1. Altered Cells and Tissues
Cellular Adaptation and Response to Stress
Cellular Injury and Death

2. Cellular Adaptation and Response to Stress
When cells are challenged with damaging stressors like changes in:
Oxygenation
Temperature
Molecular toxins
Electrolytes
Adaptation or Death

3. Stages of the cellular response to stress and injurious stimuli.
Cellular Responses to Stress and Toxic Insults: Adaptation, Injury, and Death
Perkins, James A., MS, MFA, Robbins and Cotran Pathologic Basis of Disease, Chapter 1, 3-42
Copyright © Copyright © 2010 by Saunders, an imprint of Elsevier Inc.

4. Adaptive cell changes (Size, Number, and Structure)
Atrophy
Hypertrophy
Hyperplasia
Metaplasia
Dysplasia

5. Atrophy Decrease in size of a cell or tissue.
Decreased size results in decreased oxygen consumption and metabolic needs of the cells
may increase the overall efficiency of cell function.

6. Atrophy is generally a reversible process, except for atrophy caused by loss of nervous innervation to a tissue.

7. Causes of atrophy include
(1) disuse,
(2) denervation, e.g in paralyzed limbs
(3) loss of endocrine stimulation, e.g. estrogen stimulation during menopause
(4) inadequate nutrition, and
(5) ischemia: decrease in blood flow

8. Hypertrophy Increase in cell size and tissue mass.
Occurs when a cell or tissue is exposed to an increased workload.
Occurs in tissues that cannot increase cell number as an adaptive response.

9. Hypertrophy may be a normal physiologic response, such as the increase in muscle mass that is seen with exercise,
or it may be pathologic as in the case of the cardiac hypertrophy that is seen with prolonged hypertension

10. The relationship between normal, adapted, reversibly injured, and dead myocardial cells. The cellular adaptation is myocardial hypertrophy (lower left) , caused by increased blood flow requiring greater mechanical effort by myocardial cells. This adaptation leads to thickening of the left ventricular wall to over 2 cm (normal, 1–1.5 cm). In reversibly injured myocardium (illustrated schematically, right ) there are generally only functional effects, without any readily apparent gross or even microscopic changes. In the specimen showing necrosis, a form of cell death (lower right) , the light area in the posterolateral left ventricle represents an acute myocardial infarction caused by reduced blood flow (ischemia). All three transverse sections of the heart have been stained with triphenyltetrazolium chloride, an enzyme substrate that colors viable myocardium magenta. Failure to stain is due to enzyme loss following cell death.
Cellular Responses to Stress and Toxic Insults: Adaptation, Injury, and Death
Perkins, James A., MS, MFA, Robbins and Cotran Pathologic Basis of Disease, Chapter 1, 3-42
Copyright © Copyright © 2010 by Saunders, an imprint of Elsevier Inc.

12. Hypertrophy may also be a compensatory process
Hypertrophy may also be a compensatory process. When one kidney is removed, for example, the remaining kidney hypertrophies to increase its functional capacity.

13. Hyperplasia Increase in the number of cells in an organ or tissue.
Can only occur in cells capable of mitosis (therefore, not Cardiac muscle or nerve cells).

14. Hyperplasia may be a normal process, as in the breast and uterine hyperplasia that occurs during pregnancy,
or pathologic such as the gingival hyperplasia (overgrowth of gum tissues) that may be seen in certain patients receiving the drug phenytoin.

15. hyperplasia may also be a compensatory mechanism.
For example, when a portion of the liver is surgically removed, the remaining hepatocytes (liver cells) increase in number to preserve the functional capacity of the liver.

16. Although hypertrophy and hyperplasia are two distinct processes, they may occur together and are often triggered by the same mechanism.

17. Metaplasia
The conversion of one cell type to another cell type that might have a better chance of survival under certain circumstances.
Metaplasia usually occurs in response to chronic irritation or inflammation.

18. An example of metaplasia occurs in the respiratory passages of chronic cigarette smokers. Following years of exposure to irritating cigarette smoke, the ciliated columnar epithelium lining the respiratory passages gradually converts to stratified squamous epithelium.

19. Metaplasia of columnar to squamous epithelium. A , Schematic diagram
Metaplasia of columnar to squamous epithelium. A , Schematic diagram. B , Metaplasia of columnar epithelium (left) to squamous epithelium (right) in a bronchus.
Cellular Responses to Stress and Toxic Insults: Adaptation, Injury, and Death
Perkins, James A., MS, MFA, Robbins and Cotran Pathologic Basis of Disease, Chapter 1, 3-42
Copyright © Copyright © 2010 by Saunders, an imprint of Elsevier Inc.

20. Dysplasia
A derangement of cell growth that leads to tissues with cells of varying size, shape and appearance.
Generally occurs in response to chronic irritation and inflammation.
Dysplasia may be a strong precursor to cancer in certain instances such as in the cervix or respiratory tract

22. Cellular injury
Cellular injury can occur in a number of different ways. The extent of injury that cells experience is often related to the intensity and duration of exposure to the injurious event or substance.
Cellular injury may be a reversible process, in which case the cells can recover their normal function, or it may be irreversible and lead to cell death.

23. Although the causes of cellular injury are many (see Table 1
Although the causes of cellular injury are many (see Table 1.1 in the book), the underlying mechanisms of cellular injury usually fall into one of two categories:
1- free radical injury
2- hypoxic injury.

24. Table 1.1 Classification of Cellular Injury
Physical injury
Mechanical trauma
Temperature extremes (burn injury, frostbite)
Electrical current
Chemical injury
Chemicals, toxins, heavy metals, solvents, smoke,
pollutants, drugs, gases
Radiation injury
Ionizing radiation — gamma rays, X rays
Non-ionizing radiation — microwaves, infrared, laser
Biologic agents
Bacteria, viruses, parasites
Nutritional injury
Malnutrition
Obesity

25. Free radical injury
Free radicals are highly reactive chemical species that have one or more unpaired electrons in their outer shell.
Examples of free radicals include superoxide
(O 2 ), hydroxyl radicals (OH  ) and hydrogen peroxide(H2O2).

26. Free radicals are generated as by-products of normal cell metabolism and are inactivated by free radical–scavenging enzymes within the body such as catalase and glutathione peroxidase.
When excess free radicals are formed from exogenous sources or the free radical protective mechanisms fail, injury to cells can occur.

27. Free radicals are highly reactive and can injure cells through:
1. Peroxidation of membrane lipids
2. Damage of cellular proteins
3. Mutation of cellular DNA
Exogenous sources of free radicals include tobacco smoke, organic solvents, pollutants, radiation and pesticides.

29. Free radical injury has been implicated as playing a key role in the normal aging process as well as in a number of disease states such as diabetes mellitus, cancer, atheroscelrosis, Alzheimer’s disease and rheumatoid arthritis.

30. Hypoxic cell injury
Hypoxia is a lack of oxygen in cells and tissues that generally results from ischemia.
During periods of hypoxia, aerobic metabolism of the cells begins to fail.
This loss of aerobic metabolism leads to dramatic decreases in energy production (ATP) within the cells.

31. The cellular injury process may be reversible, if oxygen is quickly restored, or irreversible and lead to cell death.
Certain tissues such as the brain are particularly sensitive to hypoxic injury. Death of brain tissues can occur only 4 to 6 minutes after hypoxia begins.

32. Cell death Cell death falls into two main categories: 1- apoptosis
2- necrosis.

33. Apoptosis
A controlled, “preprogrammed” cell death that occurs with aging of cells.
Apoptosis may be a mechanism to eliminate worn-out or genetically damaged cells.
Apoptosis involves the activation of certain “suicide genes,” which in response to certain chemical signals activate and lead to cell lysis and destruction.
It has been theorized that cancer may arise as a failure of normal apoptosis in damaged or mutated cells.

34. Necrotic cell death
unregulated, enzymatic digestion (“autolysis”) of a cell and its components.
Occurs as a result of irreversible cellular injury.
Local inflammation and death of cells
Damage to mitochondria
Triggers WBCs
Swelling of cells
Depletion of ATP
Spilling of cell contents

37. Quiz
The underlying mechanisms of cellular injury usually fall into one of two categories: 1- 2-
Atrophy is
Hyperplasia is
Apoptosis is