00:01
Okay, let's look at the
other end of the spectrum.
00:05
Let's say we can't regenerate.
00:06
Okay, we're starting
at the same point.
00:08
So the green arrow is exactly
at the same point,
as before, when we were
looking at regeneration.
00:13
But in this case,
we have certain conditions
where we cannot get regeneration,
and we're going to make scar.
00:20
So they're going to be a couple
of additional steps in there,
including the formation
of granulation tissue,
that's the neovascularization,
that's angiogenesis.
00:29
And that's going to provide
the provisional matrix
and railroad tracks.
00:34
so we can bring in fibroblasts
that can lay down collagen,
and extracellular matrix
to make a scar.
00:40
Starting at the green arrow.
00:43
So this is scarring.
00:45
It's the other end of the spectrum
from that perfect regeneration.
00:49
This occurs when there
is extensive damage,
when we have lost the blueprint for
putting the tissue back together.
00:56
An abscess would
be a perfect example,
where there's been so much
death and destruction,
that we have lost the blueprint
to put the tissue back together.
01:06
It happens when there are
permanent cells.
01:08
So we talked about
labile cells and stable cells.
01:11
Now permanent cells,
what are those?
Well, those are cells that are
terminally differentiated,
that cannot replicate.
01:18
And these include
cardiomyocytes,
heart muscle cells,
and neurons.
01:23
So permanent cells
when they are killed,
that's it, there is no regeneration.
I can't make more.
01:30
So if I have
permanent cells injured,
all I can do is make a scar.
01:34
And then if I've destroyed the
extracellular matrix scaffolding,
all I can do is make a scar.
01:41
Again, that's because
not only are soluble factors
necessary for regeneration,
but matrix is also important
for regeneration.
01:48
So the sequence of scarring
at about 24 hours,
this is a slice of myocardium.
01:53
And the thin wall on the right
it's a transverse slice,
so the wall on the on the left
is the right ventricle.
02:00
And the big round circle in
kind of on the left hand side
is the left ventricle.
02:06
So we're looking at the wall
and there's clearly been
a large area of injury
but maybe some hemorrhage
going on in the posterior wall.
02:16
That it about 24 hours.
02:18
And if we look down the microscope,
which we will in just a second,
you'd expect to see
lots of neutrophils
and coagulation necrosis.
02:25
Okay.
After about 7 to 10 days,
we are well into the beginning
of the healing process.
02:33
So at seven to 10 days,
we've had a major wave
of macrophages come through,
and we're now into
making new blood vessels.
02:40
So remember, this is a heart tissue
can't regenerate.
02:44
All we can do is make a scar.
02:45
So at seven to 10 days,
we will have induced angiogenesis
in a lot of that previous injury
myocardial infarct.
02:53
And then we'll begin
laying down scar,
which will remodel over
the course of months to years
and see how the wall
got thinner there.
03:02
That's because the
connective tissue is remodeling.
03:05
We don't need the
same thickness of muscle
to maintain an intact
ventricle wall.
03:12
The downside is
that scar doesn't contract.
03:15
So that portion of the wall
is non-contractile, okay.
03:19
But this is the sequence
of scarring.
03:21
Let's look at a microscopically.
03:22
Microscopic sequence.
03:24
So this is viable myocardium.
03:26
You see the nuclei,
everything's looking pretty good.
03:30
Let's infarct it.
03:31
And about 12 to 24 hours,
about one day,
we see a major influx
of neutrophils
and we see
clear cut coagulation necrosis.
03:40
Okay, next slide.
03:42
This is one to two days.
03:43
This is the peak of the
neutrophilic infiltrate.
03:46
All those little blue dots
down there
polymorphonuclear leukocytes,
neutrophils polys,
and they are surrounding,
and invading, and degrading
dead myocytes,
coagulation necrosis.
04:00
That's it one to two days.
04:02
By two to three days,
we are now starting
to recruit in macrophages.
04:08
So we're starting
to now change over
from acute to
chronic inflammation
and we're going to begin
the definitive degradation
of the dead myocytes.
04:17
By seven to 10 days,
we still have a fair amount
of macrophages that are in there,
but the connective tissue knows
much looser.
04:24
There's much more white in there,
and the cellular density
is not quite as great.
04:29
If we looked with
special stains,
we would see that there are
many, many more capillaries.
04:35
So we've already started
the vasculogenesis,
the angiogenesis,
that's going to provide
the kind of railroad tracks
to bring in scar material.
04:45
So this is the peak of
the granulation tissue
that we will talk about.
04:51
And then in that area,
where we've had the infarct
we'd now lay down collagen,
other extracellular matrix
components,
and over the course
of weeks to months,
it looks like this.
05:04
It's just a dense scar.
05:05
So that's the sequence
for the final scarring process.
05:11
So here's where we are
at the beginning of this
granulation tissue,
and then scar regeneration.
05:18
And they are all
happening concurrently,
even as we are peaking
with chronic inflammation.
05:23
So again, we're gonna start
where the green arrow is.
05:27
A topic for the next
exciting passage
as we move from
acute to chronic inflammation
and healing.