Efferocytosis
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Encyclopedia of Cancer DOI 10.1007/978-3-642-27841-9_7215-1 # Springer-Verlag Berlin Heidelberg 2015 Efferocytosis Nikko Brix*, Anna Tiefenthaller and Kirsten Lauber Clinic for Radiotherapy and Radiation Oncology, LMU Munich, Munich, Germany Keywords Apoptosis; Necrosis; Phagocytes; Macrophages; Dendritic cells; Immune response; Inflammation; Immune tolerance; Autoimmunity; Cancer; “Find-me” signals; “Eat-me” signals; “Don’t-eat-me” signals Definition The term efferocytosis (from effere, Latin for “to take away”, “to carry to the grave”, “to bury”) has been defined as the process of apoptotic cell removal, which involves phagocyte recruitment, dying cell recognition, and engulfment. Characteristics The Efferocytic Process Apoptotic Cell Death In higher multicellular organisms, the removal of dying cells is a common event: It is estimated that one million cells undergo apoptosis per second in a human adult, and fundamental biological processes, such as embryogenesis, the resolution of inflammation, or homeostatic cell turnover involve apoptosis and subsequent clearance of dying cells. This is performed either by neighboring cells (when they are endowed with “amateur” phagocyte capacity) or by professional phagocytes, such as macrophages and immature dendritic cells (DCs), respectively. Macrophages and DCs serve as “undertakers” of dying cells with different tasks. Whereas macrophages can powerfully engulf and degrade huge amounts of dying cell material, DCs act as sentinels, which capture antigen and (cross-)present it to T cells, thus sculpting adaptive immune responses. The entire process of apoptosis is finely controlled, swift, and innoxious for the surrounding tissue. These characteristics starkly distinguish it from the events being observed during necrosis, which is considered to be a nonphysiological form of cell death where plasma membrane rupture and the uncontrolled release of cytosolic danger signals occur. Importantly, apoptosis is an immunogenically silent event. It is morphologically characterized by cell shrinking, chromatin condensation, nuclear fragmentation, and plasma membrane blebbing. On the molecular level, a set of proteases termed caspases commonly initiate and execute this form of programmed cell death. Besides, caspase-independent forms of apoptosis have been reported. The integrity of organelles and the plasma membrane is preserved until late stages of apoptosis. Thus, the liberation of pro-inflammatory intracellular molecules, including heat shock proteins, high mobility group box 1 protein (HMGB1), S100 proteins, and uric acid, which may damage neighboring cells and induce inflammation, is prevented. *Email: [email protected] Page 1 of 7 Encyclopedia of Cancer DOI 10.1007/978-3-642-27841-9_7215-1 # Springer-Verlag Berlin Heidelberg 2015 Phagocyte Recruitment by Apoptotic Cells In order to “orchestrate” their own burial, apoptotic cells send out soluble chemotactic factors to trigger monocyte/macrophage recruitment, which is a premise for efficient efferocytosis. These “find-me” signals comprise biomolecules of very different classes, such as nucleotides (mainly ATP and UTP), phospho- lipids (e.g. lysophosphatidylcholine and sphingosine-1-phosphate), and proteins (for instance, the ectodomain of the IL-6 receptor and soluble fractalkine), which are recognized by the corresponding phagocyte receptors. Recognition of Apoptotic Cells by Phagocytes Upon attraction to the apoptotic site, phagocytes must precisely distinguish between healthy and dying cells. This substep of the efferocytic cascade is guided by the exposure of “eat-me” signals on the apoptotic cell surface. Translocation of phosphatidylserine (PS) to the outer leaflet of the plasma membrane is the best-known and probably most important example. This phospholipid is recognized by bona fide PS receptors on the phagocytes (e.g. brain angiogenesis inhibitor 1 (BAI-1), T cell immunoglobulin mucin domain (TIM) family members 1, 3, and 4, and the stabilins 1 and 2) or indirectly via soluble bridging proteins, which bind to both PS and their respective phagocytic cell surface receptors. Examples of bridging proteins secreted by phagocytes are milk fat globule EGF factor 8 (MFG-E8) and developmental endothelial locus 1 (Del-1). Moreover, bridging proteins derived from apoptotic cells, such as annexin A1, or from interstitial body fluids (b2-glycoprotein, growth arrest specific gene 6 (GAS6), and protein S) have been described. Furthermore, additional “eat-me” signals apart from PS exist. Examples are the surface exposure of ICAM-3 on apoptotic cells being recognized by CD14 and altered sugars, which are detected by lectins on the phagocyte. Besides, the inactivation and/or the lack of “don’t-eat-me” signals (e.g. CD47 and CD46) contribute to efficient dying cell engulfment. These proteins are expressed on healthy cells and thus protect them from being accidentally ingested by phagocytes. Taken together, a plethora of different signals mediate the engulfment of apoptotic cells, and it is currently being unraveled which receptor- ligand axis dominates in which tissue or organ. Apoptotic Cell Engulfment The signaling mechanisms that are initiated upon ligation of phagocytic “eat-me” signal receptors are far from being fully understood. Yet, it is known that the ingestion of apoptotic cells requires massive modifications in the phagocyte’s actin cytoskeleton. These are regulated by small GTPases of the RHO family, such as RHOA, RAC, and CDC42. RHOA activation has been described to inhibit apoptotic cell engulfment via binding and thereby activating its downstream effector Rho-associated coiled-coil containing protein kinase (ROCK). ROCK activation may in turn alter the phosphorylation status of myosin light chain and thus the phagocytic actin cytoskeleton structure and contractility. Inversely, RHOA inhibition was shown to promote dying cell engulfment. In contrast to RHOA, RAC activation positively affects apoptotic cell engulfment. For instance, the PS receptor BAI-1 is known to activate RAC by recruiting the adaptor protein engulfment and cell motility 1 (ELMO1) and its binding partner dedicator of cytokinesis 180 (DOCK180). The Post-Phagocytic Immune Response Apoptotic cell death itself is not only immunogenically silent, it also shapes the post-phagocytic immune response. Unlike the uptake of necrotic cell material by macrophages, apoptotic cell engulfment induces the secretion of anti-inflammatory cytokines including interleukin-10 (IL-10), transforming growth factor b (TGF-b), and prostaglandin E2 (PGE2). The removal of apoptotic cell material by DCs that have been educated in this milieu leads to tolerogenic (cross-)presentation of antigens in the draining lymph nodes. Page 2 of 7 Encyclopedia of Cancer DOI 10.1007/978-3-642-27841-9_7215-1 # Springer-Verlag Berlin Heidelberg 2015 Among the “tolerate-me” signals, which are involved in the immunomodulatory processes being initiated upon apoptotic cell clearance, exposure of PS is of crucial importance. However, since PS exposure is also observed during necrosis after plasma membrane rupture, it is evident that several other biomolecules might contribute to sculpting the immunological outcome of dying cell phagocytosis. Moreover, the cause of apoptotic cell death, the predominating dying cell type, and the quantity of apoptotic cells naturally modify the post-phagocytic immune response. The latter point is of particular importance: Although efferocytosis is performed rapidly under physiological conditions, excessive apoptotic cell death and/or inefficient clearance may overwhelm the phagocytic capacity: For instance, accumulating, uncleared apoptotic cells can be observed in the context of autoimmune diseases or after tumor radio(chemo)therapy as discussed below. As a result, these apoptotic cells may transit into secondary necrosis culminating in plasma membrane rupture and liberation of pro-inflammatory intracellular components. Considering their disparate origin, the soluble mediators released from primary and secondary necrotic cells encode for different immunological outcomes but commonly induce pro-inflammatory processes, which may atten- uate the anti-inflammatory milieu at a formerly apoptotic site. Diseases Caused by Malfunctioning Efferocytosis The fact that apoptotic cells are rarely seen in homeostatic tissues testifies the efficiency of dying cell removal by professional and “amateur” phagocytes. In case of malfunctioning dying cell clearance, insufficient immunological quiescence causes recruitment of inflammatory cells into the tissue. Accumu- lation of this cell debris might initiate immunological reactions against self-antigens resulting in different types of chronic inflammatory diseases. Rheumatic Diseases The term “rheumatism” summarizes a wide range of autoimmune diseases affecting different organs. Their common pathogenesis is associated to autoimmune mechanisms – immune reactions against the body’s own tissues. From an immunological point of view, defective efferocytosis after tissue destruction leads to accu- mulation of cell corpses, which progress into secondary necrosis and release their intracellular contents (e.g., DNA, nucleosomes, and histones) upon cell membrane rupture. The immune system generates antibodies against these intracellular antigens, which in complex with their cognate antigens can stimulate an exacerbation of the inflammatory cascade. The immune reaction against own tissue structures and intracellular components results in general symptoms such as fever,