Pathophysiology of Chronic Inflammation
Chronic inflammation is a long-term inflammation lasting for several months to years. Chronic inflammatory diseases are the greatest threat to health and the most significant cause of death in the world.
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Pathophysiology of Chronic Inflammation
Most of the features of acute inflammation continue as the inflammation becomes chronic, including the expansion of blood vessels (vasodilation), increase in blood flow, capillary permeability and migration of neutrophils into the infected tissue through the capillary wall (diapedesis). However, the composition of the white blood cells changes soon and the macrophages and lymphocytes begin to replace short-lived neutrophils.
Thus the hallmarks of chronic inflammation are the infiltration of the primary inflammatory cells such as macrophages, lymphocytes, and plasma cells in the tissue site, producing inflammatory cytokines, growth factors, enzymes and hence contributing to the progression of tissue damage and secondary repair including fibrosis and granuloma formation, etc.
In response to foreign or self-antigens, the tissue immune cells such as macrophages and dendritic cells release cytokines such as IL-1 and TNF-α. These cytokines induce the injury-site-endothelial cells to release Selectins and Integrins which stimulate chemotaxis and diapedesis of the circulating leukocytes. In addition to the recruitment of leukocytes, the tissue macrophages, and dendritic cells also play a role in the clearing of the antigen by phagocytosis, the release of cytokines and serving as antigen-presenting-cells to lymphocytes.
Once the circulating leukocytes enter the local injury site, they are activated by various cytokines and chemokines secreted by the macrophages and dendritic cells. On activation, the leukocytes further release cytokines and mediators of inflammation.
Neutrophils are the initial cells and most predominant in the acute phase of inflammation. Neutrophils contain granules rich with lysozyme, matrix metalloproteinases, myeloperoxidase which are released on the foreign or self-antigen leading to its destruction. Neutrophils also destroy the antigen by phagocytosis, the release of reactive oxygen species and cytokines such as IL-1, IL-6, and TNF-α.
Lymphocytes including T-lymphocytes and B-lymphocytes are the next line of defense, and they play a crucial role in mediating inflammation by several complex mechanisms including secreting of cytokines, co-stimulation of lymphocytes, and production of antibodies and immune complexes.
Circulating platelets can also play a role in inflammation by platelet aggregation, thrombus formation and degranulation releasing chemokines and inflammatory mediators.
“Chronic Inflammation” – StatPearls NCBI Bookshelf 2018
A service of the National Library of Medicine, National Institutes of Health.
Authors: Roma Pahwa; Amandeep Goyal; Ishwarlal Jialal.
- Michels da Silva D, Langer H, Graf T. Inflammatory and Molecular Pathways in Heart Failure-Ischemia, HFpEF and Transthyretin Cardiac Amyloidosis. Int J Mol Sci. 2019 May 10;20(9) [PMC free article: PMC6540104] [PubMed: 31083399]
- Zhang X, Wu X, Hu Q, Wu J, Wang G, Hong Z, Ren J., Lab for Trauma and Surgical Infections. Mitochondrial DNA in liver inflammation and oxidative stress. Life Sci. 2019 Nov 01;236:116464. [PubMed: 31078546]
- Fritsch J, Abreu MT. The Microbiota and the Immune Response: What Is the Chicken and What Is the Egg? Gastrointest Endosc Clin N Am. 2019 Jul;29(3):381-393. [PubMed: 31078242]
- Barcelos IP, Troxell RM, Graves JS. Mitochondrial Dysfunction and Multiple Sclerosis. Biology (Basel). 2019 May 11;8(2) [PMC free article: PMC6627385] [PubMed: 31083577]
- Tsai DH, Riediker M, Berchet A, Paccaud F, Waeber G, Vollenweider P, Bochud M. Effects of short- and long- term exposures to particulate matter on inflammatory marker levels in the general population. Environ Sci Pollut Res Int. 2019 Jul;26(19):19697-19704. [PubMed: 31079306]
- Deepak P, Axelrad JE, Ananthakrishnan AN. The Role of the Radiologist in Determining Disease Severity in Inflammatory Bowel Diseases. Gastrointest Endosc Clin N Am. 2019 Jul;29(3):447-470. [PubMed: 31078247]
- Yousuf A, Ibrahim W, Greening NJ, Brightling CE. T2 Biologics for Chronic Obstructive Pulmonary Disease. J Allergy Clin Immunol Pract. 2019 May – Jun;7(5):1405-1416. [PubMed: 31076058]
- Milenkovic VM, Stanton EH, Nothdurfter C, Rupprecht R, Wetzel CH. The Role of Chemokines in the Pathophysiology of Major Depressive Disorder. Int J Mol Sci. 2019 May 09;20(9) [PMC free article: PMC6539240] [PubMed: 31075818]
- Cutolo M, Soldano S, Smith V. Pathophysiology of systemic sclerosis: current understanding and new insights. Expert Rev Clin Immunol. 2019 Jul;15(7):753-764. [PubMed: 31046487]
- Needham EJ, Helmy A, Zanier ER, Jones JL, Coles AJ, Menon DK. The immunological response to traumatic brain injury. J Neuroimmunol. 2019 Jul 15;332:112-125. [PubMed: 31005712]
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