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Relationship: 1777


The title of the KER should clearly define the two KEs being considered and the sequential relationship between them (i.e., which is upstream and which is downstream). Consequently all KER titles take the form “upstream KE leads to downstream KE”.  More help

Increased pro-inflammatory mediators leads to Leukocyte recruitment/activation

Upstream event
Upstream event in the Key Event Relationship. On the KER page, clicking on the Event name under Upstream Relationship will bring the user to that individual KE page. More help
Downstream event
Downstream event in the Key Event Relationship. On the KER page, clicking on the Event name under Upstream Relationship will bring the user to that individual KE page. More help

Key Event Relationship Overview

The utility of AOPs for regulatory application is defined, to a large extent, by the confidence and precision with which they facilitate extrapolation of data measured at low levels of biological organisation to predicted outcomes at higher levels of organisation and the extent to which they can link biological effect measurements to their specific causes. Within the AOP framework, the predictive relationships that facilitate extrapolation are represented by the KERs. Consequently, the overall WoE for an AOP is a reflection in part, of the level of confidence in the underlying series of KERs it encompasses. Therefore, describing the KERs in an AOP involves assembling and organising the types of information and evidence that defines the scientific basis for inferring the probable change in, or state of, a downstream KE from the known or measured state of an upstream KE. More help

AOPs Referencing Relationship

This table is automatically generated upon addition of a KER to an AOP. All of the AOPs that are linked to this KER will automatically be listed in this subsection. Clicking on the name of the AOP in the table will bring you to the individual page for that AOP. More help
AOP Name Adjacency Weight of Evidence Quantitative Understanding Point of Contact Author Status OECD Status
Endocytic lysosomal uptake leading to liver fibrosis adjacent High Marina Kuburic (send email) Under development: Not open for comment. Do not cite EAGMST Under Review
Increased DNA damage leading to increased risk of breast cancer adjacent Moderate Not Specified Jessica Helm (send email) Under development: Not open for comment. Do not cite Under Development
Increased reactive oxygen and nitrogen species (RONS) leading to increased risk of breast cancer adjacent Moderate Not Specified Jessica Helm (send email) Under development: Not open for comment. Do not cite Under Development

Taxonomic Applicability

Select one or more structured terms that help to define the biological applicability domain of the KER. In general, this will be dictated by the more restrictive of the two KEs being linked together by the KER. Authors can indicate the relevant taxa for this KER in this subsection. The process is similar to what is described for KEs (see pages 30-31 and 37-38 of User Handbook) More help
Term Scientific Term Evidence Link
human Homo sapiens NCBI
mouse Mus musculus NCBI

Sex Applicability

Authors can indicate the relevant sex for this KER in this subsection. The process is similar to what is described for KEs (see pages 31-32 of the User Handbook). More help
Sex Evidence

Life Stage Applicability

Authors can indicate the relevant life stage for this KER in this subsection. The process is similar to what is described for KEs (see pages 31-32 of User Handbook). More help
Term Evidence
All life stages

Key Event Relationship Description

Provide a brief, descriptive summation of the KER. While the title itself is fairly descriptive, this section can provide details that aren’t inherent in the description of the KEs themselves (see page 39 of the User Handbook). This description section can be viewed as providing the increased specificity in the nature of upstream perturbation (KEupstream) that leads to a particular downstream perturbation (KEdownstream), while allowing the KE descriptions to remain generalised so they can be linked to different AOPs. The description is also intended to provide a concise overview for readers who may want a brief summation, without needing to read through the detailed support for the relationship (covered below). Careful attention should be taken to avoid reference to other KEs that are not part of this KER, other KERs or other AOPs. This will ensure that the KER is modular and can be used by other AOPs. More help

Circulating blood leukocytes are required to migrate to sites of injury and infection with the aim to eliminate the primary inflammatory trigger and contribute to tissue repair. In this process are involved selectins (expressed both on leukocytes and endothelium) and integrins (expressed on leukocytes) (von Andrian et al., 1991), with the essential role of the vascular endothelium.

Fast activation of the endothelium with inflammatory stimuli such as histamine and PAF (type I) or slow activation with tumor necrosis factor (TNF) or cytokine interleukin-1 β (IL-1β) (type II), makes the surface of endothelium adhesive (Bevilacqua and Gimbrone, 1987; Pober and Sessa, 2007). This transformation is mediated by a transcriptionally regulated program involving the nuclear factor NF-kB dependent pathway triggered by pro-inflammatory cytokines or bacterial endotoxins (reviewed by Collins et al., 1995).

Integrins mediate attachment between cells or to basement membrane. The β2 integrin family is exclusively expressed on leukocytes and is essential for leukocyte arrest on the endothelium and for migration across the endothelium (Ley et al., 2007). In unstimulated leukocytes integrins are usually in a conformation with low binding affinity, until they receive signals from other receptors, such as chemokine receptors (G-protein-coupled receptors), when they change their conformation and display high affinity for ligands (Luo et al., 2007). Chemokines activate β1 or β2 integrins on monocytes, neutrophils, and lymphocytes and as such serve as chemoattractant for these cells during inflammation (Huber et al., 1991; Tanaka et al., 1993; Gunn et al., 1998).

The chemokines are a family of structurally related cytokines that can act as pro-inflammatory agents (Baggiolini et al., 1994; Vaddi et al., 1997). They have the ability to attract leukocyte subsets to specific sites. They recruit neutrophils, monocytes, natural killer cells (NK) and natural killer T (NKT) cells, all of which express inflammatory chemokine receptors and immature dendritic cells (DCs) that provide the link between innate and adaptive immunity (Oo et al., 2010). After antigen-specific activation of lymphocytes by activated DCs, inflammatory chemokines then attract antigen-specific effector T cells to the inflammatory site (Heydtmann and Adams, 2002).

During diapedesis, leukocytes migrate across the endothelium and basement membrane to enter tissue (Ley et al., 2007; Yadav et al., 2003). Once in tissue, the leukocyte follows chemokine gradients to sites of inflammation, using chemokine-mediated changes in the actin cytoskeleton to propel migration. For example, it was demonstrated that chemokines CXCL9, CXCL10 and CXCL11 are important not only in adhesion, but also in transmigration of effectors T lymphocytes through hepatic endothelium (Curbishley et al., 2005; Eksteen et al., 2004). Intracellular actin reorganization is a prerequisite for cell movement, and it has been shown that chemokines such as SDF-1 induce and increase intracellular filamentous actin in lymphocytes (Bleul et al., 1996).

There is essential role of interleukins, but also other factors such as tumor necrosis factor (TNF), interferon (IFN) in leukocyte recruitment and production of chemokines.

Normally, IL-1β binds to IL-1R1 receptor on the surface of target cells. Following ligand binding the adaptor molecule, myeloid differentiation factor-88 (MyD88), interacts with IL-1R1 via its toll interleukin receptor (TIR) domain (O'Neill, 2008). Signal transduction leads to activation of both mitogen-activated protein kinases (MAPKs) and the transcription factor NF-kB, and resulting in pro-inflammatory cytokine expression. For example, chemokine RANTES production requires the transcription factor NF-kB and the activation of mitogen-activated protein kinases (MAPKs) (Genin et al., 2000; Miyamoto et al., 2000; Kujime et al., 2000, Maruoka et al., 2000; Yang et al., 2000).

TNF-α cleavage produces an intracellular domain that translocates to the nucleus and induces pro-inflammatory cytokine signalling, particularly the expression of IL-12 (Friedman et al., 2006). IL-18 induces natural killer and natural killer T cells to produce IFN-γ (Okamura et al., 1998), but it requires IL-12 to induce IFN-γ production by Th1 cells (Nakanishi et al., 2001). There is an essential role of IFN-I in promoting the chronic recruitment of Ly6Chi monocytes. IFN-I production is elicited via a toll like receptor-7 (TLR-7) and MyD88-dependent pathway (Lee et al., 2008).

While CXC-chemokines, e.g. IL-8, act mostly on neutrophils (Springer, 1995), members of the CC-chemokines, e.g. RANTES and macrophage inflammatory protein have been shown to exert function on monocytes, eosinophils and lymphocytes (Baggiolini et al., 1994; Carr et al., 1994). This depends on the receptors that are expressed on leukocytes. Th1 express preferentially CCR5 and CXCR3, while Th2 cells have CCR3, CCR4 and CCR8 on their surface (Syrbe et al., 1999). Monocytes and macrophages express CCR5 and other receptors for RANTES (Weber et al., 2000).

RANTES chemokine is produced by many cells in the extravascular compartment, including fibroblasts, epithelial cells, and tissue-infiltrating lymphocytes and monocytes (MacEwan, 2002; Hehlgans and Männel, 2002; Black et al., 1997). It acts as a potent chemoattractant for monocytes, memory T cells, eosinophils, and basophils (Schall et al., 1988, 1990; Baggiolini and Dahinden, 1994). Elevated levels of RANTES transcripts are detected within hours of exposure to pro-inflammatory stimuli, including IL-1β, TNF-α, IFN-γ, viruses and LPS (Barnes et al., 1996).

Evidence Supporting this KER

Assembly and description of the scientific evidence supporting KERs in an AOP is an important step in the AOP development process that sets the stage for overall assessment of the AOP (see pages 49-56 of the User Handbook). To do this, biological plausibility, empirical support, and the current quantitative understanding of the KER are evaluated with regard to the predictive relationships/associations between defined pairs of KEs as a basis for considering WoE (page 55 of User Handbook). In addition, uncertainties and inconsistencies are considered. More help
Biological Plausibility
Define, in free text, the biological rationale for a connection between KEupstream and KEdownstream. What are the structural or functional relationships between the KEs? For example, there is a functional relationship between an enzyme’s activity and the product of a reaction it catalyses. Supporting references should be included. However, it is recognised that there may be cases where the biological relationship between two KEs is very well established, to the extent that it is widely accepted and consistently supported by so much literature that it is unnecessary and impractical to cite the relevant primary literature. Citation of review articles or other secondary sources, like text books, may be reasonable in such cases. The primary intent is to provide scientifically credible support for the structural and/or functional relationship between the pair of KEs if one is known. The description of biological plausibility can also incorporate additional mechanistic details that help inform the relationship between KEs, this is useful when it is not practical/pragmatic to represent these details as separate KEs due to the difficulty or relative infrequency with which it is likely to be measured (see page 40 of the User Handbook for further information).   More help

There is much evidence that application of chemokines attract leukocytes to specific site in different species (Beck et al., 1997; Lee et al., 2000; Fahy et al., 2001; Nikiforou et al., 2016).

Uncertainties and Inconsistencies
In addition to outlining the evidence supporting a particular linkage, it is also important to identify inconsistencies or uncertainties in the relationship. Additionally, while there are expected patterns of concordance that support a causal linkage between the KEs in the pair, it is also helpful to identify experimental details that may explain apparent deviations from the expected patterns of concordance. Identification of uncertainties and inconsistencies contribute to evaluation of the overall WoE supporting the AOPs that contain a given KER and to the identification of research gaps that warrant investigation (seep pages 41-42 of the User Handbook).Given that AOPs are intended to support regulatory applications, AOP developers should focus on those inconsistencies or gaps that would have a direct bearing or impact on the confidence in the KER and its use as a basis for inference or extrapolation in a regulatory setting. Uncertainties that may be of academic interest but would have little impact on regulatory application don’t need to be described. In general, this section details evidence that may raise questions regarding the overall validity and predictive utility of the KER (including consideration of both biological plausibility and empirical support). It also contributes along with several other elements to the overall evaluation of the WoE for the KER (see Section 4 of the User Handbook).  More help

Lloyd and colleagues found that several chemokines can stimulate the adherence of peripheral blood lymphocytes to ICAM-1 coated slides (Loyd et al., 1996). However, by using a parallel plate flow chamber, other study failed to observe such an effect (Carr et al., 1996).

Response-response Relationship
This subsection should be used to define sources of data that define the response-response relationships between the KEs. In particular, information regarding the general form of the relationship (e.g., linear, exponential, sigmoidal, threshold, etc.) should be captured if possible. If there are specific mathematical functions or computational models relevant to the KER in question that have been defined, those should also be cited and/or described where possible, along with information concerning the approximate range of certainty with which the state of the KEdownstream can be predicted based on the measured state of the KEupstream (i.e., can it be predicted within a factor of two, or within three orders of magnitude?). For example, a regression equation may reasonably describe the response-response relationship between the two KERs, but that relationship may have only been validated/tested in a single species under steady state exposure conditions. Those types of details would be useful to capture.  More help
This sub-section should be used to provide information regarding the approximate time-scale of the changes in KEdownstream relative to changes in KEupstream (i.e., do effects on KEdownstream lag those on KEupstream by seconds, minutes, hours, or days?). This can be useful information both in terms of modelling the KER, as well as for analyzing the critical or dominant paths through an AOP network (e.g., identification of an AO that could kill an organism in a matter of hours will generally be of higher priority than other potential AOs that take weeks or months to develop). Identification of time-scale can also aid the assessment of temporal concordance. For example, for a KER that operates on a time-scale of days, measurement of both KEs after just hours of exposure in a short-term experiment could lead to incorrect conclusions regarding dose-response or temporal concordance if the time-scale of the upstream to downstream transition was not considered. More help
Known modulating factors
This sub-section presents information regarding modulating factors/variables known to alter the shape of the response-response function that describes the quantitative relationship between the two KEs (for example, an iodine deficient diet causes a significant increase in the slope of the relationship; a particular genotype doubles the sensitivity of KEdownstream to changes in KEupstream). Information on these known modulating factors should be listed in this subsection, along with relevant information regarding the manner in which the modulating factor can be expected to alter the relationship (if known). Note, this section should focus on those modulating factors for which solid evidence supported by relevant data and literature is available. It should NOT list all possible/plausible modulating factors. In this regard, it is useful to bear in mind that many risk assessments conducted through conventional apical guideline testing-based approaches generally consider few if any modulating factors. More help
Known Feedforward/Feedback loops influencing this KER
This subsection should define whether there are known positive or negative feedback mechanisms involved and what is understood about their time-course and homeostatic limits? In some cases where feedback processes are measurable and causally linked to the outcome, they should be represented as KEs. However, in most cases these features are expected to predominantly influence the shape of the response-response, time-course, behaviours between selected KEs. For example, if a feedback loop acts as compensatory mechanism that aims to restore homeostasis following initial perturbation of a KE, the feedback loop will directly shape the response-response relationship between the KERs. Given interest in formally identifying these positive or negative feedback, it is recommended that a graphical annotation (page 44) indicating a positive or negative feedback loop is involved in a particular upstream to downstream KE transition (KER) be added to the graphical representation, and that details be provided in this subsection of the KER description (see pages 44-45 of the User Handbook).  More help

Domain of Applicability

As for the KEs, there is also a free-text section of the KER description that the developer can use to explain his/her rationale for the structured terms selected with regard to taxonomic, life stage, or sex applicability, or provide a more generalizable or nuanced description of the applicability domain than may be feasible using standardized terms. More help

Human (Bleul et al., 1996; Miyamoto et al., 2000; Yamada et al., 2001; Sun et al., 2015)

Sheep (Nikiforou et al., 2016)

Mouse (Narumi et al., 1992; Fahy et al., 2001; Lee et al., 2009)


List of the literature that was cited for this KER description using the appropriate format. Ideally, the list of references should conform, to the extent possible, with the OECD Style Guide (OECD, 2015). More help

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Barnes DA, Huston M, Holmes R, Benveniste EN, Yong VW, Scholz P, Perez HD. Induction of RANTES expression by astrocytes and astrocytoma cell lines. J. Neuroimmunol. (1996) 71: 207–214.

Beck LA, Dalke S, Leiferman KM, Bickel CA, Hamilton R, Rosen H, Bochner BS, Schleimer RP. Cutaneous injection of RANTES causes eosinophil recruitment: comparison of nonallergic and allergic human subjects. J Immunol. (1997) 159:2962–2972.

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Carr MW, Alon R, Springer TA. The C-C chemokine MCP-1 differentially modulates the avidity of beta 1 and beta 2 integrins on T lymphocytes. Immunity (1996) 4: 179–187.

Carr MW, Roth S, Luther E, Rose SS, Springer TA. Monocyte chemoattractant protein-1 is a major T lymphocyte chemoattractant. Pro& Natl. Acad. Sci. USA. (1994) 91:3652-3656.

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Curbishley SM, Eksteen B, Gladue RP, Lalor P, Adams DH. CXCR3 activation promotes lymphocyte transendothelial migration across human hepatic endothelium under fluid flow. Am J Pathol (2005)  167: 887–899.

Eksteen B, Grant AJ, Miles A, Curbishley SM, Lalor PF, Hübscher SG, Briskin M, Salmon M, Adams DH. Hepatic endothelial CCL25 mediates the recruitment of CCR9+ gut-homing lymphocytes to the liver in primary sclerosing cholangitis. J Exp Med (2004) 200: 1511–1517.

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Friedmann E, Hauben E, Maylandt K, Schleeger S, Vreugde S, Lichtenthaler SF, Kuhn PH, Stauffer D, Rovelli G, Martoglio B. SPPL2a and SPPL2b promote intramembrane proteolysis of TNFα in activated dendritic cells to trigger IL-12 production. Nat. Cell Biol. (2006) 8: 843-848.

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