The document discusses cellular adaptation and injury, outlining the processes of atrophy, hypertrophy, hyperplasia, and metaplasia as responses to physiological and pathological conditions. It details the causes and effects of cell injury, including reversible changes and irreversible cell death via apoptosis and necrosis, while also addressing mechanisms such as ATP depletion and oxidative stress. Additionally, the document explores intracellular accumulations and the implications of chronic exposures leading to alterations in cellular function and structure.
Introduction to cellular adaptation. Adaptation types: atrophy, hypertrophy, hyperplasia, metaplasia.
Explains apoptosis and necrosis as forms of cell injury. Describes fluid accumulation (hydropic change) and its implications.
Explains apoptosis and necrosis as forms of cell injury. Describes fluid accumulation (hydropic change) and its implications. Various causes of cell injury, including hypoxia, chemicals, and physical agents. Differentiates reversible vs. irreversible injury.
Morphological changes in cell injury, focusing on atrophy, hypertrophy, hyperplasia, and their physiological and pathological types.
Morphological changes in cell injury, focusing on atrophy, hypertrophy, hyperplasia, and their physiological and pathological types.
Describes factors leading to atrophy and preventive measures such as diet and exercise.
Discusses physiological, pathological, and compensatory hypertrophy with examples.
Definition and mechanism of hyperplasia, with physiological and pathological examples like endometrial hyperplasia.
Explains types and mechanisms of metaplasia, discusses dysplasia as a pre-cancerous condition.
Details on cellular accumulations, free radicals, oxidative stress, and their pathological implications.
Details on cellular accumulations, free radicals, oxidative stress, and their pathological implications.
Clarifies differences between apoptosis and necrosis, signaling and regulation pathways of cell death.
Discusses intracellular accumulations with examples like fatty change, exogenous pigments, and pathological calcification.
Cellular adaptation
• Cellsare the structural and functional units of tissues and
organs. They are capable of adjusting their structure and
functions in response to various physiological and
pathological conditions. This capability is called cellular
adaptation.
• Cellular adaptations include:
– Atrophy--shrinkage of cells
– Hypertrophy--increase in the size of cells which results in
enlargement of the organs
– Hyperplasia--increased number of cells in an organ or
tissue
– Metaplasia--transformation or replacement of one adult
cell type with another
3.
The Cell andthe Environment
StimuliStimuli [[Causes of Cell Injury]
Cell
AdaptationAdaptation
Cell Injury
Reversible
Irreversible (cell death)
apoptosis necrosis
Cell injury
• Ifthe cells fail to adapt under stress, they
undergo certain changes called cell
injury. The affected cells may recover
from the injury (reversible) or may die
(irreversible).
8.
Causes of CellInjury
1.1. Hypoxia:Hypoxia: (Oxygen deficiency) Mainly due to:
ischemia (impaired blood supply) most commonmost common
inadequate oxygenation of blood (cardio-respiratory failure)
loss of oxygen carrying capacity (anaemia)
Carbon monoxide poisoning
1.1. Physical AgentsPhysical Agents
Trauma, radiation, extremes of temperatures, electric shock
1.1. Chemicals and DrugsChemicals and Drugs
Wide variety
1. Microbiologic Agents
Viruses, worms, bacteria …..
1. Immunologic Reactions
Allergic reactions, autoimmune diseases
1. Genetic Defects
Obvious congenital malformations (Down syndrome)
Subtle single amino acid substitution (hemoglobin S of sickle cell anemia)
1. Nutritional Imbalances
Deficiency of nutrients/ or excess
1. Aging
9.
Morphology of cellinjury
• Reversible:
– Cellular swelling and vacuole formation (Hydropic
changes)
– Changes at this stage are better appreciated by
EM that may show blebbing of the plasma
membrane, swelling of mitochondria and
dilatation of ER
– Fatty changes
10.
Hydropic change isone
of the early signs of
cellular degeneration in
response to injury.
refers to the
accumulation of water in
the cell. This is clearly
seen in this slide.
The accumulation of
water in the tubular cells
is usually due to hypoxia
of the tissue with a
resultant decrease in
aerobic respiration in the
mitochondria and a
decreased production
ATP.
Hydropic Change
11.
Fatty changes
• Thisliver is slightly enlarged
and has a pale yellow
appearance, seen both on
the capsule and cut surface.
This uniform change is
consistent with fatty
metamorphosis (fatty
change).
12.
Morphology of cellinjury
• Irreversible/Necrosis
– The changes are produced by enzymatic digestion of dead
cellular elements, denatunation of proteins and autolysis
(by lysosomal enzymes)
– Cytoplasm - increased eosinophilia
– Nucleus - nonspecific breakdown of DNA leading to
• pyknosis (shrinkage),
• karyolysis (fading) and
• karyorrhexis (fragmentation
14.
The Cell andthe Environment
StimuliStimuli [Causes of Cell Injury]
Cell
AdaptationAdaptation
Achieving a new steady state and preserving viability
15.
IMPORTANT TARGETS OFCELL INJURY
• Aerobic respiration –
– ATP depletion or decreased synthesis.
• Cell membranes - plasma membranes,
mitochondrial, lysosomal and other organelle
membranes.
• Protein synthesis.
• Cytoskeleton.
• Genetic apparatus.
16.
ADAPTATION
1. Atrophy:
decrease insize or number of cells leading
to reduction in tissue mass
2. Hypertrophy:
increase in size of cells leading to increase
in size of organ
1. Hyperplasia:
increase in number of cells leading to
increase size of organ
2. Metaplasia:
Is the replacement of one type of cells by
another
17.
ADAPTATION
Atrophy: causes
Decreased workload
Loss of innervation
Diminished blood supply
Inadequate nutrition
Loss of endocrine stimulation
Aging
1.Atrophy of thymusgland
2.thyroglossal duct after birth
3.atrophy of ovaries & uterus after menopause
4.Atrophy of uterus following child birth
PHYSIOLOGICAL
TYPES OF ATROPHY
4.Pressure atrophy: dueto long continued pressure on a
tissue leading to decrease in its blood supply with atrophy of
its cells e.g. amyloidosis of the liver
6.Decreased work load: e.g. immobilized limb
5.Ischemic atrophy:
due to decrease of blood supply
e.g. atherosclerosis
24.
How To AvoidAtrophy?
1.eating a healthy diet
2.getting regular, moderate exercise
3.avoiding smoking or quitting
4.Do not stay in one position for too long
25.
ADAPTATION
Hypertrophy:
increase insize of cells leading to increase in size of organ
Increased functional demand
skeletal muscle in exercise
myocardium in hypertension
Specific hormonal stimulation
uterus in pregnancy
TYPES
• Physiological Hypertrophy
Increasein size due to increased work load or
exercise. The common examples includes:
I- Muscular hypertrophy: increase in bulk of
skeletal muscles that occurs in response to
strength training exercise
II- Ventricular hypertrophy: Increase in size of
ventricular muscles of the heart-good if it
occurs in response to exercise
28.
Continued….
• Pathological Hypertrophy
Increasein cell size in
response to pathological
changes
Example: Ventricular
hypertrophy that occurs
due to pathological
conditions such as high
blood pressure where the
work load of ventricles
increases
29.
Continued…
• Compensatory Hypertrophy
Increasein size of cell of an organ that occurs
in order to compensate the loss or
dysfunction of another organ of same type
Examples: Hypertrophy of one kidney when
the other kidney stops functioning
Increase in muscular strength of an arm when
other arm is lost or dysfunction
31.
ADAPTATION
Hyperplasia:
increase innumber of cells leading to increase size of
organ
Physiologic
Hormonal (breast during pregnancy)
Compensatory (partial hepatectomy)
Pathologic
Excessive hormonal / growth factor
absolute or relative increase in estrogen over
progesterone--endometrial hyperplasia
Benign Prosthetic hyperplasia (androgens)
32.
Hyperplasia: Mechanism
• Cellproliferation
• via increased production of TRANSCRIPTION
FACTORS due to
* Increased production of GF
* Increased levels of GF receptors
* Activation of intracellular signaling
• Results in larger organ
ADAPTATION
Metaplasia:
• Isthe replacement of one type of cells by another
TYPES:
Physiological metaplasia: Replacement of cells in normal conditions
Examples: transformation of cartilage into bones and transformation of
monocytes into macrophages
Pathological Metaplasia: Irrevesible replacement of cells due to constant
exposure to harmful stimului
Example: Chronic smoking results in transformation of normal mucus
secreting ciliated columnar epithilial cells into non mucus secreting
non ciliated squamous epithilial cells which become cancerous cells if
stimulus (smoking) is prolonged Squamous Metaplasia
Intestinal Metaplasia
Lower esophageal epithelium
chronic gastric reflux
37.
Metaplasia: Mechanism
• Reprogramming
1.of stem cells present in normal tissues
2. of undifferentiated mesenchymal cells in
connective tissue
• Mediated by signals from
cytokines, Growth Factor Leading to induction of
specific transcription factors
38.
Photomicrograph of thetrachea from a smoker. Note that the
columnar ciliated epithelium has been replaced by squamous
epithelium.
Dysplasia
Cellular dysplasia refersto an alteration(abnormality) in the size,
shape and organization of the cellular components of a tissue.
It is established that dysplasia is a preneoplastic lesion, in the
sence that, it is a necessary stage in the multi-step cellular
evolution to cancer.
Depletion of ATP
•Usually in hypoxic and chemical injuries.
• Sources : oxidative phosphorylation of ADP in
the mitochondria and Glycolytic pathway
using Glucose.
• The major causes of ATP depletion are
reduced supply of oxygen and nutrients,
mitochondrial damage and the actions of
some toxins (Cyanide).
49.
ATP depletion continued….
•Tissues with a greater glycolytic capacity
(liver) are more able to survive loss of oxygen
and decreased oxidative phosphorylation
better than are tissues with limited capacity
for glycolysis (brain).
• Low oxygen situation results in misfolding of
proteins which trigger a cellular response
called the unfolded protein response that may
lead to cell death (Activation of apoptosis).
50.
Mitochondrial damage
• SuppliesATP (energy) to the cell.
• Damaged by Calcium influx, reactive oxygen species,
radiation, oxygen deprivation, toxins and mutations in
mitochondrial genes.
• Consequences of mitochondrial damage: Formation of
mitochondrial permeability transition pore which leads to loss
of membrane potential, failure of phosphorylation and ATP
depletion and then necrosis.
• Release of cytochrome c into the cytosol that activate
apoptosis (death).
Failure of oxidative phosphorylation leads to
ATP depletion and formation of reactive
oxygen species(ROS).
52.
• Depleting extracellularCa protects the cell from injury and
delays it.
• Cytosolic Ca concentration is very low and is present
intracellularly in mitochondria and ER.
• Injury will lead to increase cytosolic Ca.
• Consequences of Ca increase: opening of mitochondrial
permeability transition pore, and activation of a number of
enzymes (phospholipases, proteases, endonucleases &
ATPases)
• Induction of apoptosis by direct activation of caspases and
increasing mitochondrial permeability
Influx of calcium and loss of calcium
homeostasis
54.
• It isimportant in chemical and radiation
injuries, ischemia-reperfusion injury, cellular
aging and microbial killing by phagocytosis.
• Free radicals: chemical species that have a
single unpaired electron in the outer orbital.
• Unstable atoms, react with inorganic and
organic chemicals (proteins, lipids, carbohyd.)
• Initiate autocatalytic reactions..... Creation of
more radicals (propagation).
Accumulation of oxygen derived free
radicals
56.
• One ofthe oxygen derived free radicals.
• Produced normally in small amounts and
removed by defence mechanisms.
• Once the ROS amount increases this will lead
to what so called oxidative stress.
• Oxidative stress : cell injury, cancer, aging and
some degenerative diseases like Alzheimer.
Also ROS are produced by leukocytes and
macrophages in inflammation.
Reactive oxygen species (ROS)
57.
• Decay spontaneously.
•Antioxidants: Vitamin E and A, ascorbic acid
and glutathione in the cytosol.
• Binding proteins.
• Enzymes: Catalase-----H2O2 ----- O2 and H2O,
Superoxide dismutase-(SOD)----- superoxide
anion ----H2O2, Glutathione peroxidase----
H2O2 ---H2O or OH------ H2O. Reduced
Glutathione level is important in cell safety.
Removal of free radicals
58.
Pathological applications offree radicals
• Lipid peroxidation in membranes. Oxidative damage
of the double bonds in the polyunsaturated fatty
acids resulting in formation of peroxides which are
unstable and lead to membrane damage.
• Oxidative modification of proteins. Damage the
active sites on enzymes, change the structures of
proteins and enhance proteosomal degradation of
unfolded proteins.
• Lesions in DNA. Single and double strand breaks in
DNA. Oxidative DNA damage has been implicated in
cell aging and in malignant transformation of cells.
• Radicals are involved in both necrosis and apoptosis.
Patterns of AcuteCell Injury
• Apoptosis (a falling away from)
Apoptosis is programmed cell death.
It is a pathway of cell death that is induced by a tightly
regulated intracellular program in which cells
destined to die activate their own enzymes to
degrade their own nuclear DNA, nuclear proteins and
cytoplasmic proteins.
The cell's plasma membrane remains intact, but its
structure is altered in such a way that the apoptotic
cell sends signal to macrophages to phagocytose it.
Regulation of apoptosis
•It is mediated by a number of genes and their
products :
• - bcl-2 gene inhibits apoptosis
• - bax genes facilitates apoptosis
• - p53 facilitates apoptosis by inhibiting bcl2
and promoting bax genes.
64.
Two types ofcell death
Necrosis
• Large No. of cells
• Invariably (always ) pathologic
• Disrupted Plasma membrane
• Inflammation
Apoptosis
• Single cells or small clusters
• Often physiologic; may be pathologic
• Intact Plasma membrane
• No inflammation ,
• phagocytes to eleminate it
Intracellular Accumulations
– Endogenous
•normal substance produced at normal or increased
rate/rate of metabolism inadequate for removal (fatty
liver)
• normal or abnormal substance cannot be metabolized
(storage diseases)
– Exogenous
– cell cannot degrade substance (carbon)
68.
Intracellular Accumulations
• FattyChange (Steatosis)
• Any abnormal accumulation of triglycerides within parenchymal cells.
• It is most often seen in the liver, since this is the major organ involved in fat
metabolism, but it may also occur in heart, skeletal muscle, kidney, and other
organs.
• Alcohol abuse and diabetes associated with obesity are the most common causes
of fatty change in the liver (fatty liver) in industrialized nations.
Intracellular Accumulations
• ExogenousPigments
– Carbon (anthracosis)
• When inhaled, it is phagocytosed by alveolar
macrophages and transported by lymphatics to lymph
nodes
• mild accumulations usually are of no consequence--
heavy accumulations may induce a fibroblastic
response
73.
Intracellular Accumulations
• EndogenousPigments
– Lipofuscin (“wear and tear pigment)
• insoluble brownish-yellow granular intracellular
material that accumulates in a variety of tissues
(particularly the heart, liver, and brain) as a function of
age or atrophy.
• It is not injurious to the cell but is important as a
marker of past free-radical injury.
74.
Intracellular Accumulations
• EndogenousPigments
– Melanin
• brown-black pigment produced in melanocytes
• It is synthesized exclusively by melanocytes located in
the epidermis and acts as a screen against harmful
ultraviolet radiation
75.
Intracellular Accumulations
• EndogenousPigments
– Hemosiderin
• iron containing golden-yellow pigmen
• Local or systemic
• Local excesses of iron and hemosiderin result from hemorrhages
or vascular congestion, eg hemosiderosis is the common bruise.
With lysis of the erythrocytes, the hemoglobin eventually
undergoes transformation to hemosiderin.
76.
hemosiderin
• hemosiderosis
• systemicoverload of iron, hemosiderin is deposited in many organs and tissues [ liver, bone
marrow, spleen, and lymph nodes
• occurs in
1. increased absorption of dietary iron,
2. impaired utilization of iron,
3. hemolytic anemias,
4. transfusions
• hemochromatosis
• hereditary more extensive accumulations of iron with tissue injury including liver fibrosis,
heart failure, and diabetes mellitus.
77.
PATHOLOGIC CALCIFICATION
• dystrophiccalcification
• deposition occurs in dead or dying tissues,
• normal serum levels of calcium.
• metastatic calcification
• deposition in normal tissues
• almost always reflects some derangement in calcium
metabolism (hypercalcemia).