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Cell injury. By Dr. Abdelaty Shawky Dr. Gehan Mohamed. Learning objectives: . Understand the definition of cell injury. Outline Mechanisms of Cell Injury Recognize the variability in Cellular response to injury which include : - Cellular adaptation

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cell injury

Cell injury


Dr. AbdelatyShawky Dr. Gehan Mohamed

learning objectives

Learning objectives:

Understand the definition of cell injury.

Outline Mechanisms of Cell Injury

Recognize the variability in Cellular response to injury which include :

- Cellular adaptation

- Reversible cell injury ( nonlethal hit)

- Irreversible injury and cell death (apoptosis, necrosis ).

-Identify the differences between apoptosis and necrosis.

- Recognize the different types of necrosis.


Cells are constantly exposed to a variety of stresses.

  • At first cells try to adapt themselves to overcome this stressful condition, butWhen stress is too severe or for prolonged duration, injuryresults.
  • Injury of the cell may be;
  • 1. Reversible: if the affected cells recover from the injury.
  • 2. irreversible: injury: cell may die
causes of cellular injury
* Causes of cellular injury:
  • Hypoxia:inadequate oxygenation of tissues
  • Physical agents: mechanical trauma, burns, frostbite, sudden changes in pressure, radiations, electric shock
  • Chemical agents: poisons (toxins), insecticides, CO, asbestos, alcohol, tobacco, glucose, salt, oxygen
  • Infectious agents: prions, viruses, rickettsiae, bacteria, fungi, parasites
  • Immunologic reactions: anaphylaxis, autoimmune disease.
  • Nutritional imbalances: protein calorie deficiency, vitamin deficiencies, excess food intake (obesity, atherosclerosis)
  • Genetic derangements: congenital malformations, abnormal proteins (hemoglobinopathies), abnormal or absent enzymes (storage disorders).

- The cellular response to injurious stimuli depends on :

1. Type, duration and severity of injurious agent.

2. The type, status, adaptability, and genetic makeup of the injured cell.


The precise moment of transition from reversible

injury to irreversible injury is known as the





Cell death

Point of no return

Etiologic agent


The relationships between

normal, adapted, reversibly injured, and dead myocardial cells


a. Hyperplasia: increase in cell number. e.g. benign prostatic hyperplasia.b. Hypertrophy: increase in cell size. Hypertrophied uterine muscle in pregnancy.c. Atrophy: decrease in cell mass e.g. atrophy of the breast after menopause.d. Metaplasia: change of type of cell to another e.g. squamous metaplasia of urinary bladder epithelium in response to bilharziasis.

mechanisms of reversible cell injury
* Mechanisms of reversible cell injury:

1- Decrease ATP production: soPlasma membrane energy-dependent sodium pump is reduced, resulting in cell swelling.

2. Cell membrane damage: leading to Loss of structural integrity and Loss of function.

3. Mitochondrial damage: leading to inadequate aerobic respiration.

4. Ribosomal damage: leading to altered protein synthesis.

5. Nuclear change: leading to abnormal proliferation.


6. increase intra cellular calcium.

7. Production of oxygen derived free radicals.


* Examples of cell injury:

  • Hypoxic cell injury
  • Ischemia- reperfusion injury
  • Chemical injury

- Most common cause of cell injury.

* Definition:inadequate oxygenation of tissue.

* Causes:

  • Ischemia: decreased arterial blood flow to tissues.
    • Most common cause of hypoxia.
    • Ex: Atherosclerosis (lesion in intima = atheroma) in coronary arteries.
  • Hypoxemia: decrease in the amount of oxygen dissolved in plasma. Seen in: Atelectasis, pulmonary embolus and interstitial fibrosis of lung.
  • Hemoglobinrelatedabnormalities
    • Anemia
    • Carbon monoxide poisoning (CO has high affinity for hemoglobin).
consequences of tissue hypoxia
* Consequences of tissue hypoxia:
  • Decreased synthesis of ATP by oxidative phosphorylation causing ATP depletion.
  • This leads to;
  • Impaired Na+/K+-ATPase pump
    • Diffusion of Na+ and water into cells  cellular swelling.

2. Shifting to anaerobic glycolysis: leads to;

      • Depletion of glycogen stores.
      • Accumulation of lactic acid.
      • Decrease in intracellular pH  denaturation of proteins  decreased activity of many enzymes  clumping of nuclear chromatin.

3. Decreased protein synthesis:

- Due to detachment of ribosomes from the rough endoplasmic reticulum.

-↓protein synthesis.

    • Reflected as accumulation of lipid in the cell = fatty change.
    • Since you’re not synthesizing proteins, you’re not synthesizing apolipoproteins (lipid carriers) either!
  • ↓ protein synthesis  ↓ synthesis of apolipoproteins (lipid carriers in blood)  accumulation of lipid in the cell.

4. Impaired calcium ATPase pump:

    • Increased cytosolic calcium.

↓ oxidative phosphorylation


↓↓ ATP


 Na pump

Ribosomal Detachment

Influx of Na, H2O

& Ca2+

Efflux of K

 Glycogen

 Lactic acid

 Protein


 pH

Cell Swelling

Nuclear chromatin


morphology of reversible cell injury
* Morphology of reversible cell Injury:
  • Cell Swelling:
    • First manifestation of cell injury.
    • Occurs when cells fail to maintain ionic and fluid homeostasis.
    • Manifests as small clear vacuoles.
    • Also known as hydropic change or vacuolar degeneration.
  • Fatty change:
    • Manifested by appearance of lipid vacuoles in the cytoplasm.
    • Seen in kidney, heart and liver.

Normal cell

Normal cell

Injury (hypoxia)


Cell swelling,

Swelling of

ER and


Reversible injury



cell swelling light microscopy
Cell swelling - Light Microscopy

Cellular Swelling

= hydropic change

Normal epithelium


Normal liver histology

Hepatocytes showing fatty change


Normal cell