绿脓菌素激活MAPKs、NF-κB信号通路诱导呼吸道上皮细胞IL8表达

采用绿脓杆菌培养上清及绿脓菌素刺激人呼吸道上皮细胞株A5 4 9和SPC A 1,用ELISA方法检测细胞IL 8分泌水平 ,并使用免疫印迹 (Westernblot)方法观察绿脓菌素对细胞内重要的炎症信号传导途径NF κB及丝裂原激活蛋白激酶 (MAPKs)的激活作用。实验发现 ,绿脓杆菌培养上清及绿脓菌素可诱导呼吸道上皮细胞株IL 8分泌增加 ,且具有剂量依赖效应。绿脓菌素刺激细胞可使细胞内IκB α发生降解 ,同时使MAPK家族蛋白分子 (ERK1 2、p38、JNK)发生磷酸化。MEK1 2 (ERK1 2激酶 )抑制剂U0 12 6 (10 μmol L)和p38MAPK抑制剂SB2 0 35 80 (10 μmol L)可降低绿脓菌素诱导A5 4 9细胞IL 8的合成。以上结果显示绿脓菌素通过MAPK信号传导通路增强呼吸道上皮细胞IL 8的表达 ;NF κB通路也参与了绿脓菌素调控细胞IL 8表达的过程     

NF—κB信号通路在绿脓菌素诱导气道上皮表达IL-8的作用

探讨绿脓菌素对人气道上皮细胞株（NCI—H292细胞）表达IL-8的诱导作用及通过NF—κB信号传导通路。采用ELISA法对PCN诱导NCI-H292细胞分泌IL-8进行分析,应用westernblotting检测NF-κB的蛋白表达,观察NF—κB阻断剂对IL-8表达的影响。PCN可促进NCI-H292细胞IL-8分泌。NF—κB的阻断剂PDTC能显著抑制IL培表达（P〈0．01）。PCN可能通过NF-κB信号通路诱导呼吸道上皮细胞IL-8表达。     

滋养细胞胞内双链DNA感受器通过MAPK/IκB信号介导炎性细胞因子分泌

目的:探究滋养细胞能否感受胞内双链DNA刺激及其对炎性因子分泌的影响,揭示胎盘的免疫识别和免疫屏障功能,探讨妊娠期感染所致不良妊娠结局的发病机制。方法:利用人工合成的双链DNA模拟物poly (dA:dT)转染人滋养细胞系HTR-8/SVneo,Real-Time PCR方法检测滋养细胞胞内双链DNA识别受体的表达水平;Western Blot检测滋养细胞MAPK和IκB信号的活化情况;ELISA检测HTR-8/SVneo细胞培养上清中IL-6、IL-8、MCP-1、CXCL10的分泌水平。结果:Real-Time PCR结果表明,HTR-8/SVneo能够感受胞内双链DNA刺激并上调包括IFI16、AIM2、DHX36、DHX9、LRRFIP1、KU70、ZBP1/DAI和DDX41在内的多种双链DNA感受器的m RNA表达水平;Western Blot实验结果表明,滋养细胞识别双链DNA后能够促进MAPK和IκB信号通路活化,转染90分钟后ERK、JNK、p38和IκBα的磷酸化水平最高,其后随着时间逐渐减弱;加入IκB、p38和JNK特异性抑制剂能够抑制poly(dA:dT)介导的IL-8、IL-6和CXCL10分泌,但其分泌不受ERK抑制剂的影响;MCP-1的分泌能够被p38和JNK抑制剂阻断,但p38和ERK抑制剂不影响其分泌。结论:人滋养细胞存在功能性胞内双链DNA识别机制,活化的DNA识别信号能够激活MAPK和IκB信号通路,并通过IκB、p38或JNK信号介导IL-8、IL-6、MCP-1及CXCL10等细胞因子和趋化因子的分泌。     

齐墩果酸抑制肿瘤坏死因子-α诱导的成纤维细胞样滑膜细胞炎症因子表达及其机制研究

探讨齐墩果酸(Oleanolic acid,OA)对肿瘤坏死因子-α(TNF-α)诱导成纤维细胞样滑膜细胞的炎症因子表达的影响及其机制。首先复苏培养人成纤维细胞样滑膜细胞(FLS),通过RT-PCR检测细胞IL-6及IL-1βmRNA表达,采用Western blot方法检测p38MAPK及NF-κB蛋白表达变化,通过ELISA法检测细胞上清液中IL-6及IL-1β浓度。与对照组比较,TNF-α明显诱导FLS细胞IL-6及IL-1βmRNA的表达及上清液中IL-6及IL-1β的分泌(P0.05),同时磷酸化p38蛋白和核NF-κB明显增加(P0.05),且p38MAPK阻断剂SB203580能抑制TNF-α诱导的核NF-κB增加。OA呈浓度依赖性抑制TNF-α诱导的FLS细胞p38蛋白磷酸化和核NF-κB增加(P0.05)。且OA、p38MAPK通路抑制剂SB203580或NF-κB阻断剂BAY 11-7082均能抑制TNF-α诱导的IL-6及IL-1β分泌增加(P0.05)。综上所述,OA能抑制TNF-α诱导的FLS细胞炎症因子IL-6及IL-1β的产生,其机制可能与抑制p38MAPK/NF-κB信号通路有关。     

转化生长因子β激活性激酶在胶质细胞信号转导中的作用机制

丝裂原激活蛋白激酶（MAPK）和 NFκB介导了炎症细胞转录活性的信号转导过程.转化生长因子β激活性激酶（TGFβ-activated kinase 1,TAK1）是这些转导通路的上游激酶.通过在胶质细胞株中瞬时转染TAK1和它的结合蛋白因子（TAK1-binding protein1 TAB1）基因,或与iNOS(可诱导型氧化氮合酶基因)启动子报告基因（iNOS-Luc）质粒共转染,探讨中枢两类胶质细胞在炎症反应过程中TAK1诱导iNOS 和细胞因子表达的作用机制.结果显示,TAK1明显激活iNOS 和细胞因子（TNFα、IL-1、IL-6）的表达活性. 而且当使用它的下游激酶p38 MAPK、JNK和NFκB的抑制剂（SB203580、SP620125和CAPE）后,这些表达活性明显被抑制.用IκBα的磷酸化突变体质粒(IκBαM)共转染胶质细胞株,能完全抑制iNOS的表达活性.研究结果提示：在胶质细胞内的p38 MAPK、JNK和NFκB信号介导的iNOS和细胞因子的转录表达过程中,TAK1起着非常重要的调节作用.     

p38MAPK介导的胶质细胞iNOS的转录激活机制

丝裂原激活蛋白激酶(MAPK)酶级联反应系统参与胶质细胞中iNOS的合成.通过瞬时转染p38MAPK途径中上游激酶,MAPK激酶3(MKK3)和MAPK激酶6 (MKK6 )表达质粒,进一步了解p38MAPK级联传导信号系统调节iNOS基因在胶质细胞中的转录激活机制.MKK3或MKK6表达质粒与接有荧光素酶(luciferase ,Luc)的大鼠iNOS启动基因质粒(iNOS Luc)联合转染C6星形胶质细胞株引起iNOS Luc的激活,并且使细胞因子诱导的iNOSmRNA的表达增强.这两种效应都能够被p38MAPK抑制剂SB2 0 35 80所抑制.MKK3 6也可以诱导核因子κB(NFκB Luc)依赖的转录活性.这些分子水平的研究结果为p38MAPK信号级联传导途径在调节大鼠胶质细胞中iNOS基因转录激活中的重要作用,包括转录因子NFκB的作用提供了证据.通过阻断iNOS表达或NO的生成,抑制细胞炎症发生,为防治神经细胞炎症反应性疾病提供实验依据.     

布地奈德对A549细胞胸腺基质淋巴细胞生成素表达作用的研究

目的:观察细胞因子刺激气道上皮细胞胸腺基质淋巴细胞生成素(TSLP)表达是否涉及核因子κB(NF-κB),并探讨糖皮质激素布地奈德对气道上皮细胞TSLP表达和NF-κB核转位的影响.方法:A549细胞与细胞因子白介素1β(IL-1β)、白介素4(IL-4)和布地奈德共同孵育,以不加任何细胞因子或布地奈德培养的A549细胞为对照组,采用RT-PCR方法测定TSLP mRNA表达,细胞免疫荧光方法检测TSLP和NF-κB的表达情况.结果:与对照组比较,IL-1β(10 ng/ml)及IL-4(10 ng/ml)显著刺激A549细胞TSLP mRNA表达,且NF-κB(p65)核转住增加(均P＜0.05).布地奈德干预后TSLP mRNA的表达和NF-κB(p65)的核转位显著减少(P＜0.05).结论:细胞因子促进气道上皮细胞诱导性表达TSLP与NF-κB激活有关,抑制TSLP表达和NF-κB激活可能是布地奈德治疗哮喘的重要机制.     

木犀草素通过抑制p65 NF-κB、促进p85 PI3K调节微血管内皮细胞VCAM-1表达（英文）

通过抑制微血管内皮细胞血管细胞黏附分子(VCAM)-1的表达,木犀草素可阻遏中性粒细胞与微血管内皮细胞的黏附,起到抗炎作用.木犀草素调节VCAM-1表达与三条信号通路有关:丝裂原活化蛋白激酶(MAPK)、核因子kappa B(NF-κB)/IκB和磷脂酰肌醇3激酶(PI3K)/Akt通路.其中,MAPK和NF-κB/IκB通路参与VCAM-1正向调节,PI3K/Akt通路参与VCAM-1负向调节.本文研究了木犀草素对微血管内皮细胞该三条通路中的关键蛋白p38 MAPK、p65 NF-κB、p85 PI3K磷酸化.结果表明:木犀草素在反应的30 s和1 min促进p38 MAPK磷酸化,在30 s、1 min和5 min促进p85 PI3K磷酸化,而在30 s、1 min、5 min和30 min抑制p65 NF-κB磷酸化.阻抑p38 MAPK通路导致VCAM-1表达下调,而p38 MAPK抑制剂SB203580可通过抑制p38 MAPK磷酸化也下调VCAM-1,提示木犀草素对微血管内皮细胞VCAM-1的调节作用独立于p38 MAPK磷酸化.由此可知,木犀草素通过抑制p65 NF-κB磷酸化或促进p85 PI3K磷酸化调节微血管内皮细胞VCAM-1表达.本文为木犀草素抗炎作用的分子机制研究提供了新的线索.     

木犀草素通过抑制p65 NF-κB、促进p85 PI3K调节微血管内皮细胞VCAM-1表达

通过抑制微血管内皮细胞血管细胞黏附分子(VCAM)-1的表达,木犀草素可阻遏中性粒细胞与微血管内皮细胞的黏附,起到抗炎作用。木犀草素调节VCAM-1表达与三条信号通路有关：丝裂原活化蛋白激酶(MAPK)、核因子kappa B (NF-κB)/IκB和磷脂酰肌醇3激酶(PI3K)/Akt通路。其中,MAPK和NF-κB/IκB通路参与VCAM-1正向调节,PI3K/Akt通路参与VCAM-1负向调节。本文研究了木犀草素对微血管内皮细胞该三条通路中的关键蛋白p38 MAPK、p65 NF-κB、p85 PI3K磷酸化。结果表明：木犀草素在反应的30s和1min促进p38 MAPK磷酸化,在30 s、1 min和5 min促进p85 PI3K磷酸化,而在30 s、1 min、5 min和30 min抑制p65 NF-κB磷酸化。阻抑p38 MAPK通路导致VCAM-1表达下调,而p38 MAPK抑制剂SB203580可通过抑制p38 MAPK磷酸化也下调VCAM-1,提示木犀草素对微血管内皮细胞VCAM-1的调节作用独立于p38 MAPK磷酸化。由此可知,木犀草素通过抑制p65 NF-κB磷酸化或促进p85 PI3K磷酸化调节微血管内皮细胞VCAM-1表达。本文为木犀草素抗炎作用的分子机制研究提供了新的线索。     

Smad4分子在ERK/MAPK信号转导通路中的作用

为了探讨在人永生化支气管上皮细胞BEP2D细胞中,Smad4分子对 ERK/MAPK通路的作用,我们用RNA干扰的方法分别设计了两对Smad4 siRNA,并使BEP2D细胞中Smad4靶向沉默,用Western印迹分析了细胞内ERK激酶和MEK激酶磷酸化水平的变化.结果发现,当Smad4表达沉默后,ERK激酶磷酸化水平未变,MEK激酶磷酸化水平有所降低;再加TGF-β1诱导后ERK激酶和MEK激酶磷酸化水平均显著降低至基础水平以下.结果表明在BEP2D细胞中,Smad4的缺失抑制TGF-β1对ERK/MAPK通路的活化,故提出TGF β活化ERK/MAPK通路需要Smad4存在的假设.     

Protease-activated receptor (PAR)-induced interleukin-8 production in airway epithelial cells requires activation of MAP kinases p44/42 and JNK

The mechanism underlying protease-activated receptor (PAR)-activation and subsequent interleukin (IL)-8 production in airway epithelial cells is not yet understood. In this study we investigated the role of mitogen-activated protein kinases (MAPKs) in A549 airway epithelial cells. We studied the consequence of activation of PARs with simultaneous exposure to LPS. Thrombin, PAR-2-activating peptide and LPS, were tested alone and in combination. They induced significant synthesis of IL-8. However, only activation of PAR triggered phosphorylation of ERK1/2 and JNK. The application of the inhibitors of these two MAPKs resulted in reduction of IL-8 production. Thus, activation of PARs but not stimulation with LPS leads to ERK1/2 and JNK-mediated production of IL-8.     

Involvement of p42/p44 MAPK, JNK, and NF-kappaB in IL-1beta-induced ICAM-1 expression in human pulmonary epithelial cells

Interleukin-1beta (IL-1beta) has been shown to induce the expression of intercellular adhesion molecule-1 (ICAM-1) on airway epithelial cells and contributes to inflammatory responses. However, the mechanisms regulating ICAM-1 expression by IL-1beta in human A549 cells was not completely understood. Here, the roles of mitogen-activated protein kinases (MAPKs) and NF-kappaB pathways for IL-1beta-induced ICAM-1 expression were investigated in A549 cells. IL-1beta induced expression of ICAM-1 protein and mRNA in a time- and concentration-dependent manner. The IL-1beta induction of ICAM-1 mRNA and protein were partially inhibited by U0126 and PD98059 (specific inhibitors of MEK1/2) and SP600125 [a specific inhibitor of c-Jun-N-terminal kinase (JNK)]. U0126 was more potent than other inhibitors to attenuate IL-1beta-induced ICAM-1 expression. Consistently, IL-1beta stimulated phosphorylation of p42/p44 MAPK and JNK which was attenuated by pretreatment with U0126 or SP600125, respectively. Moreover, transfection with dominant negative mutants of MEK1/2 (MEK K97R) or ERK2 (ERK2 K52R) also attenuated IL-1beta-induced ICAM-1 expression. The combination of PD98059 and SP600125 displayed an additive effect on IL-1beta-induced ICAM-1 gene expression. IL-1beta-induced ICAM-1 expression was almost completely blocked by a specific NF-kappaB inhibitor helenalin. Consistently, IL-1beta stimulated translocation of NF-kappaB into the nucleus and degradation of IkappaB-alpha which was blocked by helenalin, U0126, or SP600125. Taken together, these results suggest that activation of p42/p44 MAPK and JNK cascades, at least in part, mediated through NF-kappaB pathway is essential for IL-1beta-induced ICAM-1 gene expression in A549 cells. These results provide new insight into the mechanisms of IL-1beta action that cytokines may promote inflammatory responses in the airway disease.     

The Pseudomonas toxin pyocyanin inhibits the dual oxidase-based antimicrobial system as it imposes oxidative stress on airway epithelial cells

The dual oxidase-thiocyanate-lactoperoxidase (Duox/SCN(-)/LPO) system generates the microbicidal oxidant hypothiocyanite in the airway surface liquid by using LPO, thiocyanate, and Duox-derived hydrogen peroxide released from the apical surface of the airway epithelium. This system is effective against several microorganisms that infect airways of cystic fibrosis and other immunocompromised patients. We show herein that exposure of airway epithelial cells to Pseudomonas aeruginosa obtained from long-term cultures inhibits Duox1-dependent hydrogen peroxide release, suggesting that some microbial factor suppresses Duox activity. These inhibitory effects are not seen with the pyocyanin-deficient P. aeruginosa strain PA14 Phz1/2. We show that purified pyocyanin, a redox-active virulence factor produced by P. aeruginosa, inhibits human airway cell Duox activity by depleting intracellular stores of NADPH, as it generates intracellular superoxide. Long-term exposure of human airway (primary normal human bronchial and NCI-H292) cells to pyocyanin also blocks induction of Duox1 by Th2 cytokines (IL-4, IL-13), which was prevented by the antioxidants glutathione and N-acetylcysteine. Furthermore, we showed that low concentrations of pyocyanin blocked killing of wild-type P. aeruginosa by the Duox/SCN(-)/LPO system on primary normal human bronchial epithelial cells. Thus, pyocyanin can subvert Pseudomonas killing by the Duox-based system as it imposes oxidative stress on the host. We also show that lactoperoxidase can oxidize pyocyanin, thereby diminishing its cytotoxicity. These data establish a novel role for pyocyanin in the survival of P. aeruginosa in human airways through competitive redox-based reactions between the pathogen and host.     

Mold allergen, pen C 13, induces IL-8 expression in human airway epithelial cells by activating protease-activated receptor 1 and 2

Allergenic serine proteases are important in the pathogenesis of asthma. One of these, Pen c 13, is the immunodominant allergen produced by Penicillium citrinum. Many serine proteases induce cytokine expression, but whether Pen c 13 does so in human respiratory epithelial cells is not known. In this study, we investigated whether Pen c 13 caused IL-8 release and activated protease-activated receptors (PARs) in airway epithelial cells. In airway-derived A549 cells and normal human airway epithelial cells, Pen c 13 induced IL-8 release in a dose-dependent manner. Pen c 13 also increased IL-8 release in a time-dependent manner in A549 cells. Pen c 13 cleaved PAR-1 and PAR-2 at their activation sites. Treatment with Pen c 13 induced intracellular Ca(2+) mobilization and desensitized the cells to the action of other proteases and PAR-1 and PAR-2 agonists. Moreover, Pen c 13-mediated IL-8 release was significantly decreased in Ca(2+)-free medium and was abolished by the protease inhibitors, PMSF and 4-(2-aminoethyl) benzenesulfonyl fluoride. Blocking Abs against the cleavage sites of PAR-1 and PAR-2, but not of PAR-4, inhibited Pen c 13-induced IL-8 production, as did inhibition of phospholipase C. Pen c 13 induced IL-8 expression via activation of ERK 1/2, and not of p38 and JNK. In addition, treatment of A549 cells or normal human airway epithelial cells with Pen c 13 increased phosphorylation of ERK 1/2 by a Ca(2+)-dependent pathway. These finding show that Pen c 13 induces IL-8 release in airway epithelial cells and that this is dependent on PAR-1 and PAR-2 activation and intracellular calcium.     

Pyocyanin and its precursor phenazine-1-carboxylic acid increase IL-8 and intercellular adhesion molecule-1 expression in human airway epithelial cells by oxidant-dependent mechanisms

Pseudomonas aeruginosa secretes numerous factors that alter host cell function and may contribute to disease pathogenesis. Among recognized virulence factors is the redox-active phenazine pyocyanin. We have recently demonstrated that the precursor for pyocyanin, phenazine-1-carboxylic acid (PCA), increases oxidant formation and alters gene expression in human airway epithelial cells. We report in this work that PCA and pyocyanin increase expression of ICAM-1 both in vivo and in vitro. Moreover, phenazines enhanced cytokine-dependent increases in IL-8 and ICAM-1. Antioxidant intervention studies indicated both similarities and differences between PCA and pyocyanin. The thiol antioxidant N-acetyl cysteine, extracellular catalase, and inducible NO synthase inhibitors inhibited ICAM-1 and IL-8 increases in response to both phenazines. However, pyocyanin was significantly more sensitive to N-acetylcysteine inhibition. Interestingly, hydroxyl radical scavengers inhibited the response to pyocyanin, but not to PCA. These studies suggest that P. aeruginosa phenazines coordinately up-regulate chemokines (IL-8) and adhesion molecules (ICAM-1) by mechanisms that are, at least in part, oxidant dependent. However, results indicate that the mechanisms by which PCA and pyocyanin exert their effects are not identical, and not all antioxidant interventions are equally effective in inhibiting phenazine-mediated proinflammatory effects.     

Mite and cockroach proteases activate p44/p42 MAP kinases in human lung epithelial cells

BACKGROUND: The mechanisms underlying epithelial cell activation by indoor inhaled antigens are poorly understood. METHODS: In this study, we investigated the role of mitogen-activated protein kinases (MAPKs) in A549 epithelial cells upon exposure to antigens of house dust mite (HDMA), German cockroach (GCA), and American cockroach (ACA). RESULTS: Each of these antigens induced a significant increase in IL-8 levels compared to the medium control. Exposure of A549 cells to these antigens induced the phosphorylation of p44/42 MAPKs within 5 minutes, which reached a peak at 25 minutes later and reached baseline levels at 1 hour after exposure. PD98059, a MEK1 inhibitor, significantly decreased phosphorylation of p44/p42 MAPKs and IL-8 production. Exposure of A549 cells with antigens, which had been preincubated with different protease inhibitors, also resulted in a reduction of both MAPK phosphorylation and IL-8 production. CONCLUSION: Thus, proteolytic antigens present in HDMA, GCA and ACA activate the p44/42 MAPKs airway epithelial cells, which lead to elevated IL-8 production and initiation of the inflammatory cascade.     

MMP-12 induces IL-8/CXCL8 secretion through EGFR and ERK1/2 activation in epithelial cells

Macrophage metalloelastase (MMP-12) is described to be involved in pulmonary inflammatory response. To determine the mechanisms linking MMP-12 and inflammation, we examined the effect of recombinant human MMP-12 (rhMMP-12) catalytic domain on IL-8/CXCL8 production in cultured human airway epithelial (A549) cells. Stimulation with rhMMP-12 resulted in a concentration-dependent IL-8/CXCL8 synthesis 6 h later. Similar results were also observed in cultured BEAS-2B bronchial epithelial cells. In A549 cells, synthetic matrix metalloproteinase (MMP) inhibitors prevented rhMMP-12-induced IL-8/CXCL8 release. We further demonstrated that in A549 cells, rhMMP-12 induced transient, peaking at 5 min, activation of ERK1/2. Selective MEK inhibitors (U0126 and PD-98059) blocked both IL-8/CXCL8 release and ERK1/2 phosphorylation. IL-8/CXCL8 induction and ERK1/2 activation were preceded by EGF receptor (EGFR) tyrosine phosphorylation, within 2 min, and reduced by selective EGFR tyrosine kinase inhibitors (AG-1478 and PD168393) by a neutralizing EGFR antibody and by small interfering RNA oligonucleotides directed against EGFR, implicating EGFR activation. In addition, we observed an activation of c-Fos in A549 cells stimulated by rhMMP-12, dependent on ERK1/2. Using small interfering technique, we showed that c-Fos is involved in rhMMP-12-induced IL-8/CXCL8 production. From these results, we conclude that one mechanism, by which MMP-12 induces IL-8/CXCL8 release from the alveolar epithelium, is the EGFR/ERK1/2/activating protein-1 pathway.     

Cystic fibrosis pathogens activate Ca2+-dependent mitogen-activated protein kinase signaling pathways in airway epithelial cells

Much of the pulmonary disease in cystic fibrosis is associated with polymorphonuclear leukocyte-dominated airway inflammation caused by bacterial infection. Respiratory epithelial cells express the polymorphonuclear chemokine interleukin-8 (IL-8) in response to ligation of asialylated glycolipid receptors, which are increased on damaged or regenerating cells and those with cystic fibrosis transmembrane conductance regulator mutations. Because both Pseudomonas aeruginosa and Staphylococcus aureus, the most common pathogens in cystic fibrosis, bind asialylated glycolipid receptors such as asialoGM1, we postulated that diverse bacteria can activate a common epithelial signaling pathway to elicit IL-8 expression. P. aeruginosa PAO1 but not pil mutants and S. aureus RN6390 but not the agr mutant RN6911 stimulated increases in [Ca(2+)](i) in 1HAEo- airway epithelial cells. This response stimulated p38 and ERK1/2 mitogen-activated protein kinase (MAPK) signaling cascades resulting in NF-kappaB activation and IL-8 expression. Ligation of the asialoGM1 receptor or thapsigargin-elicited Ca(2+) release activated this pathway, whereas P. aeruginosa lipopolysaccharide did not. The rapid kinetics of epithelial activation precluded bacterial invasion of the epithelium. Recognition of asialylated glycolipid receptors on airway epithelial cells provides a common pathway for Gram-positive and Gram-negative organisms to initiate an epithelial inflammatory response.