UPSC MainsMEDICAL-SCIENCE-PAPER-I201310 Marks
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Q24.

Discuss role of mediators in different reactions of inflammation.

How to Approach

This question requires a detailed understanding of the inflammatory process and the role of various mediators involved. The answer should begin by briefly defining inflammation and its key characteristics. Then, it should systematically discuss different classes of mediators (lipid mediators, cytokines, chemokines, and plasma protein-derived mediators), their sources, mechanisms of action, and specific roles in different phases of inflammation. A structured approach, categorizing mediators and detailing their functions, is crucial for a comprehensive answer. Focus on both pro-inflammatory and anti-inflammatory mediators.

Model Answer

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Introduction

Inflammation is a complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. It is a protective attempt by the organism to remove the injurious stimuli and initiate the healing process. This response is orchestrated by a cascade of chemical mediators released from various cells, including immune cells, endothelial cells, and tissue resident cells. These mediators act locally and systemically to regulate the inflammatory process, influencing vascular changes, leukocyte recruitment, and tissue repair. Understanding the role of these mediators is crucial for comprehending the pathogenesis of inflammatory diseases and developing targeted therapies.

Role of Mediators in Inflammation

Inflammatory mediators can be broadly classified into several categories based on their chemical structure and function. These include lipid mediators, cytokines, chemokines, and plasma protein-derived mediators.

1. Lipid Mediators

Lipid mediators are derived from arachidonic acid (AA) metabolism via cyclooxygenase (COX) and lipoxygenase (LOX) pathways. They play a crucial role in initiating and amplifying the inflammatory response.

  • Prostaglandins (PGs): Produced by COX enzymes (COX-1 and COX-2). PGs like PGE2 and PGI2 cause vasodilation, increased vascular permeability, and pain sensitization. COX-2 is particularly induced during inflammation.
  • Thromboxanes (TXs): Primarily produced by platelets via COX-1. TXA2 promotes platelet aggregation and vasoconstriction.
  • Leukotrienes (LTs): Produced by LOX enzymes. LTB4 is a potent chemoattractant for neutrophils, while LTC4, LTD4, and LTE4 cause bronchoconstriction and increased vascular permeability (important in asthma).
  • Lipoxins: Generated from AA via LOX pathways, lipoxins are anti-inflammatory mediators that inhibit neutrophil recruitment and promote resolution of inflammation.

2. Cytokines

Cytokines are small proteins secreted by immune cells that regulate immune and inflammatory responses. They act through binding to specific receptors on target cells.

  • TNF-α (Tumor Necrosis Factor-alpha): A key pro-inflammatory cytokine produced by macrophages and T cells. It induces endothelial activation, leukocyte recruitment, and systemic effects like fever and cachexia.
  • IL-1 (Interleukin-1): Similar to TNF-α, IL-1 promotes inflammation, fever, and acute phase protein production.
  • IL-6 (Interleukin-6): Stimulates acute phase protein synthesis in the liver and promotes B cell differentiation.
  • IL-10 (Interleukin-10) & TGF-β (Transforming Growth Factor-beta): These are anti-inflammatory cytokines that suppress immune responses and promote tissue repair.

3. Chemokines

Chemokines are a family of small chemoattractant cytokines that direct leukocyte migration to sites of inflammation.

  • CXCL8 (IL-8): A potent chemoattractant for neutrophils.
  • CCL2 (MCP-1): Attracts monocytes and macrophages.
  • CXCL10 (IP-10): Attracts T cells and NK cells.

4. Plasma Protein-Derived Mediators

These mediators are synthesized in the liver and circulate in the plasma, becoming activated during inflammation.

  • Complement System: A cascade of proteins that leads to opsonization, chemotaxis, and cell lysis. C3a and C5a are anaphylatoxins that promote inflammation.
  • Coagulation Factors: Activation of the coagulation cascade generates thrombin, which contributes to inflammation and fibrin deposition.
  • Acute Phase Proteins: Proteins like C-reactive protein (CRP) and serum amyloid A (SAA) are produced by the liver in response to IL-6 and contribute to inflammation and host defense.

Mediator Interactions: It's important to note that these mediators don't act in isolation. There's significant crosstalk and synergy between different mediators, amplifying the inflammatory response. For example, TNF-α and IL-1 can synergistically induce COX-2 expression, leading to increased prostaglandin production.

Mediator Class Examples Primary Effects
Lipid Mediators Prostaglandins, Leukotrienes, Lipoxins Vasodilation, increased permeability, chemotaxis, bronchoconstriction, resolution of inflammation
Cytokines TNF-α, IL-1, IL-6, IL-10 Inflammation, fever, acute phase response, immune suppression
Chemokines CXCL8, CCL2, CXCL10 Leukocyte recruitment
Plasma Proteins Complement, CRP, Coagulation Factors Opsonization, chemotaxis, cell lysis, acute phase response

Conclusion

In conclusion, inflammation is a tightly regulated process driven by a complex interplay of chemical mediators. Lipid mediators, cytokines, chemokines, and plasma protein-derived mediators each contribute uniquely to the initiation, amplification, and resolution of inflammation. Understanding the specific roles of these mediators is crucial for developing effective strategies to modulate inflammatory responses in various diseases. Future research focusing on targeted therapies that selectively inhibit or enhance specific mediators holds promise for improving the treatment of inflammatory conditions.

Answer Length

This is a comprehensive model answer for learning purposes and may exceed the word limit. In the exam, always adhere to the prescribed word count.

Additional Resources

Key Definitions

Inflammation
A complex biological response of vascular tissues to harmful stimuli, characterized by redness, heat, swelling, and pain.
Acute Phase Response
A systemic response to inflammation characterized by changes in the concentration of plasma proteins, primarily produced by the liver, such as C-reactive protein (CRP) and serum amyloid A (SAA).

Key Statistics

Chronic inflammatory diseases affect approximately 1 in 3 adults in the United States.

Source: National Institutes of Health (NIH), 2023 (Knowledge Cutoff)

Globally, chronic inflammatory diseases are estimated to be responsible for 50% of all deaths.

Source: World Health Organization (WHO), 2018 (Knowledge Cutoff)

Examples

Rheumatoid Arthritis

In rheumatoid arthritis, TNF-α and IL-1 play a central role in driving chronic inflammation in the joints, leading to cartilage destruction and joint deformity. Anti-TNF therapies are commonly used to treat this condition.

Frequently Asked Questions

What is the difference between acute and chronic inflammation?

Acute inflammation is a short-term response to injury or infection, characterized by rapid onset and resolution. Chronic inflammation is a prolonged response that can last for months or years, often leading to tissue damage and disease.

Topics Covered

ImmunologyPathologyInflammationMediatorsCytokines