tc cells - major function to aid Tc cells recognise infected self cells and elimination
55
Q

Describe the Class II MHC antigens:

A
  1. 2 chains of 35kDa and 28kDa
  2. On surface of antigen-presenting cells
  3. Also has peptide binding groove
  4. Recognised principally by Th cell receptors - essential for APC presenting Ag to Th cell
56
Q

What are some differences between MHC I and MHC II?

A
  • MHC I is ubiquitous and found on ALL cells (recognised by CD8+ t cells)
  • MHC II only found on APC’s so that the immune system can efficiently and quickly activate CD4+ helper t cells
57
Q

State what is involved in the 3 signals involving T-cells and APC:

A 
Signal 1:
- TCR, MHC class II and Ag

Signal 2:
- CD28, CD80/CD86

Signal 3:
- cytokines

58
Q

What are the outcomes of signal 1?

A
  • apoptosis

- energy

59
Q

What are the outcomes of signal 2?

A
  • Proliferation
  • Differentiation
  • Effector function
60
Q

What are the outcomes of signal 3?

A

Cell-cycle arrest

61
Q

What are some physical triggers of immune response?

A
  • infections
  • toxins
  • food peptides
  • allergens
  • medications
  • auto-antigens
62
Q

What are some t-cell subsets?

A
  • Th17 (IL-17/21/22)
  • Th1 (IL-2, IFN-gamma, TNF-alpha)
  • Th2 (IL-4/5/6/10/13)
  • Treg (TGF-beta, IL-35/10)
  • APC
  • Th0
63
Q

Name the functions of macrophages:

A
  • Antigen presenting (dendritic cells)
  • Atherogenesis
  • Wound healing/regeneration
  • Inflammation resolution
  • Microbe killing
  • granuloma formation
  • angiogenesis
  • neurodegenerative disease
  • tumour biology
64
Q

What are the types of macrophage-derived products:

A
  • enzymes
  • pro-inflammatory cytokines
  • immuno-modulatory cytokines
  • chemokines
  • growth factors
  • angiogenic factors
  • adhesion, matrix molecules
  • complement proteins
  • bioactive lipids
  • reactive oxygen intermediates
  • reactive nitrogen intermediates
65
Q

Describe the M1 macrophages:

A
  • classical activation by Th1
  • stimulated by IFN-gamma or LPS
  • high levels of pro-inflammatory cytokines
  • antigen-presenting
  • produce NO
  • kills microbes
66
Q

Describe the M2 macrophages:

A
  • alternative activation by Th2
  • stimulated by IL-4/13, immune complexes, LPS, glucocorticoids, etc
  • low levels of pro-inflammatory cytokines
  • NOT antigen-presenting
  • doesn’t produce NO
  • builds ECM
67
Q

Describe the M1 macrophage activation:

A
  1. TLR receptor present on surface
  2. LPS attach to IFN-gamma receptor
  3. microbial trigger by LPS
  4. Proinflammatory cytokines released
  5. NO and respiratory burst
  6. Microbicidal tissue damage, cellular immunity, DTH
68
Q

What occurs during sepsis and multiple organ failure?

A
  • microbial initiation leading to systemic inflammatory response
  • drop in blood pressure
  • haematologic dysfunction
  • acute respiratory distress
  • kidney, liver dysfunction
  • decrease in cellular oxidative phosphorylation
69
Q

What is sepsis categorised by?

A

Profound metabolic derangements

70
Q

What serves as diagnostic/prognostic biomarkers for sepsis patients?

A
  • metabolic changes

- lactate

71
Q

What is metainflammation?

A

cold inflammation, low grade

72
Q

Describe metainflammation involvement:

A
  • associated with metabolic disease
  • high levels of C-reactive protein (CRP - general marker of inflammation)
  • adipose tissue release of inflammatory cytokine - invasion of macrophages

Malnourishment and Obesity (21 decks)

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