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通讯作者:

孙颖,E⁃mail:ebolasun@njmu.edu.cn

中图分类号:R392.12

文献标识码:A

文章编号:1007-4368(2021)06-826-06

DOI:10.7655/NYDXBNS20210606

参考文献 1
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参考文献 11
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参考文献 12
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参考文献 14
WHITE P,SAKELLARI D,ROBERTS H,et al.Peripher⁃ al blood neutrophil extracellular trap production and deg⁃ radation in chronic periodontitis[J].J Clin Periodontol,2016,43(12):1041-1049
参考文献 15
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参考文献 16
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参考文献 17
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参考文献 18
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参考文献 19
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参考文献 20
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参考文献 21
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参考文献 22
FONSECA Z,DÍAZ ⁃GODÍNEZ C,MORA N,et al.Ent⁃ amoeba histolytica induce signaling via Raf/MEK/ERK for neutrophil extracellular trap(NET)formation[J].Front Cell Infect Microbiol,2018,8:226
参考文献 23
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目录contents

    摘要

    目的:探讨Wnt5a对中性粒细胞胞外诱捕网(neutrophil extracellular trap,NET)形成的影响及可能的调控机制。方法:采用50 ng/mL Wnt5a刺激人中性粒细胞3 h,以1 μg/mL牙龈卟啉单胞菌(Porphyromonas gingivalisP.gingivalis)脂多糖(li⁃ popolysaccharide,LPS)和1 μg/mL大肠杆菌(Escherichia coli,E.coli)LPS作为阳性对照,采用免疫荧光技术观察NET的形成,Sy⁃ tox Green 荧光法对胞外DNA 进行定量,采用流式细胞术检测细胞产生的活性氧(reactive oxygen species,ROS)水平,Western blot分析信号分子磷脂酰肌醇三激酶(phosphoinositide 3⁃kinase,PI3K)/Akt和丝裂原活化蛋白激酶1/2(mitogen⁃activated protein kinase1/2,MEK1/2)、细胞外信号调节蛋白激酶1/2(extracellular regulated protein kinases1/2,ERK1/2)表达水平的变化。结果: Wnt5a刺激人中性粒细胞后,可观察到NET的形成和胞外DNA数量的增加(P < 0.05),ROS水平较刺激前明显增高(P < 0.05), Western blot 检测显示,PI3K/Akt 和 MEK1/2、RK1/2 磷酸化水平增高(P < 0.05)。结论:Wnt5a 可能通过 PI3K/Akt、MEK1/2、 ERK1/2磷酸化,调控ROS生成,进而促进人中性粒细胞形成NET。

    Abstract

    Objective:This study aims to observe the effects and mechanisms of Wnt5a on the formation of neutrophil extracellular trap(NET). Methods:Neutrophils were stimulated with 50 ng/mL Wnt5a for 3 h,1 μg/mL Porphyromonas gingivalisP.gingivalis) lipopolysaccharide(LPS)and 1 μg/mL Escherichia coliE.coli)LPS were served as positive controls. Formation of NET was observed by immunofluorescence staining,and extracellular DNA was quantified by Sytox Green fluorescence staining. Levels of reactive oxygen species(ROS)were detected by flow cytometry,and activations of phosphatidylinositol 3⁃kinase(PI3K)/Akt,mitogen⁃activated protein kinase 1/2(MEK1/2)and extracellular regulated protein kinases 1/2(ERK1/2)were explored by Western blot. Results:Compared with neutrophils without stimulations,Wnt5a stimulation led to the formation of NET and the increased levels of extracellular DNA(P < 0.05). In addition,levels of ROS and phosphorylations of PI3K/Akt,MEK1/2 and ERK1/2 were significantly increased in the cells treated with Wnt5a(P < 0.05). Conclusion:Wnt5a might contribute to the formation of NET depending on the production of ROS and the phosphorylations of PI3K/Akt,MEK1/2 and ERK1/2.

    Keywords

    Wnt5aNETROSPI3K/AktMEK1/2⁃ERK1/2

  • Wnt蛋白是一个38~43kDa的糖蛋白家族,包含Wnt1、Wnt3a、Wnt7a、Wnt8b等19种成员,由单核/巨噬细胞、上皮细胞、牙周膜干细胞等多种细胞分泌,与炎症、肿瘤等多种疾病相关[1]。根据其激活的信号通路,可分为激活经典Wnt信号通路的转化型,如Wnt3a、Wnt7a,以及激活不依赖β⁃catenin信号通路的非转化型,如Wnt4、Wnt11。Wnt5a属于后者,在胚胎发育和细胞生长分化过程中发挥了重要作用。炎性刺激能促进Wnt5a的产生。在慢性牙周炎患者的牙龈组织中,可检测到高表达的Wnt5a,牙周致病菌牙龈卟啉单胞菌(PorphyromonasgingivalisP.gingivalis)脂多糖(lipopolysaccharide,LPS)能诱导人单核细胞系THP⁃1表达Wnt5a [2]。但Wnt5a在牙周炎发生发展中的作用,目前尚不完全明确。

  • 中性粒细胞是宿主抵御牙周致病菌入侵的重要防线,能趋化至细菌入侵部位,通过吞噬、脱颗粒、呼吸爆发等机制杀灭细菌,其数量过多或活化过度也可能导致功能失调,释放过量活性氧(reac⁃ tive oxygen species,ROS)、胶原酶等产物,导致牙周软硬组织的破坏[3]

  • 21世纪初,Brinkmann采用佛波酯(phorbol12⁃ myristate⁃13⁃acetate,PMA)刺激中性粒细胞,诱导形成了一种被称为中性粒细胞胞外诱捕网(neutrophil extracellular trap,NET)的结构,后者为细胞向胞外释放的一种纤维网状染色质结构,富含大量抗菌肽和酶,包括乳铁蛋白、髓过氧化物酶(myeloperoxi⁃ dase,MPO)、弹性蛋白酶等。细菌、病毒、真菌和肿瘤坏死因子(tumor necrosis factor,TNF)⁃α、白细胞介素 (interleukin,IL)⁃8等细胞因子均可促进NET的形成,它使死亡的中性粒细胞也能捕获并杀灭微生物[4]

  • 作为一种以自分泌或旁分泌方式产生的效应分子,Wnt5a对NET的形成有何影响,这种影响又将如何改变牙周炎的发生发展,目前尚不得而知。本研究拟探讨Wnt5a对NET形成的调控作用及可能机制,以期进一步阐明Wnt5a对免疫炎症反应的影响。

  • 1 材料和方法

  • 1.1 材料

  • 重组人/小鼠Wnt5a蛋白(R&D公司,美国),中性粒细胞分离剂Polymorphprep(AXIS⁃SHIELD公司,挪威),大肠杆菌(Escherichia coli,E.coli)O127:B8LPS和DCFH ⁃DA(Sigma公司,美国),P.gingivalis ATCC 33277LPS(InvivoGen公司,美国),磷脂酰肌醇三激酶(phosphoinositide3⁃kinase,PI3K)(Abcam公司,美国),p⁃PI3K、AKT、p⁃AKT、细胞外信号调节蛋白激酶1/2(extracellular regulated protein kinases1/2,ERK1/2)、p ⁃ERK1/2、丝裂原活化蛋白激酶1/2 (mitogen ⁃ activated protein kinase1/2,MEK1/2)、p ⁃ MEK1/2、PI3K/Akt抑制剂LY294002、MEK1/2抑制剂U0126(Cell Signaling公司,美国),DAPI(杭州碧云天公司),兔抗人MPO多抗、Sytox Green核酸染色剂(Invitrogen公司,美国)。

  • 1.2 方法

  • 1.2.1 人中性粒细胞的分离

  • 本研究经南京医科大学伦理委员会批准,所有纳入研究的志愿者均签署知情同意书。采集健康志愿者外周静脉血10mL,密度梯度离心法常规分离获得中性粒细胞[5],流式细胞检测证实,其纯度及活性均高于90%,可用于后续试验。健康志愿者的纳入标准为:①全身健康,无系统性疾病;②无妊娠、哺乳;③3个月内无感冒、发热等感染性疾病;④ 3个月内未服用抗生素、非甾体类抗炎药或免疫抑制剂;⑤无吸烟史。

  • 1.2.2 NET形成的免疫荧光染色与胞外DNA检测

  • 将中性粒细胞以5×105 个/孔接种于6孔板,分为4组,空白对照组(A组)、50ng/mL Wnt5a组(B组)、1 μg/mL E.coli LPS组(C组)和1 μg/mL P.gingi⁃ valis LPS组(D组),每组3个复孔。刺激3h后,将各组细胞接种于预先涂布聚⁃L⁃赖氨酸的玻片上,采用4%多聚甲醛固定,0.2%Triton X⁃100透化细胞,随后加入1∶250MPO抗体,4℃孵育过夜,采用1∶500Alexa Fluor 488标记的山羊抗兔IgG(H + L)二抗37℃孵育2h,DAPI染色2min,正置荧光显微镜下观察NET的形成。

  • 为对NET进行定量,将中性粒细胞以5×105 个/孔接种于12孔板,细胞分为5组,每组4个复孔,A~D组刺激同前,2.5h后,加入5 μmol/L DNA特异性染料Sytox Green,避光孵育30min,E组为不添加Sy⁃ tox Green染料、无刺激的阴性对照组。采用多功能酶标仪SpectraMaxM2e(MD公司,德国)检测胞外DNA数量,发射波长523nm,激发波长504nm。结果表示为各组检测值减去阴性对照组检测值的差值。

  • 1.2.3 中性粒细胞呼吸爆发的流式细胞学检测

  • 将中性粒细胞以5×105 个/孔接种于6孔板,A~D组同1.2.2,E组为不添加DCFH⁃DA染料、无刺激的阴性对照组,每组3个复孔。刺激12h后,各组加入5 μmol/L DCFH⁃DA荧光探针,37℃孵育40min,采用流式细胞仪FACSCalibur(BD公司,美国)检测488nm波长下的荧光强度,即产生的ROS水平。结果以刺激组检测值/空白对照组检测值表示。

  • 1.2.4 Western blot检测

  • 中性粒细胞的分组同1.2.2,刺激30min后,常规裂解细胞,提取总蛋白,SDS ⁃PAGE电泳,转至PVDF膜,5%脱脂牛奶封闭2h,采用PI3K、Akt、 MEK1/2、p⁃MEK1/2、ERK1/2、p⁃ERK1/2抗体(1∶ 1 000稀释)和p⁃PI3K、p⁃Akt抗体(1∶500稀释),4℃ 孵育过夜,加入HRP标记的山羊抗兔IgG二抗(1∶ 5 000稀释),孵育2h,加入ECL化学发光剂,采用Image Quant LAS 4 000mini显影,采用Image J图像分析软件分析各条带灰度值。

  • 1.2.5 PI3K/Akt、MEK1/2⁃ERK1/2 对NET形成的影响检测

  • 将中性粒细胞以5×105 个/孔接种于12孔板,分为5组,每组4复孔,A~D组加入50 μmol/L PI3K/Akt抑制剂LY294002或10 μmol/L MEK1/2、ERK1/2抑制剂U0126,预处理30min后,分别加入空白培养液 (A组)、50ng/mL Wnt5a(B组)、1 μg/mL E.coli LPS (C组)和1 μg/mL P.gingivalis LPS(D组)。E组为不加抑制剂、不加Sytox Green、无刺激的阴性对照组。2.5h后,检测NET形成的胞外DNA水平,方法同前。

  • 1.3 统计学方法

  • 采用SPSS10.0软件进行统计学分析,各组数据间的比较采用单因素方差分析,组间比较采用Dun⁃ nett⁃t检验,P< 0.05为差异有统计学意义。

  • 2 结果

  • 2.1 Wnt5a促进NET的形成

  • 免疫荧光染色发现,未刺激的中性粒细胞仅形成少量胞外DNA网状结构。Wnt5a、P.gingivalis LPS或E.coli LPS刺激后,部分中性粒细胞核膜解体,染色质解聚,形成胞外DNA纤维网状结构,其中MPO阳性染色为绿色,DAPI阳性染色为蓝色,表明NET形成(图1A)。

  • 胞外DNA的Sytox Green荧光染色定量分析显示,与空白对照组相比,Wnt5a、P.gingivalis LPS或 E.coli LPS刺激后,胞外DNA数量明显增多(P< 0.05),而各刺激组间无明显差异(P> 0.05,图1B)。

  • 图1 Wnt5a促进NET的形成

  • Fig.1 Formation of NET stimulated by Wnt5a

  • 2.2 Wnt5a促进ROS的生成

  • Wnt5a、P.gingivalis LPS或 E.coli LPS刺激后, ROS水平均明显高于未刺激组(P< 0.05),代表性的流式细胞学检测结果如图2A所示。其中,E.coli LPS刺激后生成的ROS数量明显高于Wnt5a和 P.gingivalis LPS刺激组(P< 0.05,图2B)。

  • 2.3 PI3K/Akt和MEK1/2 ⁃ ERK1/2 信号转导对Wnt5a诱导NET形成的影响

  • Western blot检测发现,与空白对照组相比, Wnt5a和 E.coli LPS刺激后,中性粒细胞PI3K、Akt、MEK1/2和ERK1/2磷酸化程度均明显增强(P< 0.05),其中,Wnt5a组ERK1/2磷酸化程度低于E.coli LPS组(P< 0.05)。P.gingivalis LPS刺激后,Akt、 MEK1/2和ERK1/2磷酸化程度比空白对照组强 (P< 0.05)。代表性的Western blot检测结果如图3所示。

  • 图2 Wnt5a对中性粒细胞ROS生成的影响

  • Fig.2 Effects of Wnt5a on ROS production in neutrophils

  • 为进一步证实PI3k/Akt和MEK1/2、ERK1/2磷酸化在Wnt5a促进NET形成中的作用,分别采用PI3K/Akt抑制剂LY294002和MEK1/2、ERK1/2抑制剂U0126预处理中性粒细胞,结果发现,与相应的无抑制剂组相比,LY294002和U0126预处理后, Wnt5a、P.gingivalis LPS和 E.coli LPS刺激组中性粒细胞胞外DNA数量均明显减少(P<0.05,图4)。

  • 3 讨论

  • Wnt5a在牙周组织,尤其是炎性牙周组织中的表达已得到证实。Maekawa等[6] 发现,人牙龈组织中可检测到Wnt5a和分泌型卷曲相关蛋白5(secret⁃ ed frizzled⁃related protein 5,sFRP5)mRNA。其中,炎症组织以Wnt5a表达为主,健康组织以sFRP5表达为主,采用P.gingivalis LPS刺激人牙龈上皮细胞后, Wnt5a表达上调,sFRP5表达则下调。作为一种效应分子,Wnt5a可由巨噬细胞通过自分泌或者旁分泌方式产生,具有促炎作用,并参与炎症应答[7]

  • NET是中性粒细胞捕获、杀灭致病菌的一种重要机制,其过量生成或清除障碍均与炎症造成的组织破坏相关[8]。NET可由多种刺激物诱导形成,如 E.coli LPS、IL⁃8等[9]P.gingivalis LPS是P.gingivalis 的主要毒力因子之一,可直接破坏牙周组织,并引发多种免疫炎症反应,其结构和生物学功能与最经典的G菌内毒素E.coli LPS相比,存在一定差异[10-11]。因此,本研究选择P.gingivalis LPS和E.col LPS作为阳性对照。Liu等[12] 发现,在E.coli LPS介导的小鼠急性肺损伤中可检测到NET。牙周炎患者牙周袋脓性渗出物及龈沟液中也可检测到NET,后者能诱捕入侵致病微生物,并限制其传播[13]。NET同样可在牙周炎患者的菌斑生物膜及牙周袋上皮中被检测到[14]。本研究发现Wnt5a可促进中性粒细胞产生NET,进而可能影响包括牙周组织在内的多种组织的免疫炎症反应的发展和转归。

  • NET的形成主要通过两种方式,一种是依赖ROS的经典途径,细胞被激活后1~4h,细胞核分裂,核膜分解,细胞去极化,染色质去浓缩,质膜破裂,细胞死亡,释放出NET;另一种是早期快速、独立于ROS的途径,细胞被激活后5~60min,核膜分离,核DNA和线粒体DNA以囊泡形式排出胞外,形成NET,细胞依然存活[815]

  • 图3 Wnt5a对中性粒细胞PI3K、Akt、MEK1/2和ERK1/2蛋白磷酸化的影响

  • Fig.3 Effect of Wnt5a on phosphoralation of PI3K,Akt,MEK1/2and ERK1/2in neutrophils

  • 图4 LY294002/U0126对中性粒细胞胞外DNA形成的影响

  • Fig.4 Effects of LY294002/U0126inhibition on extra⁃ cellular DNA formation

  • 中性粒细胞能产生并释放大量抗菌肽、蛋白酶及ROS,杀死其捕获的病原体。ROS包括超氧化物、过氧化氢、羟自由基等,其产生过程被称为呼吸爆发。Acquier等[16] 研究发现,侵袭性牙周炎患者唾液中ROS水平较牙周健康者明显增高。在中性粒细胞脱颗粒及NET形成过程中,还原型烟酰胺腺嘌呤二核苷酸磷酸(nicotinamide adenine dinucleotide phosphate,NADPH)氧化酶产生的ROS是关键的信号分子[17]。研究发现,慢性肉芽肿病患者存在NADPH氧化酶缺陷,难以产生足够ROS,进而导致DNA释放和NET形成缺陷[17]。研究报道,E.coli 和铜绿假单胞菌能通过激活信号分子SAPK/JNK,诱导依赖ROS的NET形成[18]。本研究发现,Wnt5a、 P.gingivalis LPS和E.coli LPS均能促进ROS产生,进而可能影响NET的形成。

  • PI3K/Akt和MEK1/2⁃ERK1/2通路均受上游信号分子Ras调节。PI3K包括脂质激酶和蛋白激酶,位于Akt上游,可被磷脂酰肌醇⁃3,4,5⁃三磷酸通过丝氨酸/苏氨酸激酶磷酸化激活。PI3K/Akt广泛参与了细胞生长、增殖、代谢、血管生成等过程的调节。MEK1/2⁃ERK1/2则与细胞增殖、分化、趋化、 ROS形成等功能相关[19]。抑制PI3K能同时下调Akt及Raf/MEK/ERK信号通路[20]。抑制PI3K后,由PMA及寄生虫诱导形成的NET也受到显著抑制[21]。 Fonseca等[22] 首先发现了Raf/MEK/ERK信号通路在PMA诱导中性粒细胞形成NET中的作用。Raf/MEK/ERK信号通路激活后,形成NADPH氧化酶复合物,产生ROS,进而导致NET的形成[23]。本研究发现,Wnt5a刺激中性粒细胞后可促进PI3K/AKT及MEK1/2、ERK1/2磷酸化,PI3K/AKT抑制剂LY294002及MEK1/2、ERK1/2抑制剂U0126能抑制NET生成。因此,推测Wnt5a诱导NET形成的过程有PI3K/Akt和MEK1/2、ERK1/2的参与。

  • 综上所述,本研究发现Wnt5a能促进NET的形成,这一过程可能与ROS生成增加,以及PI3K/Akt、 MEK1/2⁃ERK1/2信号转导有关,对这一过程的调控可能有助于牙周炎在内的炎性疾病的免疫治疗。

  • 参考文献

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    • [2] NANBARA H,WARA ⁃ASWAPATI N,NAGASAWA T,et al.Modulation of Wnt5a expression by periodontopath⁃ ic bacteria[J].PLoS One,2012,7(4):e34434

    • [3] HAJISHENGALLIS G,MOUTSOPOULOS N M,HAJISH⁃ ENGALLIS E,et al.Immune and regulatory functions of neutrophils in inflammatory bone loss[J].Semin Immu⁃ nol,2016,28(2):146-158

    • [4] JOHNSON C J,CABEZAS ⁃OLCOZ J,KERNIEN J F,et al.The extracellular matrix of candida albicans biofilms impairs formation of neutrophil extracellular traps[J].PLoS Pathog,2016,12(9):e1005884

    • [5] SILVESTRE ⁃ROIG C,FRIDLENDER Z G,GLOGAUER M,et al.Neutrophil diversity in health and disease[J].Trends Immunol,2019,40(7):565-583

    • [6] MAEKAWA T,KULWATTANAPORN P,HOSUR K,et al.Differential expression and roles of secreted Frizzled ⁃ related protein 5 and the wingless homolog Wnt5a in peri⁃ odontitis[J].J Dent Res,2017,96(5):571-577

    • [7] SHAO Y,ZHENG Q,WANG W,et al.Biological func⁃ tions of macrophage ⁃ derived Wnt5a,and its roles in hu⁃ man diseases[J].Oncotarget,2016,7(41):67674-67684

    • [8] PAPAYANNOPOULOS V.Neutrophil extracellular traps in immunity and disease[J].Nat Rev Immunol,2018,18(2):134-147

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    • [10] ZHU X Q,LU W,CHEN Y,et al.Effects of porphyromon⁃ as gingivalis lipopolysaccharide tolerized monocytes on inflammatory responses in neutrophils[J].PLoS One,2016,11(8):e161482

    • [11] 陈杨,祝祥清,程筱番,等.内毒素耐受对人中性粒细胞抗炎反应的影响[J].南京医科大学学报(自然科学版),2017,37(1):30-34

    • [12] LIU S,SU X,PAN P,et al.Neutrophil extracellular traps are indirectly triggered by lipopolysaccharide and contrib⁃ ute to acute lung injury[J].Sci Rep,2016,6:37252

    • [13] VITKOV L,KLAPPACHER M,HANNIG M,et al.Neutro⁃ phil fate in gingival crevicular fluid[J].Ultrastruct Pathol,2010,34(1):25-30

    • [14] WHITE P,SAKELLARI D,ROBERTS H,et al.Peripher⁃ al blood neutrophil extracellular trap production and deg⁃ radation in chronic periodontitis[J].J Clin Periodontol,2016,43(12):1041-1049

    • [15] LIU S,YUE Y,PAN P,et al.IRF ⁃ 1 intervention in the classical ROS⁃dependent release of NETs during LPS⁃in⁃ duced acute lung injury in mice[J].Inflammation,2019,42(1):387-403

    • [16] ACQUIER A B,DE COUTO P A,BUSCH L,et al.Param⁃ eters of oxidative stress in saliva from patients with ag⁃ gressive and chronic periodontitis[J].Redox Rep,2017,22(3):119-126

    • [17] STOJKOV D,AMINI P,OBERSON K,et al.ROS and glu⁃ tathionylation balance cytoskeletal dynamics in neutro⁃ phil extracellular trap formation[J].J Cell Biol,2017,216(12):4073-4090

    • [18] HWANG T L,WANG C C,KUO Y H,et al.The heder⁃ agenin saponin SMG⁃1 is a natural FMLP receptor inhibi⁃ tor that suppresses human neutrophil activation[J].Bio⁃ chem Pharmacol,2010,80(8):1190-1200

    • [19] ASATI V,MAHAPATRA D K,BHARTI S K.PI3K/Akt/mTOR and Ras/Raf/MEK/ERK signaling pathways inhibi⁃ tors as anticancer agents:Structural and pharmacological perspectives[J].Eur J Med Chem,2016,109:314-341

    • [20] EBI H,COSTA C,FABER A C,et al.PI3K regulates MEK/ERK signaling in breast cancer via the Rac⁃GEF,P⁃ Rex1[J].Proc Natl Acad Sci U S A,2013,110(52):21124-21129

    • [21] DESOUZA ⁃ VIEIRA T,GUIMARAES ⁃ COSTA A,RO⁃ CHAEL N C,et al.Neutrophil extracellular traps release induced by Leishmania:role of PI3Kgamma,ERK,PI3Ksigma,PKC,and[Ca2+][J].J Leukoc Biol,2016,100(4):801-810

    • [22] FONSECA Z,DÍAZ ⁃GODÍNEZ C,MORA N,et al.Ent⁃ amoeba histolytica induce signaling via Raf/MEK/ERK for neutrophil extracellular trap(NET)formation[J].Front Cell Infect Microbiol,2018,8:226

    • [23] KESHARI R S,VERMA A,BARTHWAL M K,et al.Re⁃ active oxygen species⁃induced activation of ERK and p38 MAPK mediates PMA⁃induced NETs release from human neutrophils[J].J Cell Biochem,2013,114(3):532-540

  • 参考文献

    • [1] TAKADA S,FUJIMORI S,SHINOZUKA T,et al.Differ⁃ ences in the secretion and transport of Wnt proteins[J].J Biochem,2017,161(1):1-7

    • [2] NANBARA H,WARA ⁃ASWAPATI N,NAGASAWA T,et al.Modulation of Wnt5a expression by periodontopath⁃ ic bacteria[J].PLoS One,2012,7(4):e34434

    • [3] HAJISHENGALLIS G,MOUTSOPOULOS N M,HAJISH⁃ ENGALLIS E,et al.Immune and regulatory functions of neutrophils in inflammatory bone loss[J].Semin Immu⁃ nol,2016,28(2):146-158

    • [4] JOHNSON C J,CABEZAS ⁃OLCOZ J,KERNIEN J F,et al.The extracellular matrix of candida albicans biofilms impairs formation of neutrophil extracellular traps[J].PLoS Pathog,2016,12(9):e1005884

    • [5] SILVESTRE ⁃ROIG C,FRIDLENDER Z G,GLOGAUER M,et al.Neutrophil diversity in health and disease[J].Trends Immunol,2019,40(7):565-583

    • [6] MAEKAWA T,KULWATTANAPORN P,HOSUR K,et al.Differential expression and roles of secreted Frizzled ⁃ related protein 5 and the wingless homolog Wnt5a in peri⁃ odontitis[J].J Dent Res,2017,96(5):571-577

    • [7] SHAO Y,ZHENG Q,WANG W,et al.Biological func⁃ tions of macrophage ⁃ derived Wnt5a,and its roles in hu⁃ man diseases[J].Oncotarget,2016,7(41):67674-67684

    • [8] PAPAYANNOPOULOS V.Neutrophil extracellular traps in immunity and disease[J].Nat Rev Immunol,2018,18(2):134-147

    • [9] WHITE P C,CHICCA I J,COOPER P R,et al.Neutro⁃ phil extracellular traps in periodontitis:a web of intrigue [J].J Dent Res,2016,95(1):26-34

    • [10] ZHU X Q,LU W,CHEN Y,et al.Effects of porphyromon⁃ as gingivalis lipopolysaccharide tolerized monocytes on inflammatory responses in neutrophils[J].PLoS One,2016,11(8):e161482

    • [11] 陈杨,祝祥清,程筱番,等.内毒素耐受对人中性粒细胞抗炎反应的影响[J].南京医科大学学报(自然科学版),2017,37(1):30-34

    • [12] LIU S,SU X,PAN P,et al.Neutrophil extracellular traps are indirectly triggered by lipopolysaccharide and contrib⁃ ute to acute lung injury[J].Sci Rep,2016,6:37252

    • [13] VITKOV L,KLAPPACHER M,HANNIG M,et al.Neutro⁃ phil fate in gingival crevicular fluid[J].Ultrastruct Pathol,2010,34(1):25-30

    • [14] WHITE P,SAKELLARI D,ROBERTS H,et al.Peripher⁃ al blood neutrophil extracellular trap production and deg⁃ radation in chronic periodontitis[J].J Clin Periodontol,2016,43(12):1041-1049

    • [15] LIU S,YUE Y,PAN P,et al.IRF ⁃ 1 intervention in the classical ROS⁃dependent release of NETs during LPS⁃in⁃ duced acute lung injury in mice[J].Inflammation,2019,42(1):387-403

    • [16] ACQUIER A B,DE COUTO P A,BUSCH L,et al.Param⁃ eters of oxidative stress in saliva from patients with ag⁃ gressive and chronic periodontitis[J].Redox Rep,2017,22(3):119-126

    • [17] STOJKOV D,AMINI P,OBERSON K,et al.ROS and glu⁃ tathionylation balance cytoskeletal dynamics in neutro⁃ phil extracellular trap formation[J].J Cell Biol,2017,216(12):4073-4090

    • [18] HWANG T L,WANG C C,KUO Y H,et al.The heder⁃ agenin saponin SMG⁃1 is a natural FMLP receptor inhibi⁃ tor that suppresses human neutrophil activation[J].Bio⁃ chem Pharmacol,2010,80(8):1190-1200

    • [19] ASATI V,MAHAPATRA D K,BHARTI S K.PI3K/Akt/mTOR and Ras/Raf/MEK/ERK signaling pathways inhibi⁃ tors as anticancer agents:Structural and pharmacological perspectives[J].Eur J Med Chem,2016,109:314-341

    • [20] EBI H,COSTA C,FABER A C,et al.PI3K regulates MEK/ERK signaling in breast cancer via the Rac⁃GEF,P⁃ Rex1[J].Proc Natl Acad Sci U S A,2013,110(52):21124-21129

    • [21] DESOUZA ⁃ VIEIRA T,GUIMARAES ⁃ COSTA A,RO⁃ CHAEL N C,et al.Neutrophil extracellular traps release induced by Leishmania:role of PI3Kgamma,ERK,PI3Ksigma,PKC,and[Ca2+][J].J Leukoc Biol,2016,100(4):801-810

    • [22] FONSECA Z,DÍAZ ⁃GODÍNEZ C,MORA N,et al.Ent⁃ amoeba histolytica induce signaling via Raf/MEK/ERK for neutrophil extracellular trap(NET)formation[J].Front Cell Infect Microbiol,2018,8:226

    • [23] KESHARI R S,VERMA A,BARTHWAL M K,et al.Re⁃ active oxygen species⁃induced activation of ERK and p38 MAPK mediates PMA⁃induced NETs release from human neutrophils[J].J Cell Biochem,2013,114(3):532-540

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