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Samenvatting Mechanismen van ziekte: inflammatie en immunopathologie
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Samenvatting mechanismen van ziekte (deel inflammatie en immunopathologie, gegeven door Bart Lambrecht)
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1: inflammatie- Protectieve respons op weefselschade
Vasculaire fase
- VD
- permeabiliteit ↗
- oedeem
- stasis
Cellulaire fase
- restitutio at integrum
- extravasatie leukocyten
- ex/transudaat
Exsudaat
- eiwitrijk vocht
- tgv inflamm: VD + permeabiliteit ↗
o retractie endotheelcellen tgv His, leukotriënen, bradykinine
o endotheliale schade (brandwonden)
o abnorm angiogenese bij litteken
- sereus: vocht>eiw
- fibrineus: veel eiw, fibrine, verkleving
- purulent: pus
- serosanguineus: bloed (rosé)
- fibropurulent: pus + verkleving
Transudaat
- eiwitarm vocht
- tgv hydrostatische druk ↗ + colloïd osmotische druk ↘
soluble pathways
- coagulatie: fibrine + stolling
- fibrinolystisch: oplossen fibrine + vorming d-dimeren
- complement: indcutie door mo, CRP, immuuncomplexen, Ab’s
o actieve, klassieke, lectine pathway
o C3/5a: anafylatoxines
o C3b : opsonisatie + fagocytose
o C6-9 : MA
- bradykinine : VD + pijn
Neutrofielen
- oxidatie eiw/DNA => senescentie, celdood
- peroxidatie celmembr
- activ TF
- NETosis
o Auto-antilichamen tegen
Myeloperoxidase (ANCA-geassocieerde vasculitis)
1
, Gecitrullineerde histonen (rheumatoide arthritis)
dsDNA (lupus)
o intense schade
Acuut
- neutrofielen
- syst symptomen
- VD + oedeem
Chronisch
- monocyten, macrofagen, lymfocyten
- fibrose
Ontstekingsmediatoren
- Effectorcellen: vrijst bij degranulatie
o mastcellen
His: VD + permeabiliteit ↗ + jeuk
o Neutrofielen/macrofagen
Lysosomale enzymen + NETs
o Thrombycoten
Ser: permeabiliteit ↗
ATP: pijn
- Nieuw aangemaakt
o PG’s: pijn + koorts + VD
o Leukotriënen: rekrutering cellen + permeabiliteit ↗
o Complement: rekrutering cellen + permeabiliteit ↗
o Cytokines (IL-1, IL-6, TNFa, G-CSF) : koorts, leukocytose, CRP
o Chemokines: rekrutering cellen
o ROS + NO: weefselschade
2: overdreven immuunrespons
- Verstoorde balans tuss effector-controle
- Genetisch
- Trigger: exogeen/endogeen self-antigen (infectie/roken)
Hypersensitiviteitsreacties
- I: onmiddellijk (allergie)
o Schade: IgE + mastcellen
o Controle: Th2
o Vroege allergische reactie (His)
o Late allergische reactie (cytokines, cellen)
- II: antilichaam-gemedieerd
o Complementfixerend IgM/G => fagocytose + lyse
o Tegen Ag op celopp/ECM
o Inflamm
Complementactiv
C3/5a: chemotaxis + permeabiliteit ↗
2
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