内毒素耐受机制的研究进展

内毒素耐受（endotoxin tolerance）早在50多年前就已经引起人们的关注,但其具体的分子机制至今尚不清楚。Toll样受体4（Toll-1ike receptor-4,TLR4）作为脂多糖（LPS）的主要受体,参与LPS信号的跨膜转导,与LPS耐受密切相关。在内毒素耐受过程中,TLR4转导通路中的信号蛋白及下游转录因子在数量、结构和功能上发生改变,可引起炎性因子释放减少、抗炎因子产生增加,并导致特定信号通路（如P13K通路）和负性调节因子（如SHIP1、SOCS、FLN29等）的激活。除此之外,TLR2通路、Gi蛋白、蛋白激酶C（protein kinase C,PKC）以及一些信号分子的剪接异构体等也参与了内毒素耐受现象的发生。总之,内毒素耐受是一个由多种原因引起的、多种生物物质参与的复杂病理生理过程,是机体抵抗G-细菌感染的重要保护机制。因此,探索内毒素耐受的机制,寻求机体内源性的抗炎机制将为败血症等一些致死性感染性疾病的治疗提供新的思路和理论依据。     

LPS的胞内受体Caspase-11的研究进展

以往的研究认为,TLR4是内毒素(LPS)的胞膜受体.新近的研究发现含半胱氨酸的天冬氨酸蛋白水解酶11(Caspase-11,Casp11)可能在胞内LPS的识别中发挥关键作用.Caspase-11与胞内LPS结合后被激活.活化的Casp-11一方面剪切下游gasdermin D分子进而介导细胞焦亡(pyroptosis),另一方面激活NLRP3/ASC-Casp-1通路,使细胞分泌促炎因子IL-1β和IL-18等.Casp-11还能通过促进吞噬体和溶酶体融合,增强细胞对革兰氏阴性菌的杀灭.在严重内毒素血症过程中,由于Casp-11过度活化,大量细胞发生焦亡,致使大量胞内促炎介质被释放到胞外,导致机体出现难以调控的炎症反应,最终发展成内毒素休克.Casp-11是内毒素休克发生的关键分子.本文对Casp-11在LPS的识别、活化及效应方面的最新进展进行综述.     

内毒素结合蛋白的研究进展

革兰阴性菌的脂多糖(lipopolysaccharide,LPS)是引起内毒素休克的重要触发剂.近年来的研究发现,在内毒素血症的发生、发展过程中,内毒素结合蛋白(endotoxin binding protein,EBP)及其受体系统是机体识别和调控内毒素作用的关键机制,内毒素的许多生物学效应可能就是通过其增敏或抑制作用而实现的.本文就内毒素结合蛋白与LPS作用关系的研究进展作一综述.     

内毒素耐受分子调控机理

多种免疫细胞(如单核细胞等)经低剂量内毒素预处理后可产生对高剂量内毒素的耐受,这种免疫反应称之为内毒素耐受。内毒素耐受是一种由细胞因子信号通路下游负反馈激活的,具有防止炎症持续性伤害的免疫稳态维持机制,主要调控因子包括IL-10细胞因子信号通路、细胞因子信号通路抑制因子和IL-1受体相关激酶。另外,在内毒素耐受免疫反应中存在表观遗传修饰的稳定作用。现就内毒素耐受的主要调控机制及维持机制进行阐述。     

抗生素诱导内毒素血症的研究进展

许多抗生素杀死细菌时,可促使内毒素从细菌外膜释放。感染病灶内的革兰阴性菌死亡后释放进入血液的内毒素,或由大量污染液体输入而进入体内的内毒素,可通过与机体一系列连锁反应促进免疫活性因子和炎症反应介质的释放,从而引起局部水肿、充血及微循环障碍等,即内毒素血症。由抗生素诱导的内毒素血症与细菌的种类,抗生素的种类、浓度、给药方式等均有关。因此,临床医生应合理应用抗生素,将副作用降到最低。     

综述:炎症小体信号通路的负调控

炎症小体(inflammasomes)活化后产生的IL-1β和IL-18等促炎因子对天然免疫和适应性免疫具有重要作用.炎症小体持续活化可引起促炎因子过度表达,导致慢性炎症和自身免疫疾病的发生.正常生理状态下,机体存在多种炎症小体负调机制,以维持免疫反应平衡.病理状态下,感染机体的病原微生物通过多种途径抑制炎症小体信号通路的活化及促炎因子的产生,以利于免疫逃逸.本文综述了机体和病原微生物对炎症小体信号通路的负调控机理.阐明炎症小体信号通路负调控机制将为感染性疾病及其他炎症小体相关炎症性疾病的治疗提供策略.     

炎症小体信号通路的负调控

炎症小体(inflammasomes)活化后产生的IL-1β和IL-18等促炎因子对天然免疫和适应性免疫具有重要作用.炎症小体持续活化可引起促炎因子过度表达,导致慢性炎症和自身免疫疾病的发生.正常生理状态下,机体存在多种炎症小体负调机制,以维持免疫反应平衡.病理状态下,感染机体的病原微生物通过多种途径抑制炎症小体信号通路的活化及促炎因子的产生,以利于免疫逃逸.本文综述了机体和病原微生物对炎症小体信号通路的负调控机理.阐明炎症小体信号通路负调控机制将为感染性疾病及其他炎症小体相关炎症性疾病的治疗提供策略.     

α2-肾上腺素受体对大鼠肠系膜动脉床降钙素基因相关肽释放的调节作用

降钙素基因相关肽（CGRP）从感觉神经末梢的释放受多种机制的调节。本文在离体灌流的大鼠肠系膜动脉床组织上,利用药理学工具药,研究了α2-肾上腺素受体对CGRP的基础和内毒素刺激后释放的作用。结果发现,α2-受体激动剂UK14304（3×10－6mol／L）可以显著抑制CGRP的基础释放和内毒素（1～5μg／ml）刺激后的释放,抑制幅度为22％～42％;用α2-受体拮抗剂Yohimbine（10－5mol／L）可以完全阻断UK14304的作用。结果表明突触前α2-受体对CGRP从外周阻力血管组织的释放,尤其是内毒素刺激后的释放具有抑制作用,在内毒素休克晚期,α2-受体功能减低可能介导了外周组织CGRP的过量释放。     

细菌内毒素作用机理的研究进展

细菌内毒素对机体免疫系统的影响具有双重性,内毒素（ＬＰＳ）通过诱导机体内的单核巨噬细胞释放多种介质分子而发挥其生物学效应,其中细胞因子在感染性休克中起重要作用。内毒素结合蛋白（ＬＢＰ）有促进ＬＰＳ与单核巨噬细胞表面的相应受体发生结合的作用。而在ＬＰＳ诱导单核巨噬细胞产生细胞因子过程中,细胞表面ＬＢＰ受体（ＣＤ１４）的存在具有一定的意义。     

肠道菌群与高尿酸血症及痛风的相关性研究

高尿酸血症以及痛风的发病率持续升高,已经成为一个重大的公共卫生问题。肠道菌群的结构改变或失调可引起机体代谢紊乱,肠道微生态尤其与代谢性疾病的发生发展关系密切。目前研究发现高尿酸血症、痛风患者存在肠道菌群失调,降尿酸治疗后肠道菌群可发生相应改变,并且益生菌制剂具有降尿酸作用。本文概述高尿酸血症及痛风患者的肠道菌群特点,从高嘌呤及高果糖饮食对肠道菌群的影响、肠道参与嘌呤和尿酸的代谢、代谢性内毒素血症以及痛风相关炎症因子等方面探讨肠道菌群与高尿酸血症及痛风的关系,并展望肠道菌群可能成为未来诊治高尿酸血症以及痛风的一种新方法。     

Recent advances in endotoxin tolerance

Endotoxin tolerance is defined as a reduced capacity of a cell to respond endotoxin (lipopolysaccharide, LPS) challenge after an initial encounter with endotoxin in advance. The body becomes tolerant to subsequent challenge with a lethal dose of endotoxin and cytokines release and cell/tissue damage induced by inflammatory reaction are significantly reduced in the state of endotoxin tolerance. The main characteristics of endotoxin tolerance are downregulation of inflammatory mediators such as tumor necrosis factor α (TNF-α), interleukin-1β (IL-1β), and C-X-C motif chemokine 10 (CXCL10) and upregulation of anti-inflammatory cytokines such as IL-10 and transforming growth factor β (TGF-β). Therefore, endotoxin tolerance is often regarded as the regulatory mechanism of the host against excessive inflammation. Endotoxin tolerance is a complex pathophysiological process and involved in multiple cellular signal pathways, receptor alterations, and biological molecules. However, the exact mechanism remains elusive up to date. To better understand the underlying cellular and molecular mechanisms of endotoxin tolerance, it is crucial to investigate the comprehensive cellular signal pathways, signaling proteins, cell surface molecules, proinflammatory and anti-inflammatory cytokines, and other mediators. Endotoxin tolerance plays an important role in reducing the mortality of sepsis, endotoxin shock, and other endotoxin-related diseases. Recent reports indicated that endotoxin tolerance is also related to other diseases such as cystic fibrosis, acute coronary syndrome, liver ischemia-reperfusion injury, and cancer. The aim of this review is to discuss the recent advances in endotoxin tolerance mainly based on the cellular and molecular mechanisms by outline the current state of the knowledge of the involvement of the toll-like receptor 4 (TLR4) signaling pathways, negative regulate factor, microRNAs, apoptosis, chromatin modification, and gene reprogramming of immune cells in endotoxin tolerance. We hope to provide a new idea and scientific basis for the rational treatment of endotoxin-related diseases such as endotoxemia, sepsis, and endotoxin shock clinically.     

Network topologies and dynamics leading to endotoxin tolerance and priming in innate immune cells

The innate immune system, acting as the first line of host defense, senses and adapts to foreign challenges through complex intracellular and intercellular signaling networks. Endotoxin tolerance and priming elicited by macrophages are classic examples of the complex adaptation of innate immune cells. Upon repetitive exposures to different doses of bacterial endotoxin (lipopolysaccharide) or other stimulants, macrophages show either suppressed or augmented inflammatory responses compared to a single exposure to the stimulant. Endotoxin tolerance and priming are critically involved in both immune homeostasis and the pathogenesis of diverse inflammatory diseases. However, the underlying molecular mechanisms are not well understood. By means of a computational search through the parameter space of a coarse-grained three-node network with a two-stage Metropolis sampling approach, we enumerated all the network topologies that can generate priming or tolerance. We discovered three major mechanisms for priming (pathway synergy, suppressor deactivation, activator induction) and one for tolerance (inhibitor persistence). These results not only explain existing experimental observations, but also reveal intriguing test scenarios for future experimental studies to clarify mechanisms of endotoxin priming and tolerance.     

IL-12 suppression during experimental endotoxin tolerance: dendritic cell loss and macrophage hyporesponsiveness

Endotoxin tolerance, the transient, secondary down-regulation of a subset of endotoxin-driven responses after exposure to bacterial products, is thought to be an adaptive response providing protection from pathological hyperactivation of the innate immune system during bacterial infection. However, although protecting from the development of sepsis, endotoxin tolerance also can lead to fatal blunting of immunological responses to subsequent infections in survivors of septic shock. Despite considerable experimental effort aimed at characterizing the molecular mechanisms responsible for a variety of endotoxin tolerance-related phenomena, no consensus has been achieved yet. IL-12 is a macrophage- and dendritic cell (DC)-derived cytokine that plays a key role in pathological responses to endotoxin as well as in the induction of protective responses to pathogens. It recently has been shown that IL-12 production is suppressed in endotoxin tolerance, providing a likely partial mechanism for the increased risk of secondary infections in sepsis survivors. We examined the development of IL-12 suppression during endotoxin tolerance in mice. Decreased IL-12 production in vivo is clearly multifactorial, involving both loss of CD11c(high) DCs as well as alterations in the responsiveness of macrophages and remaining splenic DCs. We find no demonstrable mechanistic role for B or T lymphocytes, the soluble mediators IL-10, TNF-alpha, IFN-alphabeta, or nitric oxide, or the NF-kappaB family members p50, p52, or RelB.     

Mucosal modulation of immune responses to heat shock proteins in autoimmune arthritis

Induction of oral tolerance to antigens that are targets of self-reactive immune responses is an attractive approach to antigen-specific immune therapy of autoimmune diseases. Oral tolerization has indeed proven to be safe and effective in amelioration of autoimmune diseases in animal models. In humans, results have been somewhat controversial. The emphasis given to clinical outcome rather than to immunomodulation, and the difficulty in identifying appropriate candidate antigens contribute to the controversy. Heat shock proteins are promising targets for immune intervention. Immune reactivity to heat shock proteins has indeed been correlated with autoimmune arthritis in animal models, and abnormal immune responses to heat shock proteins have been described in human arthritis as well. Despite significant recent progress, little is known at a molecular level regarding the mechanisms which are responsible for a switch from autoimmunity to tolerance in humans. This is particularly true with respect to sequential analysis of several molecular and immunologic markers during both the course and treatment of disease. Novel approaches are currently under way to fill the gaps. We will briefly detail here the experience gained to date, and identify some of the avenues which future research will explore.     

Regulation of cyclooxygenase 2 expression by agonists of PPAR nuclear receptors in the model of endotoxin tolerance in astrocytes

Endotoxin tolerance (ET) represents a state of an altered immune response induced by multiple stimulations of a cell, a tissue, or an organism with lipopolysaccharide. Characteristics of ET include downregulation of induction of proinflammatory genes (TNFα, IL6, and others) and enhancement of induction of antiinflammatory genes (IL10, TGFβ). ET generally has protective functions; nevertheless, it might result in a state of innate immune deficiency and cause negative outcomes. A current issue is the search for the mechanisms controlling the level of inflammation in the course of endotoxin tolerance. In this work, we investigated the change in cyclooxygenase 2 (Cox2) expression in the model of endotoxin tolerance in astrocytes and analyzed the possibility of regulating this process applying nuclear receptor PPAR agonists. Our results indicate that: 1) endotoxin tolerance can be induced in astrocytes and results in TNFα and Cox2 mRNA induction decrease upon secondary stimulation; 2) tolerance is revealed on the level of TNFα release and Cox2 protein expression; 3) PPAR agonists GW7647, L-165041, and rosiglitazone control Cox2 mRNA expression levels under conditions of endotoxin tolerance. In particular, rosiglitazone (a PPARγ agonist) induces Cox2 mRNA expression, while GW7647 (a PPARα agonist) and L-165041 (a PPARβ agonist) suppress the expression. Our results demonstrate that Cox2 can be upand downregulated during endotoxin tolerance in astrocytes, and PPAR agonists might be effective for controlling this target under conditions of multiple proinflammatory stimulations of brain tissues with endotoxin.     

Multiple mechanisms of reduced major histocompatibility complex class II expression in endotoxin tolerance

Patients after polytrauma, burns, or septic shock frequently develop a life-threatening immunodeficiency. This state is associated with specific functional alterations of monocytic cells. We previously proposed endotoxin tolerance, the monocyte state after acute response to lipopolysaccharide, as a respective model system. One major feature in both the clinical situation and the in vitro model is the dramatic down-regulation of monocyte major histocompatibility complex (MHC) class II surface expression, which is associated with impaired antigen presentation capacity. This study focused on the mechanisms behind reduced MHC class II expression in endotoxin tolerance. Endotoxin priming provoked a decrease of monocyte intracellular MHC class II. It also led to a reduced expression of the chaperonic invariant chain and to an inhibited synthesis of the major lysosomal enzyme for final cleavage of the invariant chain going along with a relative accumulation of p10. The expression of HLA-DM necessary for loading MHC class II with antigenic peptide was also decreased. Additionally, reduced export of MHC class II alphabeta complexes to the cell surface was observed. The down-regulation of HLA-DR, invariant chain, and HLA-DM was regulated at the mRNA level and may be the consequence of reduced class II transactivator expression observed in this study. The simultaneous interference at different regulatory levels may explain the uniquely strong and long lasting MHC class II down-modulating effect of endotoxin priming compared with transforming growth factor-beta and interleukin-10. These results not only contribute to a better understanding of experimental endotoxin tolerance but may also give rise to new therapeutics for temporary immunodeficiency and, conversely, for MHC class II-dependent diseases such as autoimmunity and transplant rejection.     

The biology of endotoxin

Endotoxin (lipopolysaccharide, LPS) is the major component of the outer leaflet of Gram-negative bacteria and has profound immunostimulatory and inflammatory capacity. The septic shock syndrome caused by endotoxin still has an unacceptably high mortality rate and, owing to increasing numbers of resistant strains, remains an ongoing threat throughout the world. However, the past years have provided new insights especially into the receptors of the innate immune system that are involved into the recognition of LPS and the initial signal transduction pathways that are engaged after the primary recognition on the cell surface. The knowledge about the molecular basis for the responses to endotoxin may eventually lead to the development of new drugs to fight the fatal effects of bacterial infections.     

Mapping the areas sensitive to long-term endotoxin tolerance in the rat brain: a c-fos mRNA study

We have recently found that a single endotoxin administration to rats reduced the hypothalamic-pituitary-adrenal response to another endotoxin administration 4 weeks later, which may be an example of the well-known phenomenon of endotoxin tolerance. However, the time elapsed between the two doses of endotoxin was long enough to consider the above results as an example of late tolerance, whose mechanisms are poorly characterized. To know if the brain plays a role in this phenomenon and to characterize the putative areas involved, we compared the c-fos mRNA response after a final dose of endotoxin in animals given vehicle or endotoxin 4 weeks before. Endotoxin caused a widespread induction of c-fos mRNA in the brain, similar to that previously reported by other laboratories. Whereas most of the brain areas were not sensitive to the previous experience with endotoxin, a few showed a reduced response in endotoxin-pretreated rats: the parvocellular and magnocellular regions of the paraventricular hypothalamic nucleus, the central amygdala, the lateral division of the bed nucleus and the locus coeruleus. We hypothesize that late tolerance to endotoxin may involve plastic changes in the brain, likely to be located in the central amygdala. The reduced activation of the central amygdala in rats previously treated with endotoxin may, in turn, reduce the activation of other brain areas, including the hypothalamic paraventicular nucleus.     

Flt3 ligand treatment reverses endotoxin tolerance-related immunoparalysis

Endotoxin tolerance, the secondary blunting of a subset of microbial product-driven responses, is presumed to provide protection from pathological hyperactivation of the innate immune system during infection. However, endotoxin tolerance can itself be harmful. A significant percentage of sepsis survivors exhibit the phenotype of systemic endotoxin tolerance, a state termed immunoparalysis. Similar immune hyporeactivity, associated with an elevated risk of succumbing to bacterial superinfection, is also seen in the aftermath of major trauma, surgery, and burns. We recently demonstrated that in vivo endotoxin tolerance in murine models involves dendritic cell loss as well as alterations in the responsiveness of macrophages and remaining dendritic cells. Furthermore, the kinetics of recovery from immunoparalysis-associated inhibition of proinflammatory and immunoregulatory cytokine production directly parallels the kinetics of dendritic cell repopulation in these models. Given this, we examined whether recovery from immunoparalysis could be accelerated therapeutically with flt3 ligand, a growth factor that stimulates the differentiation and mobilization of dendritic cells. Notably, administration of flt3 ligand rapidly reverses immunoparalysis in vivo, accelerating and amplifying repopulation of tissues with proinflammatory and immunoregulatory cytokine-producing dendritic cells.