BASIC MECHANISM INVOLVED IN THE

PROCESS OF INFLAMMATION AND

REPAIR
Introduction of inflammation
•Inflammation is critical homeostatic process that is activated by cellular
injury regardless ( without consideration of ) of the mechanism of that injury.
•Inflammation is an essential part of your body's healing process.
•It is local response of living tissue due to injury
•Inflammation is essentially local in nature although cellular mediators released
during inflammation may initiate systemic response as well.
•Inflammation is local response of living mammalian tissue to injury due to any
agents.
•Inflammation is not the synonyms of infection. But sometimes inflammation is
caused by the infections.
Clinical Sign of inflammation
Inflammation is characterized by 5 signs & symptoms (Clinical Sign of
inflammation)
1. Rubor (redness): Dilatation of small blood vessels in damaged area
2. Calor (heat): Increased blood flow to area
3. Tumour (swelling): Accumulation of fluid in extracellular space (edema)
4. Dolor (pain): Stretching/distortion of tissue from oedema (esp. from pus),
5. Loss of function: Movement hindered etc

Agents causes inflammation is:

6. physical agent: heat ,cold , radiation
7. Chemical: Organic and inorganic poison
8. Infective agents: Bacteria , viruses
9. Immunological agent: antigen antibody interaction
Different types of inflammation
Depending upon the defence capacity of the host and duration of
response inflammation can be classified as,

1. Acute inflammation

2. Chronic Inflammation.
 1. Acute inflammation
Is of short duration and represent early body reaction and is usually followed by
heating
Condition caused acute inflammation is:
•Acute bronchitis (Inflammation of the mucous membrane in the bronchial tubes.)
•Sore throat due to cold
•Cut of skin
•Acute appendicitis ( serious medical condition in which the appendix becomes inflamed
and painful.)
•Acute dermatitis (general term that describes a common skin irritation)
•Acute tonsillitis ( an inflammatory process of the tonsillar tissues)
Causative agents: harmful bacteria, injury to tissue
Major cell involved: neutrophil, basophiles, esinophil
Duration of action: short lived only for few days.
Systemic effect: Fever, shock, inflammation of lymph node
 2. Chronic inflammation
Is of longer duration and eigher after the causative agents of acute inflammation
persist for longtime

Condition caused chronic inflammation is

1. Untreated causes of acute inflammation, such as an infection or injury
2. An autoimmune disorder, which involves your immune system mistakenly
attacking healthy tissue
3. Long-term exposure to irritants, such as industrial chemicals or polluted air,
asthama, tb, chronic peptic ulcer

Causative agents: non- degradable pathogens that cause persistent inflammation

eg virus, foreign bodies

Major cell involved:

4. Macrophages (A type of white blood cell that surrounds and kills microorganisms,
removes dead cells)
5. lymphocyte (A lymphocyte is a type of white blood cell that is part of the immune
system),
6. plasma cell
Duration of action: from several month to year. Systemic effect: Fever, anemia,
Mechanism of inflammation:

Pathogenesis of inflammation can be explained by two events;

1. Vascular Event

2. Cellular Event
1. Vascular Event : Alteration in arteriole, capillary is early response of cell
injury.

2. Cellular Event: escape of WBC from capillary to extracellular space.

1. Vascular Event Vascular Event

Tissue Injury

Release of chemical for local effect (Histamine, Prostaglandins, Kinins,

Leukotriens, Etc)

Immediate Response is Vascular Contraction

It may persist for 3-5 second or last for 5 minutes depending on the severity of injury

It is known as transient vasoconstriction

After this phase arterioles get dilate known as persistent progressive vasodilation

It increase the blood flow and this type of vascular expansion produce redness and
heat known as erythema
So fluid from the capillary get migrate in to the tissue and this fluid is know as transudate

When the volume of blood flow may raise more and permeability gets increase

Fluid with the protein migrate from capillary to tissue known as exudates

Loss of the Protein rich fluid from the capillary reduces the intravascular
osmotic pressure and increase the osmotic pressure of the interstitial fluid
(Fluid present in to the tissue due to migration from capillary)

So it produces out flow of the water and ions into the extra-
vascular

These fluids accumulate in to the extravascular space and produce edema.

2.Cellular Event

Cellular event of the inflammation is described by the two processes;

1.Leukocytes (WBC) movement process

2. Phagocytosis:
Leukocytes (WBC) movement process
Tissue injury

Produce vasodilation due to increases the volume of blood flow

So the permeability of capillary get increases and fluid (Plasma) get move from capillary
to tissue

Plasma or fluid gets discharge from the capillary so the ratio of WBCs and RBCs get
increases, plasma discharge due to the exudates known as migration

So it increases the viscosity of blood and slowing the flow of blood is known as stasis

Due to the increasing the viscosity, the leukocyte roll on the endothelial of the capillary

The leukocyte on their surface consist integrin protein and endothelial cell of blood
capillary consist selectin (E-Selectin & P-Selectin) protein on their surface.
 During the leukocyte rolling on to the endothelial cell, integrin and selectin get activated
and produce adhesion of leukocyte on endothelial cell of capillary.

After the adhesion or sticking leukocyte moves in to the extravascular space from the gap
between endothelial cells or from the capillary

These phenomenons is known as emigration

At the site of injury, several mediators get released which attract the leukocytes

That kind of mediators at a site of injury s known as chemokines (Histamine,

Leukotrines, Platelet activating factors, Prostaglandins, Cytokines, Complementary
proteins etc) and the attraction process of the leukocyte towards the injury is known
as chemotaxis process

Endothelial cells form a single cell layer that lines all blood vessels and regulates
exchanges between the bloodstream and the surrounding tissues.
Mediators of inflammation
Biochemical mediators released during the inflammation. These mediators are
soluble, diffusible molecules that can act locally and systemically.
1.Vascular amines
I. Histamine
II. Serotonine
2. Plasma Protease
III. Complement system
IV. Kinin system
V. Clotting system
3. Arachidonic acid metabolites
4. Cytokines
5. Nitric oxide
6. Growth factor
Basic principles of wound healing in the skin

Injury to tissue may result in cell death and tissue destruction. Healing on the
other hand is body response to injury in attempt to restore normal structure
and function

The process of healing involved two processes

•1. Regeneration
•2. Repair: The process of repair involves
1. Granular tissue formation
2. Contraction of wound
1. Regeneration
When healing takes place by proliferation of parenchyma cell and usually result in
complete restoration of original tissue.
Regeneration of any type of parenchyma cell involves following process:

1. Proliferation of original cell from the margin of injury with migration so as to

cover the gap
2. .Proliferation of migrated cells with subsequent different ion ands maturation
so as to reconstitute original tissue
Depending upon their capacity ton devide cells of body can be divided into
three groups

1. Labile cell: These cells continue to multiply throughout life under

normal psychological condition.
Egg: surface epithelial cells of epidermis, alimentary tract, respiratory
tract, urinary tract.

2. Stable cell: these cells decreases or lose their ability to proliferate after
adolescence but retain the capacity to multiply in response to stimuli
throught out adult life
egg: Parenchyma cell of liver, pancreases, kidney, thyroid

3. Permanent cell: These cells lose their ability to proliferate around the
time of birth
Eg: Neuron, cardiac cell, skeletal muscle
2. Repair

Repair is a replacement of injured tissue by fibrous tissue

Response takes place by participation of mesenchymal cell( connective tissue,
stem cells)
•The process of repair involves
1. Granular tissue formation
2. Contraction of wound
1. Granular tissue formation

•The term granulation tissue derives its name from slightly granular and pink
appearance of the tissue.
• Each granules corresponds histologically to proliferation of new small blood
vessels which are slightly lifted on the surface by the covering fibroblast and
young collagen

It involves three phases

•1. Phase of inflammation
•2. Phase of clearance
•3. phase of growth of granulation tissue
2. Contraction of wound

•The wound starts contracting after 3-2 days and the process is completed by 14
days.
•During this period wound is reduced by approximately 80% of original size
•Contracted wound result rapid healing since lesser surface area of the injured
tissue has too be replaced.
It involves three phases
• Dehydration involves removal of fluid by drying wound
•Contraction of collagen was thought be responsible for contraction
•Discovery of myofibroblast appearing in active granulation, their migration into
the wound an correction of wound
Wound Healing mechanism
Due to the Injury

removal of damage and dead tissue

Inflammation is occur

Then Proliferation and migration of parenchymal and connective tissue is

held.

formation of new blood vessels (Angiogenesis) and granulation

Synthesis of ECM proteins and collagen deposition

Tissue remodeling

Wound Contraction