Receptor-mediated inflammatory process

Chronic dry eye is the result of an underlying cytokine and receptor-mediated inflammatory process that affects the ocular surface and lacrimal gland, leading to decreased tear production or altered tear film contents. Hormonal, anti-inflammatory, or immunomodulatory agents may be able to suppress the inflammation and normalize the neural reflex between the ocular smrfece and lacrimal glands. 

Glucocorticoids have been shown to inhibit gene transcription of other proteins involved in the inflammatory process, including the key inflammation mediators called cytokines (IL-1, IL3—6, IL8, GM-CSF, TNFa) (10,58,63—65). Steroids have been also shown to suppress the formation of cytokine receptors (10) dexamethasone, in particular, downregulates gene transcription of angiotensin II type 2 receptors (66). 

Cytokines are small, short-lived proteins and important mediators of local intercellular communication. They play a key role in integrating responses to a variety of stimuli in immune and inflammatory processes. By binding their cognate receptors on target cells in their immediate vicinity, these molecules participate in many important biological activities including cell proliferation, activation, death and differentiation. In... 

Fig. 14.1. The Thl/Th2 balance is central to the regulation of normal wound repair. Tissue injury results in the initiation of an inflammatory response, mediated by a variety of cells and their by-products. Immune cells are recruited and cross-regulate the Thl/ Th2 balance that occurs in response to the cytokine environment. This balance is in turn cross-regulated by the chemokine/chemokine-receptor expression profile, which functions to amplify the inflammatory process. Cells residing in the injured tissue release profibrotic mediators, which promote fibroblast activation, proliferation, and differentiation to the myofibroblast phenotype. Myofibroblasts produce collagen to repair damaged tissue, which is an event that is favored by the inhibition of MMP activity. The Thl/Th2 balance is central to whether a normal or aberrant wound-repair process is established A Thl environment promotes normal tissue resolution (fibrinolysis), whereas a Th2 environment maintains the progression of fibrotic disease (excessive collagen deposition).

Nearly all cells express kinin receptors that mediate the activities of both bradykinin and kallidin. The activation of these G-protein coupled receptors causes relaxation of venular smooth muscle and hypotension, increased vascular permeability, contraction of smooth muscle of the gut and airway leading to increased airway resistance, stimulation of sensory neurons, alteration of ion secretion of epithelial cells, production of nitric oxide, release of cytokines from leukocytes, and the production of eicosanoids from various cell types [11,12]. Because of this broad spectrum of activity, kinins have been implicated as an important mediator in many pathophysiologies including pain, sepsis, asthma, rheumatoid arthritis, pancreatitis, and a wide variety of other inflammatory diseases. Moreover, a recent report demonstrated that bradykinin B2 receptors on the surface of human fibroblasts were upregulated three-fold beyond normal in patients with Alzheimer s disease, implicating bradykinin as a participant in the peripheral inflammatory processes associated with that disease [13]. 

Expression of peripheral opioid receptors and peptides seems to be triggered by immunological and inflammatory processes, and it is speculated that these opioid receptors represent a second peripheral pain inhibitory system. This has triggered an intensive search for peripherally-acting k-agonists, which are devoid of the centrally-mediated psychogenic side-effects and which are believed to be attractive new compounds for the treatment of traumatic, inflammatory and burn-induced pain. 

The more we learn about the function of sensory neurons and their receptors and signaling mechanisms, the more it becomes clear that sensory neurons are not only passive mediators of painful or inflammatory signals. Recently it has been shown that sensory neurons play an active role in the inflammatory process in... 

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