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Rademeyer KM, R Nass S, Jones AM, Ohene-Nyako M, Hauser KF, McRae M. Fentanyl dysregulates neuroinflammation and disrupts blood-brain barrier integrity in HIV-1 Tat transgenic mice. J Neurovirol 2024; 30:1-21. [PMID: 38280928 PMCID: PMC11232468 DOI: 10.1007/s13365-023-01186-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 10/29/2023] [Accepted: 11/16/2023] [Indexed: 01/29/2024]
Abstract
Opioid overdose deaths have dramatically increased by 781% from 1999 to 2021. In the setting of HIV, opioid drug abuse exacerbates neurotoxic effects of HIV in the brain, as opioids enhance viral replication, promote neuronal dysfunction and injury, and dysregulate an already compromised inflammatory response. Despite the rise in fentanyl abuse and the close association between opioid abuse and HIV infection, the interactive comorbidity between fentanyl abuse and HIV has yet to be examined in vivo. The HIV-1 Tat-transgenic mouse model was used to understand the interactive effects between fentanyl and HIV. Tat is an essential protein produced during HIV that drives the transcription of new virions and exerts neurotoxic effects within the brain. The Tat-transgenic mouse model uses a glial fibrillary acidic protein (GFAP)-driven tetracycline promoter which limits Tat production to the brain and this model is well used for examining mechanisms related to neuroHIV. After 7 days of fentanyl exposure, brains were harvested. Tight junction proteins, the vascular cell adhesion molecule, and platelet-derived growth factor receptor-β were measured to examine the integrity of the blood brain barrier. The immune response was assessed using a mouse-specific multiplex chemokine assay. For the first time in vivo, we demonstrate that fentanyl by itself can severely disrupt the blood-brain barrier and dysregulate the immune response. In addition, we reveal associations between inflammatory markers and tight junction proteins at the blood-brain barrier.
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Affiliation(s)
- Kara M Rademeyer
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, Richmond, VA, 23298, U.S.A
| | - Sara R Nass
- Department of Pharmacology and Toxicology, School of Medicine, Virginia Commonwealth University, Richmond, VA, U.S.A
| | - Austin M Jones
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, Richmond, VA, 23298, U.S.A
| | - Michael Ohene-Nyako
- Department of Pharmacology and Toxicology, School of Medicine, Virginia Commonwealth University, Richmond, VA, U.S.A
| | - Kurt F Hauser
- Department of Pharmacology and Toxicology, School of Medicine, Virginia Commonwealth University, Richmond, VA, U.S.A
| | - MaryPeace McRae
- Department of Neuroscience, School of Medicine, University of Virginia, Charlottesville, VA, 22908, U.S.A..
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Xiang Y, Zhang X, Tian Z, Cheng Y, Liu N, Meng X. Molecular mechanisms of 1,2-dichloroethane-induced neurotoxicity. Toxicol Res 2023; 39:565-574. [PMID: 37779589 PMCID: PMC10541367 DOI: 10.1007/s43188-023-00197-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 06/03/2023] [Accepted: 06/07/2023] [Indexed: 10/03/2023] Open
Abstract
The production of industrial solvents and adhesives often utilizes 1,2-dichloroethane (1,2-DCE), a highly toxic halogenated hydrocarbon compound. Occupational 1,2-DCE poisoning occurs frequently and is a public health concern. Exposure to 1,2-DCE can damage the brain, liver, and kidneys. The main and most severe damage caused by exposure to 1,2-DCE is to the nervous system, especially the central nervous system. Current research on 1,2-DCE mainly focuses on the mechanism of brain edema. Several possible mechanisms of 1,2-DCE neurotoxicity have been proposed, including oxidative stress, calcium overload, blood-brain barrier damage, and neurotransmitter changes. This article reviews the research progress on 1,2-DCE neurotoxicity and the mechanism behind it to provide a scientific basis for the prevention and treatment of 1,2-DCE poisoning.
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Affiliation(s)
- Yang Xiang
- Department of Occupational Health and Occupational Medicine, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, 1838 Guangzhoudadaobei, Guangzhou, Guangdong China
| | - Xiaoshun Zhang
- Department of Occupational Health and Occupational Medicine, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, 1838 Guangzhoudadaobei, Guangzhou, Guangdong China
| | - Zhiling Tian
- Shanghai Key Laboratory of Forensic Medicine, Ministry of Justice, Shanghai Forensic Service Platform, Key Laboratory of Forensic Science, Academy of Forensic Science, Shanghai, China
| | - Yibin Cheng
- Shanghai Key Laboratory of Forensic Medicine, Ministry of Justice, Shanghai Forensic Service Platform, Key Laboratory of Forensic Science, Academy of Forensic Science, Shanghai, China
| | - Ningguo Liu
- Shanghai Key Laboratory of Forensic Medicine, Ministry of Justice, Shanghai Forensic Service Platform, Key Laboratory of Forensic Science, Academy of Forensic Science, Shanghai, China
| | - Xiaojing Meng
- Department of Occupational Health and Occupational Medicine, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, 1838 Guangzhoudadaobei, Guangzhou, Guangdong China
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Treponema pallidum Tp0751 alters the expression of tight junction proteins by promoting bEnd3 cell apoptosis and IL-6 secretion. Int J Med Microbiol 2022; 312:151553. [DOI: 10.1016/j.ijmm.2022.151553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 02/04/2022] [Accepted: 03/13/2022] [Indexed: 02/02/2023] Open
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Roles of Crosstalk between Astrocytes and Microglia in Triggering Neuroinflammation and Brain Edema Formation in 1,2-Dichloroethane-Intoxicated Mice. Cells 2021; 10:cells10102647. [PMID: 34685627 PMCID: PMC8534694 DOI: 10.3390/cells10102647] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/30/2021] [Accepted: 09/30/2021] [Indexed: 12/30/2022] Open
Abstract
We have previously reported that the activation of astrocytes and microglia may lead to the overproduction of proinflammatory mediators, which could induce neuroinflammation and cause brain edema in 1,2-dichloroethane (1,2-DCE)-intoxicated mice. In this research, we further hypothesized that astrocyte–microglia crosstalk might trigger neuroinflammation and contribute to brain edema in 1,2-DCE-intoxicated mice. The present research revealed, for the first time, that subacute intoxication with 1,2-DCE might provoke the proinflammatory polarization of microglia, and pretreatment with minocycline, a specific inhibitor of microglial activation, may attenuate the enhanced protein levels of ionized calcium-binding adapter molecule1 (Iba-1), cluster of differentiation 11b (CD11b), glial fibrillary acidic protein (GFAP), soluble calcium-binding protein 100B (S100B), tumor necrosis factor α (TNF-α), interleukin 6 (IL-6), inducible nitric oxide synthase (iNOS), vascular cell adhesion molecule-1 (VCAM-1), intercellular adhesion molecule-1 (ICAM-1), matrix metalloproteinase-9 (MMP-9), Toll-like receptor 4 (TLR4), MyD88, and p-p65, and ameliorate the suppressed protein expression levels of occludin and claudin 5; we also observed changes in water content and made pathological observations on edema in the brains of 1,2-DCE-intoxicated mice. Moreover, pretreatment with fluorocitrate, an inhibitor of reactive astrocytes, could also reverse the alteration in protein expression levels of GFAP, S100B, Iba-1, CD11b, TNF-α, IL-6, iNOS, VCAM-1, ICAM-1, MMP-9, occludin, and claudin 5 in the brain of 1,2-DCE intoxicated mice. Furthermore, pretreatment with melatonin, a well-known anti-inflammatory drug, could also attenuate the above-mentioned changes in the brains of 1,2-DCE-intoxicated mice. Altogether, the findings from this research indicated that microglial activation might play an important role in triggering neuroinflammation, and hence may contribute to brain edema formation; additionally, the findings suggested that molecular crosstalk between reactive astrocytes and activated microglia may amplify the neuroinflammatory reaction, which could induce secondary brain injury in 1,2-DCE-intoxicated mice.
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Wan FC, Zhang C, Jin Q, Wei C, Zhao HB, Zhang XL, You W, Liu XM, Liu GF, Liu YF, Tan XW. Protective effects of astaxanthin on lipopolysaccharide-induced inflammation in bovine endometrial epithelial cells†. Biol Reprod 2021; 102:339-347. [PMID: 31566218 DOI: 10.1093/biolre/ioz187] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 08/21/2019] [Accepted: 09/12/2019] [Indexed: 01/20/2023] Open
Abstract
Astaxanthin (AST), a natural antioxidant carotenoid, has been shown to exert anti-inflammatory effects. However, to our knowledge, no study has specifically addressed the potential protective effects of AST against bovine endometritis. The purpose of this study was to examine whether treatment with AST could protect endometrial epithelial cells against lipopolysaccharide (LPS)-induced inflammatory injury. Treatment of bovine endometrial (BEND) epithelial cell line with AST reduced LPS-induced production of interleukin-6 and tumor necrosis factor-alpha, increased the cellular activity of superoxide dismutase and catalase, decreased the proportion of apoptotic cells, and promoted the production of insulin-like growth factor and epithelial growth factor. The effects of AST were mediated through the downregulation of B-cell lymphoma 2 (Bcl-2) associated X, apoptosis regulator (Bax), and cleaved caspase-3 and through the upregulation of Bcl-2. Moreover, AST significantly increased the expression of the tight junction proteins (TJP) claudin, cadherin-1, and TJP1, which play an essential role in the maintenance of host endometrial defense barrier against pathogen infection. Collectively, these results demonstrated that treatment with AST protected against oxidative stress, prevented cell apoptosis, promoted BEND cells viability, and increased the production of growth factors, in addition to activating the endometrial defense barrier. Therefore, AST is a promising therapeutic agent for the prevention and treatment of endometritis. This finding is of utmost importance in the present times when the excessive use of antibiotics has resulted in the development of antibiotic-resistant bacteria.
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Affiliation(s)
- Fa-Chun Wan
- Institute of Animal Science and Veterinary Medicine, Shandong Academy of Agricultural Sciences, Ji'nan City, China.,Shandong Key Lab of Animal Disease Control and Breeding, Ji'nan City, China.,Shandong Provincial Testing Center of Beef Cattle Performance, Ji'nan City, China.,College of Life Sciences, Shandong Normal University, Ji'nan City, China
| | - Chen Zhang
- College of Life Sciences, Shandong Normal University, Ji'nan City, China
| | - Qing Jin
- Institute of Animal Science and Veterinary Medicine, Shandong Academy of Agricultural Sciences, Ji'nan City, China.,Shandong Key Lab of Animal Disease Control and Breeding, Ji'nan City, China.,Shandong Provincial Testing Center of Beef Cattle Performance, Ji'nan City, China
| | - Chen Wei
- Institute of Animal Science and Veterinary Medicine, Shandong Academy of Agricultural Sciences, Ji'nan City, China.,Shandong Key Lab of Animal Disease Control and Breeding, Ji'nan City, China.,Shandong Provincial Testing Center of Beef Cattle Performance, Ji'nan City, China
| | - Hong-Bo Zhao
- Institute of Animal Science and Veterinary Medicine, Shandong Academy of Agricultural Sciences, Ji'nan City, China.,Shandong Key Lab of Animal Disease Control and Breeding, Ji'nan City, China.,Shandong Provincial Testing Center of Beef Cattle Performance, Ji'nan City, China
| | - Xiang-Lun Zhang
- Institute of Animal Science and Veterinary Medicine, Shandong Academy of Agricultural Sciences, Ji'nan City, China.,Shandong Key Lab of Animal Disease Control and Breeding, Ji'nan City, China.,Shandong Provincial Testing Center of Beef Cattle Performance, Ji'nan City, China
| | - Wei You
- Institute of Animal Science and Veterinary Medicine, Shandong Academy of Agricultural Sciences, Ji'nan City, China.,Shandong Key Lab of Animal Disease Control and Breeding, Ji'nan City, China.,Shandong Provincial Testing Center of Beef Cattle Performance, Ji'nan City, China
| | - Xiao-Mu Liu
- Institute of Animal Science and Veterinary Medicine, Shandong Academy of Agricultural Sciences, Ji'nan City, China.,Shandong Key Lab of Animal Disease Control and Breeding, Ji'nan City, China.,Shandong Provincial Testing Center of Beef Cattle Performance, Ji'nan City, China
| | - Gui-Fen Liu
- Institute of Animal Science and Veterinary Medicine, Shandong Academy of Agricultural Sciences, Ji'nan City, China.,Shandong Key Lab of Animal Disease Control and Breeding, Ji'nan City, China.,Shandong Provincial Testing Center of Beef Cattle Performance, Ji'nan City, China
| | - Yi-Fan Liu
- Institute of Animal Science and Veterinary Medicine, Shandong Academy of Agricultural Sciences, Ji'nan City, China.,Shandong Key Lab of Animal Disease Control and Breeding, Ji'nan City, China.,Shandong Provincial Testing Center of Beef Cattle Performance, Ji'nan City, China
| | - Xiu-Wen Tan
- Institute of Animal Science and Veterinary Medicine, Shandong Academy of Agricultural Sciences, Ji'nan City, China.,Shandong Key Lab of Animal Disease Control and Breeding, Ji'nan City, China.,Shandong Provincial Testing Center of Beef Cattle Performance, Ji'nan City, China
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Integrative Analysis of MAPK14 as a Potential Biomarker for Cardioembolic Stroke. BIOMED RESEARCH INTERNATIONAL 2020; 2020:9502820. [PMID: 32879891 PMCID: PMC7448239 DOI: 10.1155/2020/9502820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/09/2020] [Accepted: 07/15/2020] [Indexed: 01/22/2023]
Abstract
The aim of this study was to obtain the candidate genes and biomarkers that are significantly related to cardioembolic stroke (CS) by applying bioinformatics analysis. In accordance with the results of the weighted gene coexpression network analysis (WGCNA) in the GSE58294 dataset, 11 CS-related coexpression network modules were identified in this study. Correlation analysis showed that the black and pink modules are significantly associated with CS. A total of 18 core genes in the black module and one core gene in the pink module were determined. We then identified differentially expressed genes (DEGs) of CS at 3 h, 5 h, and 24 h postonset. After performing intersection, it was found that 311 genes were coexpressed at these three time points. These genes were majorly enriched in positive regulation of transferase activity and regulation of peptidase activity. The abovementioned coexpressed DEGs were subjected to protein-protein interaction analysis and subnetwork module analysis. Subsequently, we used cytoHubba to obtain 11 key genes from DEGs. The intersection of the core genes screened from WGCNA and the key genes selected from DEGs yielded the MAPK14 gene. The expression level of MAPK14 on the receiver operating characteristic (ROC) curves of CS at 3 h, 5 h, and 24 h showed that the area under the ROC curve (AUC) was 0.923, 0.934, and 0.941, respectively. In a nutshell, MAPK14 screened out by using WGCNA showed differential expression in CS. We conclude that MAPK14 can be used as a potential biological marker of CS and exhibits potential to predict the physiopathological condition of CS patients.
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Pérez-Rodríguez MJ, Ibarra-Sánchez A, Román-Figueroa A, Pérez-Severiano F, González-Espinosa C. Mutant Huntingtin affects toll-like receptor 4 intracellular trafficking and cytokine production in mast cells. J Neuroinflammation 2020; 17:95. [PMID: 32220257 PMCID: PMC7102443 DOI: 10.1186/s12974-020-01758-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 02/24/2020] [Indexed: 12/22/2022] Open
Abstract
Background Huntington’s disease (HD) is caused by the expression of a mutated variant of Huntingtin (mHtt), which results in the complex pathology characterized by a defective function of the nervous system and altered inflammatory responses. While the neuronal effects of mHtt expression have been extensively studied, its effects on the physiology of immune cells have not been fully described. Mast cells (MCs) are unique tissue-resident immune cells whose activation has been linked to protective responses against parasites and bacteria, but also to deleterious inflammatory allergic reactions and, recently, to neurodegenerative diseases. Methods Bone marrow-derived mast cells (BMMCs) were obtained from wild-type (WT-) and mHtt-expressing (R6/1) mice to evaluate the main activation parameters triggered by the high-affinity IgE receptor (FcεRI) and the Toll-like receptor (TLR) 4. Degranulation was assessed by measuring the secretion of β-hexosaminidase, MAP kinase activation was detected by Western blot, and cytokine production was determined by RT-PCR and ELISA. TLR-4 receptor and Htt vesicular trafficking was analyzed by confocal microscopy. In vivo, MC-deficient mice (c-KitWsh/Wsh) were intraperitonally reconstituted with WT or R6/1 BMMCs and the TLR4-induced production of the tumor necrosis factor (TNF) was determined by ELISA. A survival curve of mice treated with a sub-lethal dose of bacterial lipopolysaccharide (LPS) was constructed. Results R6/1 BMMCs showed normal β-hexosaminidase release levels in response to FcεRI, but lower cytokine production upon LPS stimulus. Impaired TLR4-induced TNF production was associated to the lack of intracellular dynamin-dependent TLR-4 receptor trafficking to perinuclear regions in BMMCs, a diminished ERK1/2 and ELK-1 phosphorylation, and a decrease in c-fos and TNF mRNA accumulation. R6/1 BMMCs also failed to produce TLR4-induced anti-inflammatory cytokines (like IL-10 and TGF-β). The detected defects were also observed in vivo, in a MCs-dependent model of endotoxemia. R6/1 and c-KitWsh/Wsh mice reconstituted with R6/1 BMMCs showed a decreased TLR4-induced TNF production and lower survival rates to LPS challenge than WT mice. Conclusions Our data show that mHtt expression causes an impaired production of pro- and anti-inflammatory mediators triggered by TLR-4 receptor in MCs in vitro and in vivo, which could contribute to the aberrant immunophenotype observed in HD.
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Affiliation(s)
- Marian Jesabel Pérez-Rodríguez
- Departamento de Farmacobiología, Centro de Investigación y de Estudios Avanzados del IPN, Calzada de los Tenorios 235, Granjas Coapa, Tlalpan, 14330, Mexico City, Mexico.,Laboratorio de Neurofarmacología Molecular y Nanotecnología, Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez", Insurgentes Sur 3877, La Fama, Tlalpan, 14269, Mexico City, Mexico
| | - Alfredo Ibarra-Sánchez
- Departamento de Farmacobiología, Centro de Investigación y de Estudios Avanzados del IPN, Calzada de los Tenorios 235, Granjas Coapa, Tlalpan, 14330, Mexico City, Mexico
| | - Abraham Román-Figueroa
- Departamento de Farmacobiología, Centro de Investigación y de Estudios Avanzados del IPN, Calzada de los Tenorios 235, Granjas Coapa, Tlalpan, 14330, Mexico City, Mexico
| | - Francisca Pérez-Severiano
- Laboratorio de Neurofarmacología Molecular y Nanotecnología, Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez", Insurgentes Sur 3877, La Fama, Tlalpan, 14269, Mexico City, Mexico
| | - Claudia González-Espinosa
- Departamento de Farmacobiología, Centro de Investigación y de Estudios Avanzados del IPN, Calzada de los Tenorios 235, Granjas Coapa, Tlalpan, 14330, Mexico City, Mexico.
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Jin X, Wang T, Liao Y, Guo J, Wang G, Zhao F, Jin Y. Neuroinflammatory Reactions in the Brain of 1,2-DCE-Intoxicated Mice during Brain Edema. Cells 2019; 8:cells8090987. [PMID: 31461951 PMCID: PMC6770564 DOI: 10.3390/cells8090987] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 08/24/2019] [Accepted: 08/26/2019] [Indexed: 12/19/2022] Open
Abstract
We previously reported that expression of matrix metalloproteinase-9 (MMP-9) mRNA and protein was upregulated during 1,2-dichloroethane (1,2-DCE) induced brain edema in mice. We also found that the p38 mitogen-activated protein kinase (p38 MAPK) signaling pathway resulted in MMP-9 overexpression and nuclear factor-κB (NF-κB) activation in mice treated with 1,2-DCE. In this study, we further hypothesized that inflammatory reactions mediated by the p38 MAPK/ NF-κB signaling pathway might be involved in MMP-9 overexpression, blood–brain barrier (BBB) disruption and edema formation in the brain of 1,2-DCE-intoxicated mice. Our results revealed that subacute poisoning by 1,2-DCE upregulates protein levels of glial fibrillary acidic protein (GFAP), ionized calcium-binding adapter molecule 1 (Iba-1), interleukin-1β (IL-1β), vascular cell adhesion molecule-1 (VCAM-1), intercellular adhesion molecule-1 (ICAM-1), inducible nitric oxide synthase (iNOS) and p-p65 in mouse brains. Pretreatment with an inhibitor against p38 MAPK attenuates these changes. Moreover, pretreatment with an inhibitor against NF-κB attenuates alterations in brain water content, pathological indications notable in brain edema, as well as mRNA and protein expression on levels of MMP-9, VCAM-1, ICAM-1, iNOS, and IL-1β, tight junction proteins (TJs), GFAP and Iba-1 in the brain of 1,2-DCE-intoxicated mice. Furthermore, pretreatment with an inhibitor against MMP-9 obstructs the decrease of TJs in the brain of 1,2-DCE-intoxicated mice. Lastly, pretreatment with an antagonist against the IL-1β receptor also attenuates changes in protein levels of p-p38 MAPK, p-p65, p-IκB, VCAM -1, ICAM-1, IL-1β, and Iba-1 in the brain of 1,2-DCE-intoxicated-mice. Taken together, findings from the current study indicate that the p38 MAPK/ NF-κB signaling pathway might be involved in the activation of glial cells, and the overproduction of proinflammatory factors, which might induce inflammatory reactions in the brain of 1,2-DCE-intoxicated mice that leads to brain edema.
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Affiliation(s)
- Xiaoxia Jin
- Department of Occupational and Environmental Health, School of Public Health, China Medical University, Shenyang 110122, Liaoning, China
- Department of Occupational and Environmental Health, School of Public Health, Shenyang Medical College, Shenyang 110034, Liaoning Province, China
| | - Tong Wang
- Department of Occupational and Environmental Health, School of Public Health, China Medical University, Shenyang 110122, Liaoning, China
| | - Yingjun Liao
- Department of Physiology, China Medical University, Shenyang 110122, Liaoning, China
| | - Jingjing Guo
- Department of Occupational and Environmental Health, School of Public Health, China Medical University, Shenyang 110122, Liaoning, China
| | - Gaoyang Wang
- Department of Occupational and Environmental Health, School of Public Health, China Medical University, Shenyang 110122, Liaoning, China
| | - Fenghong Zhao
- Department of Occupational and Environmental Health, School of Public Health, China Medical University, Shenyang 110122, Liaoning, China
| | - Yaping Jin
- Department of Occupational and Environmental Health, School of Public Health, China Medical University, Shenyang 110122, Liaoning, China.
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