Furthermore, heme induces ROS generation dependent on enzymatic reactions.
Heme induces ROS generation independently of TLR4.
Heme activates neutrophils and endothelial cells, by ROS generation.
Differently from biliverdin and CO, which have anti-inflammatory effects (Otterbein et al., 2000; Baranano et al., 2002), free Fe is highly oxidative and can promote free radicals generation through the Fenton reaction, which catalyzes hydroxyl radicals from the reaction of Fe with H2O2 (Fenton, 1894).
Heme also induces the expression of the adhesion molecules ICAM-1, VCAM-1, and E-selectins.
CO inhibits Hb oxidation and subsequently heme release, thus blocking heme accumulation in serum and preventing heme from exerting its inflammatory effects in the course of malaria disease (Ferreira et al., 2011).
Besides its physiological importance, heme has a potent oxidative capacity oxidizing lipids (Tappel, 1953, 1955; Vincent et al., 1988) and proteins (Aft and Mueller, 1984; Vincent, 1989), and damaging DNA (Aft and Mueller, 1983).
Heme-induced necroptosis is reversed by deferoxamine, a Fe chelator.
Once intercalated into cellular plasma membranes heme amplifies cellular susceptibility to oxidative-mediated injury by oxidants such as H2O2 or those derived from activated inflammatory cells (Balla et al., 1991a,b, 1993).
These concepts challenged the idea that the cytotoxic and inflammatory effects of heme were exclusively mediated by the oxidative capability of the Fe associated with the amphipathic property of the porphyrin ring.
In fact, heme can induce neutrophil migration by acting as a chemotactic molecule (Porto et al., 2007) or by inducing the production of leukotriene B4 (LTB4) by macrophages (Monteiro et al., 2011).
As described before, LTB4 has an important function regulating heme-induced neutrophils migration (Monteiro et al., 2011).
KC (keratinocyte-derived chemokine) is a chemokine that attracts neutrophils to sites of inflammation and LTB4 is a lipid mediator that functions as a chemoattractant molecule and also activates leukocytes.
Low-density lipoprotein is the major lipid involved in plaque formation.
In fact, heme-induced LDL oxidation is highly cytotoxic for endothelial cells and LDL oxidation seems to be mediated by Fe (Jeney et al., 2002; Nagy et al., 2010).
mROS scavenger (Mito-TEMPO) and NADPH oxidases inhibitors (apocynin and DPI) block TNF production induced by heme.
mROS scavenger (Mito-TEMPO) and NADPH oxidases inhibitors (apocynin and DPI) block heme-induced necroptosis.
Heme injection in mice leads to vascular permeability, leukocyte migration from the intravascular environment to tissues and increase of acute-phase proteins (Lyoumi et al., 1999; Wagener et al., 2001b), hallmarks of acute inflammation.
Heme activates endothelial cells inducing the expression of the adhesion molecules ICAM-1 (intercellular adhesion molecule 1), VCAM-1 (vascular cell adhesion molecule 1), E-selectin, Pselectin, and von Willebrand factor (VWF; Wagener et al., 1997; Belcher et al., 2014) and causes neutrophil migration (GraçaSouza et al., 2002; Porto et al., 2007).
Importantly, heme b interaction with heme oxygenase (HO; Lad et al., 2003), the enzyme responsible for heme intracellular catabolism, and hemopexin (Hx; Paoli et al., 1999), a plasmatic heme scavenger, is essential for the regulation of free heme availability and Fe recycling (Kovtunovych et al., 2010; Tolosano et al., 2010).
Heme amplifies cytokines induced by cell surface receptors (TLR2, TLR4, TLR5), endosome receptors (TLR3, TLR9), and cytosolic receptors (NOD1 and NOD2).
During intravascular hemolysis the serum proteins responsible for removing heme get saturated and heme can exert its inflammatory effects.
The consequences of heme toxicity can be appreciated in hemolytic diseases such as β-thalassemia, sickle-cell disease (SCD), ischemia-reperfusion (IR), and malaria (Katori et al., 2002; Pamplona et al., 2007;Vinchi et al., 2013).
. Heme can destabilize biological membranes increasing its permeability and the chance of lysis (Schmitt et al., 1993), as it happens with erythrocytes (Chiu and Lubin, 1989).
Alternatively, heme induced formation of radical species relies on the conversion of low-reactive organic hydroperoxides (ROOH) into highly reactive alkoxyl (RO•) and peroxyl (ROO•) radicals (Tappel, 1953, 1955; Van der Zee et al., 1996).
In endothelial cells, heme induces TLR4-dependent degranulation of Weibel–Palade bodies and P-selectins and VWF release.
A seminal study demonstrated that the ability of heme to activate neutrophils depend on protein kinase C (PKC) activation and ROS generation, inducing the expression of adhesion molecules and modifying actin cytoskeleton dynamics, necessary features for neutrophils migration (Graça-Souza et al., 2002).
Heme-induced neutrophils activation leads to extracellular traps (NETs) release through a mechanism dependent on ROS generation (Chen et al., 2014).
In this context, heme inhibits neutrophils apoptosis, increasing their longevity, and possibly enhancing harmful stimuli from these cells (Arruda et al., 2004, 2006).
. Heme activates macrophages inducing the production of TNF, KC (Figueiredo et al., 2007), IL-1β (unpublished), and LTB4 (Monteiro et al., 2011).
On the other hand, TNF secretion induced by heme is essential for the activation of the programed necrotic cell death pathway, which is denominated necroptosis (Fortes et al., 2012).
Moreover, heme amplifies MyD88- (TNF and IL-6) and TRIF-dependent (IP-10) cytokines.
Highly purified heme free of endotoxin contamination was used, as well as polymyxin B, anti-TLR4/MD2, and lipid A antagonist, all of which inhibited the effects of LPS but did not interfere with the induction of TNF by heme.
The TLR4 activates two distinct pathways: MyD88 and TRIF. In macrophages, heme induces a biased MyD88 activation and the secretion of the pro-inflammatory cytokines TNF and KC.
Moreover, human embryonic kidney (HEK) cells transfected with human TLR4 secretes IL-8 upon stimulation with heme (Piazza et al., 2011).
In fact, TLR4 is involved in intracerebral hemorrhage (ICH) induced by heme (Lin et al., 2012).
Moreover, HO-1 has a protective effect during heme-induced necroptosis.
Therefore, it is clear that heme triggers ROS-induced sensitization of macrophages to TNFR-mediated cell death through RIP1 and RIP3 activation to promote necroptosis (Figure 2).
Heme induces Syk phosphorylation in macrophages.
Moreover, heme induces apoptosis in human brain vascular endothelial cells (HBVEC) by STAT3 (signal transducer and activator of transcription 3)-dependent activation of matrix metallopeptidase 3 (MMP3; Liu et al., 2013).
These radicals may initiate further lipid peroxidation forming alkyl radicals that in the presence of O2 form more peroxyl radicals leading to a facile propagation of free radical reactions.
. In the presence of reactive oxygen species (ROS), Hb is oxidized to methemoglobin (MetHb; Balla et al., 1993), characterized by the change in the oxidative state of the Fe present in the heme molecule from ferrous (Fe+2) to ferric (Fe+3).
Although neutrophils have important functions controlling infection, these cells can promote vascular and tissue injury by generating ROS, secreting proteases, and releasing extracellular chromatin (NETs; reviewed in Mócsai, 2013).
However, ROS is necessary to induce TNF secretion and MAPK activation.
Because of its large molecular size, this complex is maintained in the intravascular space, preventing the association of otherwise free Hb with nitric oxide (NO; Reiter et al., 2002) and inhibiting the release of free heme (Melamed-Frank et al., 2001).
Stimulation of astrocytes with heme, as a model of hemorrhagic injury, causes cell death with characteristics of programed necrosis including the loss of plasma membrane integrity, reversion by necrostatin-1, a selective inhibitor of RIP1, and by antioxidants (Laird et al., 2008).
Hemoglobin is used as a nutrient by Plasmodium, the protozoan parasite that causes malaria, during its replication stage inside erythrocytes in the course of the infection in mammals (Francis et al., 1997).
Similarly to heme, ferrylHb activates endothelial cells through NFκB activation (Silva et al., 2009).
Moreover, ferrylHb is unable to induce cytokine secretion by endothelial cells (Silva et al., 2009), another difference to heme which induces IL-8 production (Natarajan et al., 2007).
Like MetHb, ferrylHb is unstable and releases free heme to further increase oxLDL formation (Potor et al., 2013).
Similarly to heme, Hz also induces the production of several inflammatory mediators by macrophages such as cytokines and chemokines, and induces leukocytes migration (reviewed by Olivier et al., 2014).
Atypical hemolytic uremic syndrome (aHUS) is characterized by an over activation of the complement alternative pathway (CAP) due to genetic and acquired abnormalities (Noris and Remuzzi, 2009).
Once inside the cells, heme is catabolized by HO enzymes, generating equimolar amounts of biliverdin, carbon monoxide (CO), and Fe (Tenhunen et al., 1968).
LXR-β protects against lipid overload by activating a lipid exportation program regulated by proteins such as LXR-α and ATP binding cassette transporter A1 (ABCA1), preventing foam cells formation.
Hemolysis increases the concentration of Hb which, under oxidative stress, releases free heme.
In vivo, injection of heme and LPS induces a significant increase in the concentrations of TNF and IL-6 when compared to the challenge with LPS alone (Fernandez et al., 2010).
Hx inhibits the oxidative property of heme (Eskew et al., 1999) and mediates heme transportation to intracellular compartments through the macrophage receptor CD91 (Hvidberg et al., 2005), a critical step on heme catabolism.
In fact, hemolysis or heme injection in Hx−/− mice cause increased inflammation and severe renal damage compared to wild type (WT) mice (Tolosano et al., 1999; Vinchi et al., 2008).
TLR4 activation leads to MAPKs and NFκB activation, which are necessary to TNF secretion.
In fact, Tlr4-/- or anti-TLR4 treatment suppresses heme-induced neuroinflammation, edema, and neurologic deficit.
Indeed, TLRs and NLRP3 have been associated with atherosclerosis development.
After hemolysis, sustained interaction between Hb and ROS can lead to ferrylhemoglobin (ferrylHb) formation, which is characterized by an increase in the Fe oxidative state to Fe+4 (Harel and Kanner, 1988; Patel et al., 1996).
Hb synergizes with LPS enhancing the production of pro-inflammatory cytokines by macrophages (Yang et al., 2002).
WhileMAPK8 increases ROS generation, TNF induces RIP1–RIP3 necrosome which triggers necroptosis.
Cells deficient on FtH are more susceptible to oxidative damage, while increased amounts of FtH protects cells from death induced by challenges such as Fe, tumor necrosis factor (TNF), heme, heme plus TNF, or oxidized low-density lipoprotein (LDL; Juckett et al., 1995; Pham et al., 2004; Gozzelino et al., 2012).
Importantly, increased expression of FtH also protects different cell types from the cytotoxic effects of heme, TNF or heme and TNF (Balla et al., 1992; Berberat et al., 2003; Cozzi et al., 2003; Gozzelino et al., 2012).
The antioxidant property of FtH blocks TNF-induced JNK activation, reducing cell death (Pham et al., 2004; Kamata et al., 2005; Gozzelino et al., 2012).
Interestingly, a 6-year-old patient with HO-1 deficiency experienced a severe atherosclerotic pathology (Yachie et al., 1999).
During the resolution phase of inflammation HO-1 expression in leukocytes reduces adhesion molecules expression and leukocytes migration, thus contributing to wound healing (Wagener et al., 2003a).
Moreover, IL-1β and TNF modifies the hypothalamus threshold of the body temperature causing fever.
Although KC and IL-1β functions were not investigated during heme-induced inflammatory effects, TNF and LTB4 were described as essential inflammatory mediators during inflammatory events induced by heme.
The MyD88-dependent pathway leads to the activation of mitogen-activated protein kinases (MAPKs) and NF-κB (nuclear factor kappa-light-chain-enhancer of activated B cells) transcription factors inducing the expression of inflammatory cytokines such as TNF, IL-6, IL-1β, and KC (Takeuchi and Akira, 2010)
. Interestingly, NLRP3 knockdown and mROS inhibitors reduce brain edema and improve neurological functions (Ma et al., 2014).
The VWF is prothrombotic and can increase the adhesion of erythrocytes to the endothelium.
Mice lacking HO-1 (Hmox1−/−) are highly susceptible to pathologic conditions associated with increased serum heme concentration.
For instance, Hmox−/− mice develops acute renal failure and marked mortality when submitted to rhabdomyolysis, a pathological condition that increases serum myoglobin which can be oxidized and release heme (Nath et al., 2000).
Furthermore, Hmox1−/− mice are susceptible to liver IR which is characterized by tissue damage in sites that are reperfused after ischemia injury and hemolysis (Devey et al., 2009).
Depending on the extension of the vaso-occlusion, some tissues may experience hypoxia and damage.
Vaso-occlusion of the lung microvasculature may result in the development of the ACS through the infarction of the lung parenchyma.
SCD and β-thalassemia are genetic diseases associated to erythrocytes that are prone to lysis due to defective Hb production (Heinle and Read, 1948; Pauling et al., 1949; Ingram, 1957; discussed later).
Hemolysis can happen due to ischemia/reperfusion, SCD or β-thalassemia.
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If you find BEL Commons useful in your work, please consider citing: Hoyt, C. T., Domingo-Fernández, D., & Hofmann-Apitius, M. (2018). BEL Commons: an environment for exploration and analysis of networks encoded in Biological Expression Language. Database, 2018(3), 1–11.