AIMS AND LEARNING OUTCOMES

The General Pathology course aims:
- to provide the knowledge about the etiology and the pathogenesis of human diseases, the physical and chemical causes of disease, the mechanisms of cell injury and cell death, the neoplastic transformation, and the defense responses to injury:
- to provide an overall comprehension of the mechanisms at the base of inflammation and tissue repair;
- to develop an adequate knowledge about the immunological mechanisms involved in the immune response against infectious agents and tumors  and in diseases involved in immune system alterations.

At the end of the course the student will be able:
- to classify the different causes of disease; 
- to recognize the adaptation responses to cell injury; 
- to recognize the morphological and biochemical modifications associated with cell death; 
- to apply the acquired knowledge on the immune response to explain  defense mechanisms against damaging agents; 
- to acquire a correct terminology for the proper presentation of the processes examined.

TEACHING METHODS

The course is organized in frontal lessons and deals with various topics of general pathology, immunology, and immunopathology. These topics are explained by the teachers through Poweroint presentations that are shared with the students. The teachers always recommend the use of a textbook to expand the overall view of the subject.

The frontal lessons could be carried out remotely in online mode using the Teams platform and recorded by the teacher.

SYLLABUS/CONTENT

INTRODUCTION

Fields of interest of General Pathology. Concept of homeostasis. Differences between disease, pathological state, process and phenomenon. Definition of metaplasia and anaplasia.

GENERAL AETIOLOGY

Intrinsic and extrinsic causes of disease.

Intrinsic causes: genetic and chromosomal disorders. Congenital malformations. Aplasia, agenesis and hypoplasia. Embryopathies and fetopathies.

Physical extrinsic causes. Radiations: definition, classification (corpuscolar and electromagnetic). Non-ionizing and ionizing radiations. Ionizing radiations: direct and indirect effects. Action on cells and tissues. Total body irradiation. Carcinogenesis, mutagenesis and teratogenesis by ionizing radiations. Non-ionizing radiations: direct and indirect effects. Acute and chronic action on the skin.

Mechanical causes. Trauma of superficial tissues and internal organs, osteoarticular trauma. Regeneration and repair. Healing by first or secondary intention. Healing of skin wounds.

Thermal causes. Thermal balance. Burns and frostbite. Heat stroke.

Extrinsic chemical causes. Mode of action of pathogenic chemicals. Alteration of the pH: local action of acids and bases. Solvent action. Denaturing action. Toxic action. Definition of concentration at active site, dose, distribution volume, time and route of administration. Classification of venoms  based on their origin. Inherent and acquired defence mechanisms against venoms. General defences. Enzymatic defences: phase I and II enzymes; concepts of isoform, genetic polymorphism, inducibility by substrate. Acquired defences: addiction, antibody production.

CANCER

Definition of neoplasia: concepts of autonomy, afinalism, progression. Morphological atypies: tissue, cellular, and subcellular atypies (atypies concerning/of intermitotic nucleus and of mytosis, of the plasmamembrane, of mytochondria, of ribosomes).

Biochemical atypies. Atypies of the glucidic metabolism (Warburg effect), of the lipidic metabolism, of the azotate metabolism (quantitative and qualitative alterations of protein synthesis). Behaviour atypies; loss af adherence, loss of contact inhbition, acquisition of motility and invasive properties. Metastasis: definition, metastasis routes, concept of organotropism. 

Molecular basis of cancer: oncogenes and their activation. Alterations of tumor suppressors. Retinoblastoma.

Etiology of cancer. Initiation and promotion. Inheritance and familiar predisposition. Carcinogenic physical factors. Carcinogenic chemical factors: carcinogen classes. Viral carcinogenesis. Oncogenic retrovirus (rapid and slow); example of oncogenic RNA virus in human beings : HTLV. Oncogenic DNA viruses and concept of transforming proteins; examples of oncogenic DNA viruses in human beings: EBV, HPV, HBV. Relationships between diet and tumors and between hormones and tumors.

CELLULAR PATHOLOGY

Cellular adaptations (hypertrophy, hyperplasia, atrophy). Cell injury and cell death: necrosis and apoptosis.

INFLAMMATION

Acute inflammation. Chemical mediators of inflammation. Inflammatory cytokines. Systemic effects of inflammation. Acute phase proteins. Classification and outcome of acute inflammation. Chronic inflammation. Granulomas.

IMMUNOLOGY

The immune system: general characteristics of the innate and acquired immune response.

Cells and organs of the immune system. Innate immune response.

Humoral and cell-mediated immune response. Antigen recognition by B and T cells.

Humoral immune response: B cell activation and effector mechanisms. Structure and function of antibodies. The complement system.

Cell-mediated immune response: Major Histocompatibility Complex (MHC). Antigen processing and presentation. T cell activation and effector mechanisms. Cytotoxic T lymphocytes. Helper T lymphocytes. Cytokines. Natural Killer cells.

Defense mechanisms against viruses and bacteria. Immune response against cancer. Vaccination.

IMMUNOPATHOLOGY:

Autoimmunity. Solid organ transplants. Hematopoietic stem cell transplantation.

Congenital and acquired immune deficiencies. Hypersensitivity reactions: type I, II, III and IV.

RECOMMENDED READING/BIBLIOGRAPHY

Parola, PATOLOGIA GENERALE, EdiSES
Pontieri, ELEMENTI DI PATOLOGIA GENERALE Ed. Piccin
Rubin, PATOLOGIA GENERALE - L’ESSENZIALE, Ed. Piccin

Immunology e Immunopathology:
Actor, INTRODUZIONE ALL’IMMUNOLOGIA, Ed. Pearson
Regueiro Gonzalez et al., BIOLOGIA E PATOLOGIA DEL SISTEMA IMMUNITARIO, Ed. Piccin

Sompayrac, COME FUNZIONA IL SISTEMA IMMUNITARIO, Ed. Piccin

Del Gobbo, IMMUNOLOGIA PER LE LAUREE SANITARIE, Ed. Piccin