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Relationship: 3052
Title
Increased proinflammatory mediators leads to Systemic acute phase response
Upstream event
Downstream event
Key Event Relationship Overview
AOPs Referencing Relationship
AOP Name | Adjacency | Weight of Evidence | Quantitative Understanding | Point of Contact | Author Status | OECD Status |
---|---|---|---|---|---|---|
Substance interaction with lung resident cell membrane components leading to atherosclerosis | non-adjacent | High | Moderate | Ulla Vogel (send email) | Under development: Not open for comment. Do not cite | Under Development |
Taxonomic Applicability
Sex Applicability
Sex | Evidence |
---|---|
Male | High |
Female | High |
Life Stage Applicability
Term | Evidence |
---|---|
All life stages | High |
Key Event Relationship Description
This KER presents the association between the secretion of pro-inflammatory mediators (Key event 1496) and the induction of systemic acute phase response (Key event 1439). Pro-inflammatory mediators are secondary messengers that initiate and regulate inflammatory reactions. They are secreted during inflammation in all species. Acute phase response is the systemic response to acute and chronic inflammatory states, that includes changes in plasma concentration of proteins (Gabay & Kushner, 1999). The evidence of the KER presented is based on animal studies (mice), controlled human studies and epidemiological studies.
Evidence Collection Strategy
The evidence for this KER was mainly based on novel experimentation and literature search on the search engine PubMed. The first part of the relationship was assessed as the concentration of pro-inflammatory markers in blood or increase neutrophil numbers in blood or bronchoalveolar lavage fluid (BALF), while the second part of the relationship was assessed measuring the concentration of acute phase proteins in blood plasma or serum.
Evidence Supporting this KER
Biological Plausibility
The biological plausibility is high. The production of acute phase proteins during acute phase response is induced by the release of pro-inflammatory markers as interleukin (IL)-6, IL-1β, and tumor necrosis factor α (TNF-α) at inflammatory sites (Gabay & Kushner, 1999; Mantovani & Garlanda, 2023).
In this KER, pulmonary inflammation has been considered as an indirect marker of the release of pro-inflammatory factors because the release of inflammatory mediators (i.e. cytokines and chemokines) recruits immune cells to inflammation sites (Janeway, Murphy, Travers, & Walport, 2008). In mice, pulmonary inflammation is commonly assessed as the number or fraction of neutrophils in the broncheoalveolar lavage fluid (BALF) (Van Hoecke, Job, Saelens, & Roose, 2017).
Empirical Evidence
The table below presents evidence for this KER. Secretion of pro-inflammatory mediators is measured as change in concentration of pro-inflammatory markers in blood or increase neutrophil numbers in blood or bronchoalveolar lavage fluid (BALF) (Key event 1496), while systemic acute phase response is measured as the concentration of acute phase proteins in blood plasma or serum (Key event 1439).
Species |
Stressor |
Secretion of pro-inflammatory mediators |
Systemic acute phase response |
Reference |
Mouse |
Carbon black nanoparticles |
Yes, significant increase of neutrophil number 1, 3 and 28 days after exposure. |
Yes, significant increase of plasma serum amyloid A (SAA) at 1 and day 28 after exposure. |
(Bourdon, Halappanavar, et al., 2012; Bourdon, Saber, et al., 2012) |
Mouse |
Multiwalled carbon nanotubes (referred as CNTsmall) |
Yes, increased neutrophil numbers in BALF 1, 3 and 28 days after exposure to 18, 54 and 162 μg. |
Yes, increased plasma SAA3 1, 3 and 28 days after exposure to 162 µg, and 3 days after exposure to 18 and 54 µg. |
(Poulsen, Saber, Mortensen, et al., 2015; Poulsen, Saber, Williams, et al., 2015) |
Mouse |
Multiwalled carbon nanotubes (referred as CNTlarge) |
Yes, increased neutrophil numbers in BALF 1, 3 and 28 days after exposure to 18, 54 and 162 μg. |
Yes, increased plasma SAA3 1 and 3 days after exposure to 162 µg, and 3 days after exposure to 54 µg. |
(Poulsen, Saber, Mortensen, et al., 2015; Poulsen, Saber, Williams, et al., 2015) |
Mouse |
Graphene oxide |
Yes, increased neutrophil numbers in BALF 1 and 3 days after exposure to 18, 54 and 162 µg. |
Yes, increased SAA3 plasma levels 3 days after exposure to 54 and 162 µg. |
(Bengtson et al., 2017) |
Mouse |
Multiwalled carbon nanotubes (MWCNT) |
Yes, increased neutrophil numbers in BALF 1 day after exposure to 6, 18 and 54 μg. Increased neutrophil numbers in BALF 28 days after exposure to 6, 18 and 54 μg. Increased neutrophil numbers in BALF 92 days after exposure to 54 μg. |
Yes, increased SAA1/2 and SAA3 plasma levels 1 day after exposure. No change in SAA1/2 and SAA3 plasma leves28 and 92 days after exposure. |
(Poulsen et al., 2016, 2017) |
Mouse |
Carbon black |
Yes, increased neutrophil numbers in BALF after 1, 28, 92 days after exposure. |
Yes, increased SAA3 plasma levels 1 days after exposure. No change in SAA3 28 and 92 days after exposure. No change in SAA1/2 plasma levels. |
(Poulsen et al., 2016, 2017) |
Mouse |
Particulate matter from non-commercial airfield |
Yes, increased neutrophil numbers in BALF 1 day after exposure to 18 and 54 µg. |
Yes, increased plasma SAA3 levels after exposure to 54 µg. |
(Bendtsen et al., 2019) |
Mouse |
Diesel exhaust particles |
Yes, increased neutrophil numbers in BALF 1 day after exposure to 54 and 162 µg, and 28 days after exposure to 162 μg. |
Yes, increased plasma SAA3 levels after exposure to 54 µg. |
(Bendtsen et al., 2019) |
Mouse |
Nanofibrilated celluloses (FINE NFC, BIOCID FINE NFC and AS) |
Yes, increased neutrophil numbers in BALF 1 day after exposure to 6 and 18 µg of FINE NFC, 18 µg of AS, and 18 µg of BIOCID FINE NFC. Increased neutrophil numbers in BALF 28 days after exposure to 6 and 18 µg of FINE NFC, and 18 µg of AS. |
FINE NFC increased plasma SAA3 1 day after exposure to 6 and 18 µg, while AS increased SAA3 after exposure to 18 µg. After 28 days, only 6 µg of FINE NFC increased plasma SAA3. |
(Hadrup, Knudsen, et al., 2019) |
Mouse |
Copper oxide |
Yes, increased neutrophil numbers in BALF 1 day after exposure to 2, 6 and 12 µg. |
Yes, increased plasma SAA1/2 level after exposure to 6 µg. |
(Gutierrez et al., 2023) |
Mouse |
Tin dioxide |
Yes, increased neutrophil numbers in BALF 1 and 28 days after exposure to 162 µg. |
Yes, increased plasma SAA3 after exposure to 162 µg. |
(Gutierrez et al., 2023) |
Mouse |
Titanium dioxide |
Yes, increased neutrophil numbers in BALF 1 and 28 days after exposure. |
Yes, increased plasma SAA3 and SAA1/2 after exposure to 162 µg. |
(Gutierrez et al., 2023) |
Mouse |
Carbon black |
Yes, increased neutrophil numbers in BALF 1 and 28 days after exposure. |
Yes, increased plasma SAA3 and SAA1/2 after exposure to 162 µg. |
(Gutierrez et al., 2023) |
Mouse |
Serum amyloid A |
Yes, increased neutrophil numbers in BALF. |
Yes, increased levels of endogenous plasma SAA3. |
(Christophersen et al., 2021) |
Human |
Welding fumes |
Yes, significant increase in blood neutrophil numbers 6 hours after exposure, but no change 16 hours after welding. |
No changes in serum C reactive protein (CRP) 6 hours after exposure, but significantly increased serum CRP levels 16 hours after welding. |
(Kim et al., 2005) |
Human |
Wood smoke |
Yes, significant lower increase in serum interleukin (IL)-6 3 h after exposure than exposure to clean air. No change immediately after exposure and 20 h after exposure. No change in serum tumor necrosis factor α (TNF-α). |
Yes, significant increase in blood SAA immediately after exposure, and 3 and 20 h after exposure, no change in CRP. |
(Barregard et al., 2006) |
Human |
Fumes from brazing galvanized steel, using aluminum bronze wire |
Yes, significant increase in serum IL-6 levels 10 h after exposure. |
Yes, significant increase in serum CRP and SAA 29 h after exposure. No change 6 nor 10 h after exposure. |
(Baumann et al., 2016) |
Human |
Fumes from welding galvanized steel and aluminum, using zinc wire |
Yes, significant increase in serum IL-6 levels 10 h after exposure. |
Yes, significant increase in serum CRP and SAA 29 h after exposure. No change 6 nor 10 h after exposure. |
(Baumann et al., 2016) |
Human |
Fumes from brazing galvanized steel using zinc wire |
Yes, significant increase in serum IL-6 levels 10 h after exposure. |
Yes, significant increase in serum CRP 29 h after exposure. No change 6 nor 10 h after exposure. |
(Baumann et al., 2016) |
Human |
Zinc oxide |
Yes, dose-response relationship in blood neutrophils 24 h after exposure. |
Yes, dose-response relationship in CRP and SAA blood levels 24 h after exposure. |
(Monse et al., 2018) |
Human |
Fumes from small arms firing |
Yes, increased blood neutrophils 24h after exposure. |
Yes, increased blood CRP levels 24h after exposure |
(Sikkeland et al., 2018) |
Human |
Ambient particulate matter |
Yes, significant decrease of blood neutrophils. |
Yes, increased blood levels of SAA and CRP 1h and 20h after exposure. |
(Wyatt et al., 2020) |
Human |
Micro-sized zinc oxide |
Yes, increased neutrophil number in blood 22 h after exposure. |
Yes, increased blood CRP 22h and 2 days after exposure. No changes in CRP or SAA 3 days after exposure. |
(Monse et al., 2021) |
Human |
Nano-sized zinc oxide |
Yes, increased neutrophil number in blood 22 h after exposure. |
Yes, increased blood CRP and SAA 22h and 2 days after exposure. No changes in CRP or SAA 3 days after exposure. |
(Monse et al., 2021) |
Uncertainties and Inconsistencies
Wyatt et al. observed a decrease in blood neutrophil numbers in humans after exposure to ambient particulate matter although an increase in serum amyloid A (SAA) and C reactive protein (CRP) was observed. It was mentioned this might be due to the translocation of neutrophil from major vessels to smaller arteries (Wyatt et al., 2020).
In the study by Meier et al., the authors obtained a negative association between particulate matter with a diameter of less than 2.5 μm (PM2.5) exposure and blood levels of tumor necrosis factor (TNF-α) and interleukin (IL)-6, while SAA and CRP were positive associated with the exposure. The authors mentioned these results might be due the time point where the samples were taken (Meier et al., 2014).
Barregard et al. also observed that IL-6 levels were lower after exposure to wood smoke than after exposure to clean air. They suggested that this response was due to a possible sequestering of cytokines in the pulmonary capillary bed (Barregard et al., 2006).
The table below presents inconsistencies for this KER, where secretion of pro-inflammatory mediators has been observed after exposure to a stressor, while systemic acute phase response was not observed, or viceversa. Secretion of pro-inflammatory mediators was measured as change in concentration of pro-inflammatory markers in blood or increase neutrophil numbers in blood or bronchoalveolar lavage fluid (BALF), while systemic acute phase response was measured as the concentration of acute phase in blood plasma or serum.
Species |
Stressor |
Secretion of pro-inflammatory mediators |
Systemic acute phase response |
Reference |
Mouse |
Diesel exhaust particles |
Yes, significant increase of neutrophils in BALF. |
No effect |
(Saber et al., 2005, 2009, 2013) |
Mouse |
Reduced graphene oxide |
Yes, increased neutrophil numbers 1 and 3 days after exposure to 162, and 90 days after exposure to 18, 54 and 162 μg. |
No, no change in serum amyloid A (SAA)3 plasma concentration 3 days after exposure. |
(Bengtson et al., 2017) |
Mouse |
Crocidolite |
Yes, increased neutrophil numbers in BALF after 1 and 28 days after exposure to 6 and 18 μg, and 92 days after exposure to 18 μg. |
No change in SAA1/2 nor SAA3 plasma levels. |
(Poulsen et al., 2016, 2017) |
Mouse |
Particulate matter from commercial airport |
Yes, increased neutrophil numbers in BALF 1 day after exposure to 18 and 54 µg. |
No change in plasma SAA3. |
(Bendtsen et al., 2019) |
Mouse |
Carbon black |
Yes, increased neutrophil in BALF after 1, 28 and 90 days of exposure. |
No change in plasma SAA3. |
(Bendtsen et al., 2019) |
Mouse |
Coated zinc oxide nanoparticles |
Yes, increased neutrophil numbers in BALF 1 and 3 days after exposure to 2 µg, and 28 days after exposure to 0.2 and 0.7 µg. |
No effect on plasma SAA3. |
(Hadrup, Rahmani, et al., 2019) |
Mouse |
Zinc oxide |
Yes, increased neutrophil numbers in BALF 1 day after exposure to 0.7 µg. |
No change in plasma SAA3 or SAA1/2 levels. |
(Gutierrez et al., 2023) |
Mouse |
Aluminum oxide |
Yes, increased neutrophil numbers in BALF 1 and 28 days after exposure to 54 µg. |
No change in plasma SAA3 or SAA1/2 levels. |
(Gutierrez et al., 2023) |
Human |
Brazing fumes |
No significant change in blood neutrophils. |
Yes, increased blood C reactive protein (CRP) after exposure to 2 and 2.5 mg/m3. |
(Brand et al., 2014) |
Human |
Fumes from welding aluminium |
No significant change in blood neutrophils 24 h nor 7 days after exposure. |
Yes, significantly increased blood CRP 24 after exposure. No change after exposure nor a week after exposure. |
(Hartmann et al., 2014) |
Human |
Fumes from welding zinc coated materials |
No significant change in blood neutrophils 24 h nor 7 days after exposure. |
Yes, significantly increased blood CRP 24 after exposure. No change after exposure nor a week after exposure. |
(Hartmann et al., 2014) |
Human |
Traffic related particulate matter |
No, IL-6 had no significant association with exposure, and TNF-α had a negative significant association with the exposure. |
Yes, serum CRP and SAA were significantly and positively associated with increases in exposure. |
(Meier et al., 2014) |
Human |
Emissions from iron foundries |
No significant increase in blood levels of IL-6 and IL-8. |
Yes, blood SAA levels increased with increasing particulate matter exposure. No significant effects were observed for CRP. |
(Westberg et al., 2019) |
Human |
Emissions from pine wood stove (three stone fire stove) |
No significant change in blood levels of IL-6, IL-8 and TNF-α. |
Yes, increased CRP and SAA blood levels 24 h after exposure. No change 3h after exposure. |
(Walker et al., 2022) |
Known modulating factors
Quantitative Understanding of the Linkage
Response-response Relationship
Neutrophil number in brochoalveolar lavage fluid (BALF) (indirect measure of the secretion of proinflammatory mediators – Key event 1496) correlates with plasma SAA3 levels (Key event 1439), in female C57BL/6J mice 1 day after intratracheal instillation of metal oxide nanomaterials (Figure 1). The Pearson’s correlation coefficient was 0.79 (p<0.001) between log-transformed neutrophil number in BALF and log-transformed SAA3 plasma protein levels (Gutierrez et al., 2023).
Figure 1. Correlation between neutrophil numbers and SAA3 plasma protein levels in mice 1 day after exposure to nanomaterials. Reproduced from Gutierrez et al. (2023).
A linear dose-response has also been found between neutrophil numbers in BALF and SAA3 plasma protein levels in mice, 1 day after exposure to multiwalled carbon nanotubes (Figure 2) (Poulsen et al., 2017).
Figure 2. Transformed SAA3 protein vs. transformed neutrophil influx. Reproduced from Poulsen et al. (2017).
Time-scale
It has been shown that the concentration of pro-inflammatory mediators increases before acute phase proteins:
- In patients with atherosclerotic renal stenosis, blood interleukin (IL)-6 increased in the first hour after renal artery stenting and reached its highest concentration at 6h, while C-reactive protein (CRP) increased 6h after the treatment, peaking at 24h after treatment (Li et al., 2004).
- In human infants undergoing cardiopulmonary bypass, it has been observed that blood concentrations of IL-6 significantly increased after cessation of the procedure and remained elevated 24h later, while CRP started increased 6h after bypass and kept increasing at 12h and 24h after bypass (Allan et al., 2010).
Known Feedforward/Feedback loops influencing this KER
Interleukin (IL)-1, IL-6 and TNF- α can decrease acute phase response by decreasing their own production through the induction of corticosteroids (Uhlar & Whitehead, 1999).
Domain of Applicability
Acute phase response is conserved in vertebrate species (Cray, Zaias, & Altman, 2009).
References
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