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The Journal of Immunology, 1998, 161: 3569-3574.
Copyright © 1998 by The American Association of Immunologists

Oxidant Stress Incites Spreading of Macrophages via Extracellular Signal-Regulated Kinases and p38 Mitogen-Activated Protein Kinase1

Makoto Ogura and Masanori Kitamura2

Glomerular Bioengineering Unit, Department of Medicine, University College London Medical School, London, United Kingdom


    Abstract
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
Cultured macrophages exhibit spreading in response to external stimuli. It is relevant to in vivo morphologic changes of macrophages during extravasation, migration, and differentiation. The present study was performed to elucidate molecular mechanisms that regulate spreading of macrophages. Redox is a crucial factor that modulates a wide range of cell function. We found that macrophages undergo spreading in response to oxidant stress caused by hydrogen peroxide or an oxidant generating agent menadione. To identify signaling pathways involved, a role of mitogen-activated protein (MAP) kinases was investigated. Western blot analysis showed that treatment of macrophages with menadione rapidly induced phosphorylation of extracellular signal-regulated kinases (ERK1, ERK2) and p38 MAP kinase, but not c-Jun N-terminal kinase (JNK). Pharmacologic inhibition of either ERK or p38 activation blunted the macrophage spreading. Similarly, transfection with dominant-negative mutants of ERKs or a mutant p38 significantly suppressed the oxidant-triggered spreading. ERKs and p38 are known to activate serum response element (SRE) via phosphorylation of the ternary complex factor Elk-1. To further identify downstream events, we focused on a role of SRE. Stimulation of macrophages with menadione induced activation of SRE. Intervention in the SRE activation by a dominant-negative mutant of Elk-1 inhibited the menadione-induced spreading. These results suggest that oxygen radical metabolites, the well-known mediators for tissue injury, incite spreading of macrophages via the MAP kinase-SRE signaling pathways.


    Introduction
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
Monocytes/macrophages are regarded as important players for maintaining integrity of host defense. Macrophages participate in Ag presentation, phagocytosis of pathogens, and production of defending molecules, including cytokines and reactive oxygen/nitrogen species (1). Following insults, circulating monocytes are attracted, adhere to the local endothelium, migrate into extravascular tissues, and function as differentiated macrophages. During this process, monocytes/macrophages alter their morphologic feature from the round shape to the "spreading form" (1). It has been reported that, in vitro, several pharmacologic stimuli induce spreading of macrophages. Those include phorbol ester, calcium ionophore, and steroidal/nonsteroidal antiinflammatory drugs (2, 3, 4). However, currently, little is understood about pathophysiologically relevant triggers that incite spreading of macrophages at local tissues.

Cellular redox state is a crucial factor that controls a wide range of cell function (5). It is mainly due to the fact that a variety of signaling molecules are redox sensitive. For example, reactive oxygen species trigger phosphorylation of various kinases and activate transcription factors, including activating protein-1 and nuclear factor-{kappa}B (6). We recently found that oxidants, well-known mediators for tissue injury and inflammation, induce spreading of macrophages in culture. Under pathologic milieu, oxidant stress may be an important trigger for in vivo transition of macrophages to the spreading form.

A previous report (7) suggested a role of Egr-1 in the spreading of macrophages. The expression of egr-1 gene is regulated by serum response elements (SREs)3 in its promoter region (8). The activity of SRE is up-regulated by ternary complex factors that are phosphorylated by the mitogen-activated protein (MAP) kinase family of molecules (9). It has been shown that MAP kinases and SRE are redox sensitive and are activated in response to oxidant stress in certain cell types (10, 11). Based on these, the present study was conducted to identify intracellular events required for the oxidant-initiated spreading of macrophages, especially highlighting the roles of extracellular signal-regulated kinases (ERKs), c-Jun N-terminal kinase (JNK), and p38 MAP kinase.


    Materials and Methods
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
Macrophages and pharmacologic manipulation

The normal alveolar rat macrophage NR8383 (12) was purchased from American Type Culture Collection (ATCC, Manassas, VA). The cells were maintained in DMEM/Ham’s F-12 (DMEM-F12; Life Technologies, Gaithersburg, MD) supplemented with 100 U/ml penicillin G, 100 µg/ml of streptomycin, 0.25 µg/ml amphotericin B, and 10 to 15% FCS.

For induction of spreading, NR8383 macrophages seeded in 24-well tissue culture plates (Becton Dickinson, Lincoln Park, NJ) were stimulated with menadione (2-methyl-1,4-naphthoquinone; 25 to 100 µM; Sigma, St. Louis, MO) or 300 µM hydrogen peroxide (Sigma). Menadione is a quinone compound that generates superoxide (O2-) via one-electron-transfer reactions and produces H2O2 and hydroxy radical (OH) (13). Menadione, 50 to 100 µM, was generally used as an inducer of spreading. Morphologic examination was performed after 1 h using phase-contrast microscopy. The percentage of spreading cells was counted in each well, and the mean value of four wells was used to compare data in different groups. More than 60 cells per well were randomly examined for the evaluation. In some experiments, macrophages were pretreated with antioxidant N-acetyl-L-cysteine (10 mM; Sigma) for 2 h and then stimulated by menadione.

To examine roles of ERKs and p38 MAP kinase in the oxidant-triggered spreading, NR8383 macrophages were pretreated with PD098059 (10–75 µM; a gift from Dr. A. R. Saltiel, Parke-Davis Pharmaceutical Research, Ann Arbor, MI) (14) or SB203580 (10 µM; Calbiochem-Novabiochem, Nottingham, U.K.) for 2 h and then stimulated by menadione. All experiments were performed in quadruplicate.

Transfection

The role of ERKs in the oxidant-triggered cell spreading was investigated by transient transfection. Using a modified calcium phosphate coprecipitation method (15), NR8383 macrophages were transfected with pCI-ßGal (a gift from Promega, Madison, WI) together with pCEP4Erk1 + pCEP4Erk2 or pCEP4Erk1(K71R) + pCEP4Erk2(K52R), as described below. pCI-ßGal introduces a ß-galactosidase gene under the control of the immediate-early enhancer/promoter of human cytomegalovirus. pCEP4Erk1 and pCEP4Erk2 code for wt ERK1 and ERK2. pCEP4Erk1(K71R) and pCEP4Erk2(K52R) encode dominant-negative mutants of ERK1 and ERK2, respectively. When overexpressed, these mutants effectively suppress the function of endogenous ERK1 and ERK2 (16). NR8383 cells (2–6 x 106) were suspended in 1 ml of calcium phosphate-DNA complex containing 2 µg pCI-ßGal + 3 µg pCEP4Erk1 + 3 µg pCEP4Erk2, or 2 µg pCI-ßGal + 3 µg pCEP4Erk1(K71R) + 3 µg pCEP4Erk2(K52R). After incubation for 20 min, growth medium (10–15% FCS/DMEM-F12; 9 ml) was added, incubated for additional 2 h, and treated with chloroquine at a concentration of 50 µg/ml. After 2 h incubation, cells were washed and exposed to 15% glycerol in PBS for 90 s. Then, the cells were washed and seeded in 12-well plates. After incubation for 48 h, cells were reseeded in 6-well plates or 10-cm tissue culture plates, stimulated by 100 µM menadione for 1 h, and subjected to 5-bromo-4-chloro-3-indolyl-ß-D-galactopyranoside (X-gal) assay. To test contribution of p38 MAP kinase, NR8383 macrophages were transfected with pCI-ßGal (2 µg) together with empty vector pcDNA3 (6 µg) or pcDNA3-p38(TY) (6 µg) encoding a dominant negative mutant of p38 (17).

To examine a role of SRE in the oxidant-triggered spreading of macrophages, a dominant-negative mutant of Elk-1 was used (18). Elk-1 forms complexes with serum response factor (SRF), and binding of Elk-1-SRF complexes to SRE leads to induction of target genes. If the dominant-interfering form of Elk-1 is overexpressed, activity of SRE is suppressed (18). NR8383 macrophages were transiently transfected with pCI-ßGal (3 µg) together with an empty plasmid pCMV5 (6 µg) or pDN-Elk (6 µg) encoding a mutated Elk-1 with deletion of the carboxyl-terminal activation domain. After 48 h, cells were exposed to menadione and subjected to X-gal assay. All transfection experiments were performed in quadruplicate.

X-gal assay

X-gal assay was performed as described before (19). In brief, cells were fixed in 0.5% glutaraldehyde, 2 mM MgCl2, and 1.25 mM EGTA in PBS for 10 min at room temperature and incubated at 37°C for 2 h in X-gal solution containing 1 mg/ml X-gal (Sigma), 20 mM K3Fe(CN)6, 20 mM K4Fe(CN)6·3H2O, 2 mM MgCl2, 0.01% sodium deoxycholate and 0.02% Nonidet P-40 in PBS (pH 7.4). Percentage of spreading blue cells against total number of blue cells was calculated in each well, and the mean value of four wells was used to compare data in different groups.

Western blot analysis

Phosphorylated forms of ERKs and p38 were detected by Western blot analysis. NR8383 macrophages (1–2 x 106/well) cultured in six-well plates were stimulated by 75 µM menadione for 15 to 60 min. After the exposure, cells were rinsed by PBS, lysed with 300 µl of sample buffer (4% SDS, 10% glycerol, 0.006% bromphenol blue, and 2% ß-mercaptoethanol in 250 mM Tris-HCl; pH 6.8) and boiled for 5 min. Samples were passaged several times through 23-gauge needles. After centrifugation, supernatants were electrophoresed in 10% acrylamide gels and transferred onto nitrocellulose membranes. Analyses were performed using PhosphoPlus MAPK Ab Kit and PhosphoPlus p38 MAP Kinase Ab Kit (New England Biolabs, Hitchin, U.K.) following protocols provided by the manufacturer.

Activity of JNK was evaluated by phosphorylation of c-Jun, using SAPK/JNK Assay Kit (New England Biolabs). In brief, after exposure to menadione, cells were lysed with 300 µl of lysis buffer and passaged several times through needles. After centrifugation, each supernatant containing 50 µg of total protein was incubated with 1 µg of c-Jun fusion protein beads at 4°C overnight. After centrifugation, the pellets were washed, suspended in 50 µl of kinase buffer supplemented with 100 µM ATP, and incubated for 30 min at 30°C. Then, 50 µl of sample buffer was added to each, boiled for 5 min, and centrifuged. Supernatants were then subjected to electrophoresis and immunoblot analysis following the protocol provided by the kit.

Northern blot analysis

NR8383 macrophages were exposed to 50 µM menadione for 0.5, 1, and 2 h. Total RNA was extracted by a single-step method (20) and subjected to Northern blot analysis, as described before (21). In brief, RNA samples were electrophoresed on 1.2% agarose gels containing 10% formaldehyde and transferred onto nitrocellulose membranes. A mouse egr-1 cDNA (22), a human c-fos cDNA (23), and a rat glyceraldehyde-3-phosphate dehydrogenase (GAPDH) cDNA were labeled with [32P]dCTP using the random priming method. The membranes were hybridized with probes at 65°C overnight in a solution containing 4x SSC (600 mM sodium chloride, 60 mM sodium citrate), 5x Denhardt’s solution, 10% dextran sulfate, 50 µg/ml herring sperm DNA, and 50 µg/ml poly(A), washed at 50°C, and exposed to Kodak XAR films at -80°C.

Statistical analysis

Data were expressed as means ± SE. Statistical analysis was performed using the nonparametric Mann-Whitney U test to compare data in different groups. We used a value of p < 0.05 to indicate a statistically significant difference.


    Results
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
Induction of macrophage spreading by oxidant stress

To investigate the effect of oxidants on macrophage spreading, NR8383 cells were plated on tissue culture plastic and incubated in the absence or presence of menadione, which generates reactive oxygen intermediates. Within 1 h, the majority of cells adhered on plastic and showed round appearance, with bright cytoplasm and clear margin (Fig. 1GoA, left). After exposure to menadione, macrophages altered their shape within 30 min and exhibited the "spreading form" characterized by a flat and ameboid shape and dark cytoplasm with vacuolation (1, 24) (Fig. 1GoA, right). After 1 h, approximately 60% of stimulated macrophages showed spreading. The effect of menadione was dose dependent; i.e., percentages of spreading cells were 9.6% by 25 µM, 25.5% by 50 µM, 45.9% by 75 µM, and 55.5% by 100 µM, compared with untreated control (4.8%) (Fig. 1GoB). This effect was completely abrogated in the presence of antioxidant N-acetyl-L-cysteine (Fig. 1GoC). The stimulatory effect of oxidant stress on the cell spreading was further confirmed using H2O2. As shown in Figure 1GoD, 300 µM H2O2 induced spreading of macrophages (53.5 ± 4.1%, mean ± SE, p < 0.05) similarly to the effect of menadione.



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FIGURE 1. Induction of macrophage spreading by oxidant stress. A, Morphologic examination of menadione-induced macrophage spreading. NR8383 rat macrophages were plated on tissue culture plastic and incubated for 1 h in the absence (left) or presence (right) of 75 µM menadione, which generates reactive oxygen intermediates. Phase-contrast microscopy. B, Dose-dependent effect of menadione. NR8383 cells were exposed to menadione at concentrations ranging from 25 µM to 100 µM, and percentages of spreading cells were evaluated by phase-contrast microscopy. C, Inhibition of the menadione-induced spreading by antioxidant N-acetyl-L-cysteine (NAC). NR8383 macrophages were pretreated with or without 10 mM NAC for 2 h and stimulated by menadione. Assays were performed in quadruplicate, and data were presented as means ± SE. An asterisk indicates a statistically significant difference (p < 0.05) compared with the cells treated with menadione alone. D, Induction of macrophage spreading by hydrogen peroxide (H2O2). NR8383 cells were stimulated by 300 µM H2O2 for 1 h, and percentages of spreading cells were evaluated. Assays were performed in quadruplicate. An asterisk indicates a statistically significant difference (p < 0.05) compared with untreated control.

 
Involvement of ERKs

To identify signaling pathways involved in the oxidant-initiated macrophage spreading, a role of ERKs was investigated. NR8383 macrophages were treated with menadione for 15 min, and phosphorylation of ERK1 and ERK2 was examined using phospho-specific Abs. Western blot analysis showed that stimulation of macrophages with menadione rapidly induced phosphorylation of ERK1 and ERK2 (Fig. 2GoA).



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FIGURE 2. Involvement of extracellular signal-regulated kinases (ERKs) in the oxidant-triggered macrophage spreading. A, Activation of ERK1 and ERK2 in menadione-treated macrophages. NR8383 macrophages were treated with 75 µM menadione for 15 min, and phosphorylation of ERK1 and ERK2 was examined by Western blot analysis. As loading controls, the amount of ERK1 and ERK2 proteins are shown on the bottom. B, Dose-dependent inhibition of oxidant-triggered spreading by the mitogen-activated protein kinase kinase inhibitor PD098059. NR8383 macrophages were pretreated with serial concentrations of PD098059 (10–75 µM), stimulated by 50 µM menadione for 1 h, and percentages of spreading cells were evaluated. Assays were performed in quadruplicate. Asterisks indicate statistically significant differences (p < 0.05) compared with the control without PD098059. C, Inhibition of oxidant-triggered spreading by dominant-negative mutants of ERKs. NR8383 cells were transiently transfected with a reporter plasmid pCI-ßGal together with pCEP4Erk1 + pCEP4Erk2 encoding wild-type ERKs (wt ERKs) or pCEP4Erk1(K71R) + pCEP4Erk2(K52R) coding for dominant-interfering forms of ERKs ({Delta}ERKs), as described in Materials and Methods. After incubation for 48 h, cells were stimulated by menadione for 1 h and subjected to X-gal assay. Percentages of spreading cells were evaluated using X-gal-positive cells. Assays were performed in quadruplicate. Percentage of spreading blue cells against total number of blue cells was calculated in each well, and the mean value was used to compare data in different groups. The result (mean ± SE) is shown as a relative percentage against the value of control (100%). An asterisk indicates a statistically significant difference (p < 0.05) compared with the cells transfected with wt ERKs.

 
To examine whether the activation of ERKs is essential for the oxidant-induced cell spreading, NR8383 macrophages were pretreated with serial concentrations of the MAP kinase kinase inhibitor PD098059 and then stimulated by menadione. Microscopic analysis showed that PD098059 inhibited cell spreading in a dose-dependent manner (Fig. 2GoB). Significant suppression was observed at concentrations higher than 50 µM. Compared with control (42.7 ± 2.8%), the percentages of spreading cells were reduced to 28.6 ± 1.6% (50 µM) and 26.0 ± 3.0% (75 µM).

The crucial role of ERKs was further confirmed by a transient transfection assay. NR8383 cells were transfected with a reporter plasmid pCI-ßGal together with pCEP4Erk1 + pCEP4Erk2 encoding wt ERKs or pCEP4Erk1(K71R) + pCEP4Erk2(K52R) coding for dominant-interfering forms of ERKs. After incubation for 48 h, cells were stimulated with menadione and subjected to X-gal assay. Percentages of spreading cells were evaluated using X-gal-positive cells. As shown in Figure 2GoC, transfection with dominant-negative mutants significantly inhibited macrophage spreading. Compared with control (100%), the relative percentage of spreading cells was reduced to 60.8 ± 9.4% (p < 0.05) by the inhibition of ERKs.

Involvement of p38 MAP kinase and JNK

Pharmacologic and genetic inactivation of ERKs only partially inhibited the oxidant-induced macrophage spreading. To further identify molecules that cooperate with ERKs, involvement of p38 MAP kinase and JNK was tested. NR8383 macrophages were treated with menadione for 15 to 60 min, and phosphorylation of p38 and c-Jun was examined. Western blot analysis showed that treatment of macrophages with menadione rapidly induced phosphorylation of p38, with a peak at 30 min (Fig. 3GoA). In contrast, JNK was constitutively active in NR8383 cells, and its activation state was not affected in response to the oxidant stress (Fig. 3GoB).



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FIGURE 3. Involvement of p38 MAP kinase, but not JNK, in the oxidant-triggered macrophage spreading. A, Activation of p38 in menadione-treated macrophages. NR8383 macrophages were stimulated by 75 µM menadione, and, after 15 to 60 min, phosphorylation of p38 was examined by Western blot analysis. As a loading control, the amount of p38 protein is shown on the bottom. B, Activity of JNK in menadione-treated macrophages. NR8383 cells were stimulated by menadione, and phosphorylation of c-Jun was examined by Western blot analysis. As a loading control, the amount of c-Jun protein is shown on the bottom. C, Inhibition of oxidant-triggered spreading by the p38 inhibitor SB203580. NR8383 macrophages were pretreated with SB203580 (10 µM) together with or without PD098059 (50 µM) for 2 h and stimulated by menadione for 1 h. Assays were performed in quadruplicate. An asterisk indicates a statistically significant difference (p < 0.05) compared with the control treated with menadione alone. A double asterisk indicates a significant difference compared with the cells treated with menadione and SB203580. D, Inhibition of oxidant-triggered spreading by a dominant-negative mutant of p38. NR8383 cells were transiently transfected with a reporter plasmid pCI-ßGal together with an empty plasmid pcDNA3 or pcDNA3-p38(TY) that encodes a dominant-negative mutant of p38. After incubation for 48 h, cells were stimulated with menadione (100 µM) for 1 h and subjected to X-gal assay. An asterisk indicates a statistically significant difference (p < 0.05).

 
To examine whether the activation of p38 is required for the oxidant-induced cell spreading, NR8383 cells were pretreated with a pharmacologic inhibitor of p38, SB203580, and then stimulated by menadione. Morphologic analysis showed that SB203580 partially inhibited cell spreading (Fig. 3GoC). Compared with control (40.9 ± 3.3%), the percentage of spreading cells was reduced to 24.6 ± 2.1%. Pretreatment of the cells with SB203580 together with PD098059 led to dramatic suppression of the macrophage spreading (6.8 ± 0.9%).

The role of p38 was further confirmed by a transient transfection assay. NR8383 cells were transfected with a reporter plasmid pCI-ßGal together with an empty plasmid pcDNA3 or pcDNA3-p38(TY) that encodes a dominant-negative mutant of p38. After incubation for 48 h, cells were stimulated with menadione and subjected to X-gal assay. As shown in Figure 3GoD, transfection with p38(TY) significantly inhibited macrophage spreading. Compared with control (100%), the relative percentage of spreading cells was reduced to 57.9 ± 7.5% by the inhibition of p38.

Involvement of SRE

ERKs and p38 are known to activate SRE via phosphorylation of a ternary complex factor Elk-1 (9). To further identify molecular events downstream of the MAP kinase activation, we examined the involvement of SRE. Expression of egr-1 and c-fos are regulated by SREs located in their 5'-flanking regions (8, 25). Using these genes as indicators, activity of SRE was tested by Northern blot analysis. After stimulation of macrophages with menadione, expression of both egr-1 and c-fos was rapidly induced within 30 min and peaked at 1 h (Fig. 4GoA). To examine whether activation of SRE is required for the oxidant-triggered spreading, a dominant-negative mutant of Elk-1 was used. Elk-1 forms complexes with SRF, and binding of Elk-1-SRF complexes to SRE leads to induction of target genes. If the dominant-interfering form of Elk-1 is overexpressed, activity of SRE is abrogated (18). NR8383 macrophages were transiently transfected with pCI-ßGal together with an empty plasmid pCMV5 or pDN-Elk. After 48 h, cells were exposed to menadione, and X-gal assay was performed. As shown in Figure 4GoB, introduction of the Elk-1 mutant significantly inhibited macrophage spreading. The relative percentage of spreading cells was reduced to 29.0 ± 10.7% compared with the value of control (100%).



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FIGURE 4. Involvement of SRE in the oxidant-triggered macrophage spreading. A, Induction of SRE-regulated genes in menadione-treated macrophages. NR8383 macrophages were exposed to menadione (50 µM) for 0.5, 1, and 2 h, and Northern blot analysis was performed on the expression of egr-1 and c-fos. Expression of GAPDH is shown as a loading control. B, Inhibition of oxidant-triggered spreading by a dominant-negative mutant of Elk-1. NR8383 macrophages were transiently transfected with pCI-ßGal together with an empty plasmid pCMV5 or pDN-Elk encoding a mutated Elk-1 with deletion of the carboxyl-terminal activation domain. After 48 h, cells were exposed to menadione (75 µM), and X-gal assay was performed. An asterisk indicates a statistically significant difference (p < 0.05).

 

    Discussion
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
Spreading of macrophages has been considered as a marker of cellular activation and differentiation (1, 24). It has been shown that several pharmacologic agents induce macrophage spreading. For example, phorbol ester, an activator of protein kinase C, induces the spread formation in cells of monocyte-macrophage lineage (2, 26, 27). Calcium ionophore, bleomycin, corticosteroids, nonsteroidal antiinflammatory drugs, and certain immunosuppressants may also induce spreading of macrophages in vitro (3, 4, 28). Currently, however, little is known about pathophysiologically relevant factors that incite spreading of macrophages. In the present report, we describe a novel mechanism that regulates this process. Oxygen radical metabolites, the crucial mediators in various pathophysiologic situations, were identified as triggers for macrophage spreading.

Oxidant stress is involved in various diseases, including inflammation (29), where monocytes/macrophages play an important role. It is known that oxygen radical species stimulate production of monocyte chemoattractant protein-1 and expression of receptors for leukocyte adhesion, leading to accumulation of circulating monocytes at affected sites (30, 31). Our current results, together with the previous reports, suggest potential roles of oxygen radical intermediates for local macrophage function. At the site of inflammation, oxidant stress may attract monocytes and facilitate their extravasation, migration, and differentiation to tissue macrophages. Of note, in the pathologic milieu, the monocyte/macrophage is an important source of local oxidant production. Oxygen radical intermediates produced by local macrophages may further facilitate accumulation and activation of macrophages.

Intracellular signaling pathways involved in macrophage spreading are poorly understood. Previous reports suggested possible roles of certain signaling molecules, including protein kinase C, cytosolic free calcium, phospholipase A2, and arachidonic acid (2, 3, 32, 33). To date, however, successive signaling cascades involved in the macrophage spreading are not identified. In the present investigation, we highlighted the role of the MAP kinase-SRE pathways. ERKs, JNK, and p38 MAP kinase are known to be redox sensitive and activated by oxidants in certain cell types (10, 34). SRE is also regarded as an oxidant-responsive regulatory element (11, 35). Consistent with these, our results showed that menadione phosphorylated ERKs and p38, leading to activation of SRE. Inhibition of either step partially suppressed the oxidant-mediated spreading of macrophages. When both pathways were concomitantly blocked, dramatic suppression of macrophage spreading was observed. Similar, substantial suppression was also achieved by inactivation of SRE. These results indicate that, in response to oxidant stress, the ERK pathway and the p38 pathway cooperatively incite macrophage spreading via activation of SRE.

Rho family members of GTP-binding proteins (Rho, Rac, and Cdc42) play a role in alteration in cytoskeleton organization, motility, and cell shape (36, 37). It has been reported that these GTP-binding proteins can be activated in response to oxidant stress (38) and participate in phorbol ester-induced spreading of macrophages (39). The activation of the Rho family molecules leads to phosphorylation of JNK (40), which may phosphorylate Elk-1 and activate SRE (41). Although, in NR8383 cells, the activity of JNK was not affected by the oxidant stress, the Rho-JNK-SRE pathway might, in part, participate in the oxidant-induced spreading in other cells of monocyte/macrophage lineage.

Molecular events downstream of SRE are currently undetermined. Since the spreading of macrophages is rapid, some immediate-early genes may be involved. A previous report has shown that expression of egr-1 is essential for phorbol ester-induced spreading of myeloid leukemia cells and normal myeloblasts (7). As is known, the expression of egr-1 is induced by oxidants and regulated by SREs in its 5'-flanking region (8, 42). We observed that menadione transiently induced the expression of egr-1 in macrophages preceding their spreading. However, our preliminary results showed that 1) inhibition of egr-1 expression by antisense oligodeoxynucleotides did not inhibit the oxidant-induced spreading of macrophages, and 2) transient transfection with a full-length egr-1 cDNA failed to induce macrophage spreading. Similarly, transfection with a c-fos cDNA, another oxidant inducible immediate-early gene controlled by SRE (25), did not result in macrophage spreading (our unpublished observation). These data imply a possibility that downstream molecule(s) other than egr-1 and c-fos may be involved in the oxidant-initiated macrophage spreading.


    Acknowledgments
 
We thank Drs. R. J. Davis, M. Cobb, J. Han, and H. D. Rupprecht for expression plasmids, and Dr. A. R. Saltiel for PD098059.


    Footnotes
 
1 This work was supported by grants from Baxter Healthcare Corporation (Extramural Grant Program), Wellcome Trust, and National Kidney Research Fund (to M.K.). Back

2 Address correspondence and reprint requests to Dr. Masanori Kitamura, Glomerular Bioengineering Unit, Department of Medicine, University College London Medical School, The Rayne Institute, 5 University Street, London WC1E 6JJ, U.K. E-mail address: Back

3 Abbreviations used in this paper: SRE, serum response element; MAP kinase, mitogen-activated protein kinase; ERK, extracellular signal-regulated kinase; JNK, c-Jun N-terminal kinase; X-gal, 5-bromo-4-chloro-3-indolyl-ß-D-galactopyranoside; SRF, serum response factor; GAPDH, glyceraldehyde-3-phosphate dehydrogenase; wt, wild-type. Back

Received for publication January 22, 1998. Accepted for publication June 1, 1998.


    References
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 

  1. Jr Johnston, R. B.. 1988. Monocytes and macrophages. N. Engl. J. Med. 318:747.[Medline]
  2. Phaire-Washington, L., E. Wang, S. C. Silverstein. 1989. Phorbol myristate acetate stimulates pinocytosis and membrane spreading in mouse peritoneal macrophages. J. Cell Biol. 86:634.[Abstract/Free Full Text]
  3. Smith, B. M., R. J. Sturm, R. A. Carchman. 1983. Calcium modulation of phorbol ester-induced alterations in murine macrophage morphology. Cancer Res. 43:3385.[Abstract/Free Full Text]
  4. Haynes, D. R., M. W. Whitehouse, B. Vernon-Roberts. 1991. The effects of some anti-arthritic drugs and cytokines on the shape and function of rodent macrophages. Int. J. Exp. Pathol. 72:9.[Medline]
  5. Nakamura, H., K. Nakamura, J. Yodoi. 1997. Redox regulation of cellular activation. Annu. Rev. Immunol. 15:351.[Medline]
  6. Suzuki, Y. J., H. J. Forman, A. Sevanian. 1997. Oxidants as stimulators of signal transduction. Free Radical Biol. Med. 22:269.[Medline]
  7. Nguyen, H. Q., B. Hoffman-Liebermann, D. A. Liebermann. 1993. The zinc finger transcription factor Egr-1 is essential for and restricts differentiation along the macrophage lineage. Cell 72:197.[Medline]
  8. Sukhatme, V. P.. 1990. Early transcriptional events in cell growth: the Egr family. J. Am. Soc. Nephrol. 1:859.[Abstract]
  9. Whitmarsh, A. J., R. J. Davis. 1996. Transcription factor AP-1 regulation by mitogen-activated protein kinase signal transduction pathways. J. Mol. Med. 74:589.[Medline]
  10. Guyton, K. Z., Y. Liu, M. Gorospe, Q. Xu, N. J. Holbrook. 1996. Activation of mitogen-activated protein kinase by H2O2: role in cell survival following oxidant injury. J. Biol. Chem. 271:4138.[Abstract/Free Full Text]
  11. Datta, R., N. Taneja, V. P. Sukhatme, S. A. Qureshi, R. Weichselbaum, D. W. Kufe. 1993. Reactive oxygen intermediates target CC(A/T)6GG sequences to mediate activation of the early growth response 1 transcription factor gene by ionizing radiation. Proc. Natl. Acad. Sci. USA 90:2419.[Abstract/Free Full Text]
  12. Helmke, R. J., R. L. Boyd, V. F. German, J. A. Mangos. 1987. From growth factor dependence to growth factor responsiveness: the genesis of an alveolar macrophage cell line. In Vitro Cell. Dev. Biol. 23:567.[Medline]
  13. Thor, H., M. T. Smith, P. Hartzell, G. Bellomo, S. A. Jewell, S. Orrenius. 1982. The metabolism of menadione (2-methyl-1, 4-naphthoquinone) by isolated hepatocytes. J. Biol. Chem. 257:12419.[Abstract/Free Full Text]
  14. Dudley, D. T., L. Pang, S. J. Decker, A. J. Bridges, A. R. Saltiel. 1995. A synthetic inhibitor of the mitogen-activated protein kinase cascade. Proc. Natl. Acad. Sci. USA 92:7686.[Abstract/Free Full Text]
  15. Jr M. F., Smith, D. Eidlen, W. P. Arend, A. Gutierrez-Hartmann. 1994. LPS-induced expression of the human IL-1 receptor antagonist gene is controlled by multiple interacting promoter elements. J. Immunol. 153:3584.[Abstract]
  16. Xie, W., H. R. Herschman. 1995. v-src induces prostaglandin synthase 2 gene expression by activation of the c-Jun N-terminal kinase and the c-Jun transcription factor. J. Biol. Chem. 270:27622.[Abstract/Free Full Text]
  17. Han, J., Y. Jiang, Z. Li, V. V. Kravchenko, R. J. Ulevitch. 1997. Activation of the transcription factor MEF2C by the MAP kinase p38 in inflammation. Nature 386:296.[Medline]
  18. Kitamura, M., Y. Ishikawa. 1998. Three-dimensional matrix primes mesangial cells to down-regulation of {alpha}-smooth muscle actin via deactivation of CArG box elements. Kidney Int. 53:690.[Medline]
  19. Kitamura, M., H. Kawachi. 1997. Creation of an in vivo cytosensor using engineered mesangial cells: automatic sensing of glomerular inflammation controls transgene activity. J. Clin. Invest. 100:1394.[Medline]
  20. Chomczynski, P., N. Sacchi. 1987. Single-step method of RNA isolation by acid guanidinium thiocyanate-phenol chloroform extraction. Anal. Biochem. 162:156.[Medline]
  21. Kitamura, M.. 1997. Identification of an inhibitor targeting macrophage production of monocyte chemoattractant protein-1 as TGF-ß1. J. Immunol. 159:1404.[Abstract]
  22. Rupprecht, H. D., V. P. Sukhatme, J. Lacy, R. B. Sterzel, D. L. Coleman. 1993. PDGF-induced Egr-1 expression in rat mesangial cells is mediated through upstream serum response elements. Am. J. Physiol. 265:F351.[Abstract/Free Full Text]
  23. Ruther, U., E. F. Wagner, R. Muller. 1985. Analysis of the differentiation-promoting potential of inducible c-fos genes introduced into embryonal carcinoma cells. EMBO J. 4:1775.[Medline]
  24. Auwerx, J.. 1991. The human leukemia cell line, THP-1: a multifaceted model for the study of monocyte-macrophage differentiation. Experientia 47:22.[Medline]
  25. Treisman, R.. 1992. The serum response element. Trends Biochem. Sci. 17:423.[Medline]
  26. Petty, H. R.. 1989. Regulation of RAW264 macrophage morphology and spreading: studies with protein kinase C activators, inhibitors and a cyclic AMP analog. Biochim. Biophys. Acta 1012:284.[Medline]
  27. Tonetti, D. A., C. Henning-Chubb, D. T. Yamanishi, E. Huberman. 1994. Protein kinase C-ß is required for macrophage differentiation of human HL-60 leukemia cells. J. Biol. Chem. 269:23230.[Abstract/Free Full Text]
  28. Micallef, M., M. Hosokawa, Y. Togashi, H. Kobayashi. 1992. Rat macrophage activation after treatment with the bleomycin group of antitumor antibiotics in vivo. Cancer Immunol. Immunother. 35:106.[Medline]
  29. Ames, B. N., M. K. Shigenaga, T. M. Hagen. 1993. Oxidants, antioxidants, and the degenerative diseases of aging. Proc. Natl. Acad. Sci. USA 90:7915.[Abstract/Free Full Text]
  30. Satriano, J. A., M. Shuldiner, K. Hora, Y. Xing, Z. Shan, D. Schlondorff. 1993. Oxygen radicals as second messengers for expression of the monocyte chemoattractant protein, JE/MCP-1, and the monocyte colony-stimulating factor, CSF-1, in response to tumor necrosis factor-{alpha} and immunoglobulin G. Evidence for involvement of reduced nicotinamide adenine dinucleotide phosphate (NADPH)-dependent oxidase. J. Clin. Invest. 92:1564.
  31. Lo, S. K., K. Janakidevi, L. Lai, A. B. Malik. 1993. Hydrogen peroxide-induced increase in endothelial adhesiveness is dependent on ICAM-1 activation. Am. J. Physiol. 264:L406.[Abstract/Free Full Text]
  32. Lefkowith, J. B., M. R. Lennartz, M. Rogers, A. R. Morrison, E. J. Brown. 1992. Phospholipase activation during monocyte adherence and spreading. J. Immunol. 149:1729.[Abstract]
  33. Teslenko, V., M. Rogers, J. B. Lefkowith. 1997. Macrophage arachidonate release via both the Ca2+-dependent and -independent phospholipases is necessary for cell spreading. Biochim. Biophys. Acta 1344:189.[Medline]
  34. Whisler, R. L., M. A. Goyette, I. S. Grants, Y. G. Newhouse. 1995. Sublethal levels of oxidant stress stimulate multiple serine/threonine kinases and suppress protein phosphatases in Jurkat T cells. Arch. Biochem. Biophys. 319:23.[Medline]
  35. Müller, J. M., M. A. Cahill, R. A. Rupec, P. A. Baeuerle, A. Nordheim. 1997. Antioxidants as well as oxidants activate c-fos via Ras-dependent activation of extracellular-signal-regulated kinase 2 and Elk-1. Eur. J. Biochem. 244:45.[Medline]
  36. Machesky, L. M., A. Hall. 1996. Rho: a connection between membrane receptor signaling and the cytoskeleton. Trends Cell Biol. 6:304.[Medline]
  37. Chant, J., L. Stowers. 1995. GTPase cascades choreographing cellular behavior: movement, morphogenesis, and more. Cell 81:1.[Medline]
  38. Kim, J., H. Kwack, S. Choi, B. Kim, Y. Kim, I. Kang, C. C. Kumar. 1997. Essential role of Rac GTPase in hydrogen peroxide-induced activation of c-fos serum response element. FEBS Lett. 406:93.[Medline]
  39. Aepfelbacher, M., F. Vauti, P. C. Weber, J. A. Glomset. 1994. Spreading of differentiating human monocytes is associated with a major increase in membrane-bound Cdc42. Proc. Natl. Acad. Sci. USA 91:4263.[Abstract/Free Full Text]
  40. Coso, O. A., M. Chiariello, J. C. Yu, H. Teramoto, P. Crespo, N. Xu, T. Miki, J. S. Gutkind. 1995. The small GTP-binding proteins Rac-1 and Cdc 42 regulate the activity of the JNK/SAPK signaling pathway. Cell 81:1137.[Medline]
  41. Cavigelli, M., F. Dolfi, F. X. Claret, M. Karin. 1995. Induction of c-fos expression through JNK-mediated TCF/Elk-1 phosphorylation. EMBO J. 14:5957.[Medline]
  42. Nose, K., M. Ohba. 1996. Functional activation of egr-1 (early growth response-1) gene by hydrogen peroxide. Biochem. J. 316:381.



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