Lessons in self defence

Abstract

Physiology of Inflammationedited by K. Ley,Oxford University Press, 2000. £65.00 (hardback) (xii + 564 pages)ISBN 0 1951 2829 X‘The art of war is simple enough. Find out where your enemy is. Get at him as soon as you can. Strike him as hard as you can, and keep moving on.’ Ulysses S. Grant (1822–1885).We live in a hostile environment where our bodies are subject to constant attack from without and within. Luckily, evolution has equipped us with the ability to mount an inflammatory response and, in most cases, repel infecting organisms. Parallels between our body's ability to cope with infection and Grant's ‘Art of war’ are easily drawn. We have excellent mechanisms in place to detect infection (or the risk of it) and to deliver hard-hitting effector cells rapidly to their location. After dealing with the infection, the inflammatory response resolves and we return to a state of readiness.Under usual circumstances inflammatory events occur and resolve without commotion. However, problems might be encountered under circumstances where an individual's ability to mount an adequate inflammatory response is impaired, or where the inflammatory response is misdirected or exaggerated in magnitude. ‘Know your enemy’ could be added to Grant's quotation. Scientific interest in the molecular, cellular and physiological mechanisms of inflammation is intense, driven largely by the promise that a better understanding of the underlying mechanisms will lead to improved treatment for diverse conditions where defective inflammation is implicated.Contributions from an impressive list of scientists have been drawn together to produce Physiology of Inflammation, which offers the latest opinion on hot topics in inflammation research. The book begins with an informative historical perspective, prepared by the editor, Professor Klaus Ley, on the study of inflammation and provides a fascinating insight into how the inflammatory response has been understood (and misunderstood) through the ages and describes the key advances that have brought us to our current level of understanding.The chapters that follow consider, in detail, many of the hormones (e.g. cytokines, chemokines, complement, prostanoids and nitric oxide) that coordinate inflammation and the adhesion molecules (i.e. selectins, integrins and the immunoglobulin superfamily) that support leukocyte recruitment during an inflammatory response. Interspersed with these ‘mediator’ chapters are more general sections that consider elements of the inflammatory response (e.g. leukocyte formation, differentiation and recruitment, blood flow regulation and permeability increase) and the models used to study it (e.g. in vitro flow models, intravital microscopy and knockout mice).An exciting area of current research has grown from the realization that inflammation and coagulation are not discrete entities, but related pathways with numerous crossroads. One chapter highlights the fact that many molecules (including fibrinogen, thrombin and Factor Xa) that were traditionally thought of as coagulation molecules can also have profound effects on the effectors of inflammation. The following chapter considers the link between inflammation and coagulation from the opposite direction. Detection of Gram negative bacterial infection of the blood (sepsis) is received by the host as the worst possible news. The presence of significant levels of the bacterial cell wall component lipopolysaccharide (LPS) in the blood initiates unparalleled cytokine generation, which leads to the activation of inflammatory and vascular cells as well as coagulation and fibrinolytic pathways. Activation of inflammation and coagulation under these circumstances is often so widespread that, in severe septic episodes, it is the inflammatory response to infection rather than the infection itself that spells disaster for the septic patient.‘Let us have peace’ (Ulysses S. Grant). As a successful military campaign ideally ends with lasting peace, so a successful inflammatory response resolves completely, without scarring. Physiology of Inflammation ends with a discussion of the events (e.g. removal of stimulus, clearance of debris and clearance of inflammatory cells) necessary for full resolution of inflammation. Defective resolution of inflammation can lead to chronic inflammation, scarring and loss of function. Whether a defect in the resolution of inflammation underlies a given inflammatory disease or not, a better understanding of how inflammation resolves will, undoubtedly, offer new therapeutic targets.Physiology of Inflammation is an extremely useful and up-to-date resource for those interested in or actively studying inflammation. A wide range of subjects pertinent to the study of inflammation are covered, and covered well. Writing a review for this book has been made difficult by its regular disappearance from my bookshelf. A fact that I believe speaks more for its value than any opinion of mine.