1-Metabolic

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Questions and Answers

What is the most significant biological response associated with the activation of High-mobility group protein B1?

  • Increase in apoptotic signaling pathways.
  • Decrease in cellular proliferation rates.
  • Inhibition of inflammatory response.
  • Activation of cytokines and chemokines. (correct)

Which of the following effects is NOT associated with DAMP signaling in post-trauma conditions?

  • Decrease in epithelial barrier function.
  • Procoagulant activity enhancement.
  • Increased activation of neutrophils.
  • Inhibition of chemotaxis in macrophages. (correct)

Which of the following Toll-like receptors is associated with the recognition of lipopolysaccharides?

  • TLR 4 (correct)
  • TLR 2
  • TLR 1
  • TLR 5

What is the role of heat shock proteins in cellular response to injury?

<p>They are expressed in response to oxidative stress. (B)</p> Signup and view all the answers

Which of the following statements best describes the function of chemokines in inflammation?

<p>They mediate the chemotaxis of leukocytes towards sites of inflammation. (B)</p> Signup and view all the answers

What does the degree of systemic inflammatory response indicate?

<p>It directly predicts the likelihood of subsequent organ dysfunction. (A)</p> Signup and view all the answers

Which of the following best characterizes HMGB1's role in the inflammatory response?

<p>It is a damage-associated molecular pattern (DAMP) that activates inflammation. (A)</p> Signup and view all the answers

Which response is triggered by HMGB1 binding to TLR4?

<p>Release of pro-inflammatory cytokines. (B)</p> Signup and view all the answers

What is a common consequence of altered epithelial barrier function due to trauma?

<p>Increased permeability leading to fluid loss. (A)</p> Signup and view all the answers

Which component is considered a significant outcome of the proinflammatory responses linked to HMGB1 signaling?

<p>Increased procoagulant activity on platelet surfaces. (D)</p> Signup and view all the answers

In the context of inflammatory responses, what does SIRS typically relate to?

<p>The physiological response to sterile trauma. (D)</p> Signup and view all the answers

What is the relationship between injury severity and systemic inflammatory response?

<p>They are directly proportional. (C)</p> Signup and view all the answers

What describes the main immune response in cases of trauma compared to infection?

<p>In both cases, similar pro-inflammatory responses are activated. (B)</p> Signup and view all the answers

What are Damage-Associated Molecular Patterns (DAMPs) primarily responsible for in the context of trauma?

<p>Activating innate immune cells in response to cellular injury (C)</p> Signup and view all the answers

In the acute response to trauma, what role does HMGB1 serve?

<p>It is the most characterized DAMP involved in inflammation (D)</p> Signup and view all the answers

What is the primary aim of the systemic inflammatory response (SIR) triggered by traumatic injury?

<p>To limit damage and restore homeostasis in the body (B)</p> Signup and view all the answers

How do endogenous molecules in DAMPs promote an immune response?

<p>By recruiting and activating antigen-presenting cells (A)</p> Signup and view all the answers

In the context of the acute pro-inflammatory response, what is the significance of balancing pro-inflammatory and anti-inflammatory mechanisms?

<p>It ensures proper tissue repair and immune regulation (A)</p> Signup and view all the answers

What is likely the outcome if the innate immune system fails to recognize DAMPs?

<p>Development of chronic inflammation (C)</p> Signup and view all the answers

What is the relationship between DAMPs and necrotic or damaged cells?

<p>DAMPs can be released passively or through overexpression in stressed cells (A)</p> Signup and view all the answers

What term best describes the molecules that actively promote the body's inflammatory response in trauma?

<p>Alarmins (D)</p> Signup and view all the answers

Which laboratory finding is commonly expected in critically ill patients with CIRCI?

<p>Hyperkalemia (A)</p> Signup and view all the answers

What is the primary role of antioxidants in the context of critical illness-related complications?

<p>Protecting host cells from oxidative stress (B)</p> Signup and view all the answers

What is the main function of the hypothalamic CRH in response to injury associated stress?

<p>To promote ACTH release from the anterior pituitary (D)</p> Signup and view all the answers

What is the role of chemokines in the context of injury-induced inflammation as it relates to the central nervous system?

<p>They help in the localization and recruitment of immune cells. (D)</p> Signup and view all the answers

Which type of endothelium is primarily involved in allowing inflammatory signals to reach the central nervous system?

<p>Fenestrated endothelium (B)</p> Signup and view all the answers

Which part of the adrenal gland is primarily responsible for glucocorticoid production?

<p>Zona fasciculata (A)</p> Signup and view all the answers

In the event of severe stress related to critical illness, which of the following electrolyte imbalances may occur?

<p>Hyperkalemia and hyponatremia (B), Hypoglycemia and hypokalemia (C)</p> Signup and view all the answers

Which of the following is NOT a component of pro-inflammatory mediators related to CIRCI?

<p>Insulin (D)</p> Signup and view all the answers

What neurotransmitter is noted for its regulatory role in central nervous system inflammation during injury?

<p>Acetylcholine (A)</p> Signup and view all the answers

Which enzyme is primarily involved in detecting cellular stress and reestablishing protein folding?

<p>Inositol requiring enzyme 1 (IRE1) (A)</p> Signup and view all the answers

What characterizes necrosis compared to apoptosis in cellular death?

<p>Loss of plasma membrane integrity (B)</p> Signup and view all the answers

What role does the vagus nerve play in the inflammatory response?

<p>It mediates the inflammatory reflex through acetylcholine. (B)</p> Signup and view all the answers

How do DAMPs contribute to inflammation in the central nervous system?

<p>By acting as endogenous signals of cell stress or injury. (C)</p> Signup and view all the answers

Which statement best describes the properties of the blood-brain barrier (BBB) in relation to injury?

<p>The BBB displays increased permeability during inflammatory responses. (B)</p> Signup and view all the answers

What is the effect of ACTH on the adrenal cortex?

<p>Promotes cortisol secretion from the zona fasciculata (C)</p> Signup and view all the answers

What is the role of reactive oxygen species (ROS) in the immune response?

<p>Facilitating pathogen killing by phagocytes (D)</p> Signup and view all the answers

The unfolded protein response is primarily triggered by which condition?

<p>Cellular stress disrupting protein folding (A)</p> Signup and view all the answers

Which of the following conditions illustrates hypoactivity in the HPA axis mechanisms?

<p>Adrenal insufficiency (A)</p> Signup and view all the answers

What is the effect of cytokines during the inflammatory response in the central nervous system?

<p>They can both propagate and inhibit inflammation depending on their type. (C)</p> Signup and view all the answers

Which statement regarding the secretion of CRH is accurate?

<p>CRH is secreted from the paraventricular nucleus of the hypothalamus. (D)</p> Signup and view all the answers

What can lead to hypoglycemia during critical illness?

<p>Severe stress and metabolic dysregulation (B)</p> Signup and view all the answers

What is the primary pathway for inflammatory signals to access the central nervous system according to their properties?

<p>Via leaky tight junctions of the blood-brain barrier. (D)</p> Signup and view all the answers

Which condition best describes the interaction of the central nervous system with peripheral inflammatory signals?

<p>It can be overwhelmed by excessive peripheral inflammation. (D)</p> Signup and view all the answers

What is a common characteristic of cell death via necrosis?

<p>Occurs in response to ischemia and trauma (B)</p> Signup and view all the answers

Flashcards

Damage-Associated Molecular Patterns (DAMPs)

Molecules released from damaged or dying cells that trigger an immune response.

Systemic Inflammatory Response (SIR)

A systemic inflammatory response triggered by DAMPs in response to cellular injury.

High-Mobility Group Protein B1 (HMGB1)

A type of DAMPs that plays a key role in the inflammatory response. It is often called 'HMGBest' due to it being the best characterized DAMP.

Acute Pro-Inflammatory Response

The initial phase of the immune response to injury, characterized by the release of inflammatory mediators.

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Anti-Inflammatory Response

The later phase of the immune response to injury, aimed at resolving inflammation and restoring homeostasis.

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Homeostasis

A state of balance and stability within the body.

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Tissue Repair

A critical process by which damaged tissues are repaired and replaced with healthy ones.

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Immune System Recognition

A process by which the immune system recognizes and eliminates pathogens and damaged cells.

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What is SIRS?

The systemic inflammatory response syndrome (SIRS) is a clinical syndrome characterized by a dysregulated inflammatory response.

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How is SIRS severity related to injury severity?

The severity of SIRS is directly proportional to the severity of the injury. A more severe injury leads to a more robust SIRS response.

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What is HMGB1?

HMGB1 (High Mobility Group Box 1) is a protein released by damaged cells. It acts as a danger signal to the immune system, triggering a cascade of inflammatory responses.

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How does HMGB1 trigger inflammation?

HMGB1 triggers specific immune responses, including the release of cytokines, neutrophil activation, increased permeability of epithelial barriers, and procoagulant activity.

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How does HMGB1 interact with TLR4?

HMGB1 binds to TLR4 (Toll-like receptor 4) on immune cells, like macrophages, triggering the release of pro-inflammatory cytokines, which contribute to the overall inflammatory response in SIRS.

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Can SIRS occur without infection?

SIRS can arise from both infectious and sterile injuries, meaning it can occur even without a direct infection.

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What is TLR4?

TLR4 (Toll-like receptor 4) is a key receptor on immune cells that plays a crucial role in recognizing pathogens and triggering inflammatory responses.

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How does cytokine release contribute to SIRS?

The release of pro-inflammatory cytokines by immune cells, triggered by HMGB1 binding to TLR4, contributes significantly to the overall inflammatory response in SIRS, ultimately leading to the sickness behavior.

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Cytokines

Proteins released by cells in response to injury or infection. They help recruit immune cells and trigger inflammation.

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Interferon

A type of cytokine that interferes with virus replication.

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DAMPs

A family of proteins that play a crucial role in triggering inflammation and immune responses.

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Toll-like receptor (TLR)

A protein found in the body which activates the immune response when it detects microbial components.

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TLR 1 + TLR 2

A type of TLR that is activated by bacterial lipopeptides.

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How does the CNS communicate with the body?

The central nervous system (CNS) uses sensory and motor neurons to communicate with the body, processing information to generate a coordinated response.

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How does the CNS detect inflammation?

The CNS receives information about injury-induced inflammation via soluble mediators and direct neural projections, which transmit data to brain regions involved in regulating inflammation.

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What are the main routes of inflammation signal transmission to the CNS?

The CNS receives information about injury-induced inflammation through direct communication with the body via neural projections and indirect communication through soluble mediators.

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What type of endothelium enables inflammation signals to reach the CNS?

Fenestrated endothelium is the type of capillary lining that allows inflammatory signals to reach the CNS.

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What are DAMPs, and how do they contribute to inflammation?

DAMPs (Damage-Associated Molecular Patterns) and inflammatory molecules are released from damaged cells and play a critical role in communicating injury information to the CNS.

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Which neurotransmitter regulates CNS inflammation during injury?

Acetylcholine is a neurotransmitter involved in regulating inflammation in the CNS.

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What is the role of the BBB in CNS inflammation?

Leaky blood-brain barrier (BBB) permits inflammatory signals to cross into the central nervous system.

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How does the CNS regulate inflammation?

The central nervous system (CNS) plays a role in modulating inflammation by receiving information from specialized immune cells called T cells.

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SIRS (Systemic Inflammatory Response Syndrome)

A state where the body loses its ability to maintain a stable internal environment due to an overwhelming inflammatory response.

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Inflammatory Cascade

The release of signaling molecules (primarily cytokines) from cells in response to injury or infection, leading to a cascade of immune responses.

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Vagus Nerve Anti-inflammatory Reflex

A mechanism of immune system regulation where the vagus nerve helps to dampen the inflammatory response, promoting a calmer state in the body.

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DAMPs (Damage-Associated Molecular Patterns)

A family of signaling molecules that act as 'alarm bells' for the immune system, alerting it to tissue damage or infection.

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HPA (Hypothalamic-Pituitary-Adrenal) Axis

A primary stress response pathway that releases hormones (like cortisol) to regulate the body's response to stress, including inflammation.

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Cortisol

A hormone secreted by the adrenal gland (zona fasciculata) that helps regulate inflammation and other stress responses in the body.

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Neuro-immune-endocrine Nexus

A complex system that involves the interconnectedness of the nervous system, immune system, and endocrine system, highlighting the intricate communication and regulation in the body's response to stress and inflammation.

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Apoptosis

A process by which cells die in a controlled and organized manner, characterized by the activation of caspases, DNA fragmentation, and the formation of apoptotic bodies. This process is essential for removing damaged or unwanted cells without causing inflammation.

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Necrosis

A form of cell death that occurs when cells are injured or stressed beyond their ability to repair themselves. Unlike apoptosis, necrosis is uncontrolled and leads to the release of cellular contents, causing inflammation.

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Cytokine Production and Secretion

A process involving the production and secretion of mature cytokines, which are signaling molecules that play a crucial role in regulating inflammation and immune responses.

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Unfolded Protein Response (UPR)

This unfolded protein response is triggered when misfolded proteins accumulate in the endoplasmic reticulum (ER) of cells. The ER is responsible for proper protein folding, and stress can disrupt this process. To restore balance, the ER activates a signaling pathway known as the unfolded protein response (UPR). This pathway aims to restore protein folding and reduce the stress on the ER.

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Antioxidants

Molecules that protect cells from damage caused by reactive oxygen species (ROS), which are highly reactive molecules that can damage cellular components. In the context of critical illness, antioxidants counteract the harmful effects of oxidative stress, which is implicated in the development of complications like sepsis, multi-organ dysfunction, and acute respiratory distress syndrome.

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Reactive Oxygen Species (ROS)

Reactive oxygen species (ROS) are highly reactive molecules that are naturally produced as part of normal cellular metabolism. However, excess ROS can damage cells and contribute to disease. ROS play a role also in pathogen killing by phagocytes and inflammation. The role of ROS in disease is complex and is dependent on a variety of factors such as the type of ROS, the concentration of ROS, and the tissue or cell type.

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Study Notes

Cellular Injury Detection

  • Traumatic injury initiates innate immune system response to limit damage and restore homeostasis.
  • Two mechanisms exist: acute pro-inflammatory and anti-inflammatory responses.
  • The degree of systemic inflammation correlates with injury severity and predicts organ dysfunction/mortality.
  • SIRS (systemic inflammatory response syndrome) can result from sterile or infected trauma.
  • Clinical features of SIRS include fever, increased heart and respiratory rate, and elevated white blood cell count.

Damage-Associated Molecular Patterns (DAMPs)

  • DAMPS are endogenous molecules released from damaged cells.
  • HMGB1 (High Mobility Group Protein B1) is a crucial DAMP.
  • HMGB1 triggers pro-inflammatory responses, including cytokine release from macrophages/monocytes/dendritic cells, neutrophil activation, and changes to epithelial barrier function (increased permeability).
  • HMGB1 plays a role in traumatic brain injury and hemorrhagic shock.
  • Proteins from mitochondria create inflammasomes that activate STING (Stimulator of interferon genes).

Heat Shock Proteins (HSPs)

  • HSPs are intracellular proteins that respond to oxidative stress and tissue injury.
  • HSPs have roles in chaperoning and regulating protein folding, targeting of misfolded proteins, and sequestering partially folded proteins.
  • HSPs act as DAMPS. Increased HSP70 expression induces cellular calcium flux, NF-κB activation, and cytokine production.
  • Exogenous expression of HSPs can also inhibit NF-κB activation, and reduce dendritic cell T-cell stimulation.

Toll-Like Receptors (TLRs)

  • TLRs are plasma-bound receptors (approximately 10) initially triggering immune responses.
  • TLR1&2 form a dimer to interact with triacyl lipopeptides.
  • TLR3,7,8,9 are found within endosomes.
  • These receptors initiate immune responses in response to various stimuli (parasites, yeasts, bacteria, LPS, flagellin, GPI anchors, zymosan, Diacyl Lipopetides, LTA, dsRNA (viruses), CpG DNA (bacteria)).
  • Activation of each TLR triggers a cascade activating a number of transcription factors such as AP1, IRF, or NFκB inside the nucleus, stimulating production of interferons, cytokines, and other signalling molecules.

CNS Regulation of Injury

  • The central nervous system (CNS) detects inflammation through soluble mediators, neural projections, and DAMPS signals.
  • Inflammatory signals reach the CNS through fenestrated endothelium and a leaky blood-brain barrier.
  • Acetylcholine from splanchnic nerves plays a role in CNS inflammatory regulation.
  • The hypothalamic-pituitary-adrenal (HPA) axis modulates the host response to injury-induced stress. Increased cortisol during acute stress leads to hyperglycemia, hypernatremia, and hypokalemia. Decreased cortisol during severe stress leads to the opposite: hypoglycemia, hyponatremia, and hyperkalemia.

Cellular Stress Responses

  • Reactive oxygen species (ROS) are highly reactive molecules produced during oxygen metabolism.
  • ROS cause oxidative stress by causing cell injury.
  • ROS also act as signaling molecules.
  • Inflammasomes activate inflammatory caspases and mature cytokines.
  • The body defends against oxidative stress by utilizing antioxidants like superoxide dismutase, catalase, and others.

Cytokines and Immune Responses

  • Cytokines are signaling molecules that regulate immune responses during injury.
  • Exaggerated cytokine responses lead to inflammatory complications including hemodynamic instability and metabolic derangements.
  • Interleukins (IL-1, IL-6, IL-8, IL-10, IL-2, TNFα) are signaling cytokines, regulating tissue repair and contributing to the inflammatory response.
  • Cytokines mediate cell responses, including blood flow, activation, and migration.

Eicosanoids

  • Eicosanoids like prostaglandins, leukotrienes, and thromboxanes regulate inflammation.
  • These are derived from arachidonic acid.
  • Eicosanoids exert physiological effects involving various processes such as vasodilation, blood pressure regulation, and bronchoconstriction.
  • In inflammatory responses, they mediate pain, fever, and vascular permeability.

Complement System

  • Complement systems are involved in inflammation and host responses to injury.
  • The major source of complement proteins is the liver
  • Complement system pathways include classical, lectin, and alternative pathways.

Apoptosis, Necrosis, and Pyroptosis

  • Apoptosis is a regulated form of programmed cell death and is an energy dependent process without promoting inflammatory responses.
  • Necrosis is an uncontrolled cell death due to cellular stress and triggers inflammation
  • Pyroptosis is a programmed form of cell death, similar to apoptosis, but also involving caspases and resulting in significant inflammation

Cellular Mediator Responses (Inflammation)

  • Neutrophils are initial responders to injury, exhibiting cytotoxic effects such as ROS.
  • Monocytes (macrophages) are key players in clearance and activation of immune and inflammatory responses following injury.
  • Lymphocytes (T and B cells) mediate adaptive immune responses involving cell signaling.
  • Dendritic cells act as antigen presenting cells to initiate adaptive immune responses.
  • Platelets contribute to hemostasis and inflammatory responses, releasing mediators and cytokines.
  • Mast cells mediate inflammation by releasing mediators, including histamine and cytokines.

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