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Is Interleukin-38 a Key Player Cytokine in Atherosclerosis Immune Gene

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Is Interleukin-38 a Key Player Cytokine in Atherosclerosis Immune Gene Medical Hypotheses 125 (2019) 139–143 Contents lists available at ScienceDirect Medical Hypotheses journal homepage: www.elsevier.com/locate/mehy Is Interleukin-38 a key player cytokine in atherosclerosis immune gene therapy? T ⁎ Abdolreza Esmaeilzadeha,b, , Shabnam Pouyanc, Maryam Erfanmaneshd a Department of Immunology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran b Cancer Gene Therapy Research Center, Zanjan University of Medical Sciences, Zanjan, Iran c School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran d Young Researchers and Elite Club, Zanjan Branch, Islamic Azad University, Zanjan, Iran ARTICLE INFO ABSTRACT Keywords: Atherosclerosis, a chronic inflammatory disease of the arteries associated with lipids and other metabolic al- Atherosclerosis terations is a leading cause of death all around the world and its rate is raising as a result of unhealthy lifestyles. IL-38 Reports by World Health Organization indicate that 31% of all death occurrences are due to heart attacks and Statins strokes. Today, the most common medicines for treating atherosclerosis are statins which are HMG-coA re- Inflammation ductase inhibitors. Beside their benefits in treating atherosclerosis, some side effects have been reported as well. Immune gene therapy Thus, therapeutic methods based on statins should be evaluated to result in more beneficial effects. Since atherosclerosis is an inflammatory disorder, an anti-inflammatory component can decrease the impact of this disease. Interleukin-38, a newly discovered anti-inflammatory cytokine, which acts as an Interleukin-36 receptor antagonist can block Nuclear Factor KB and Activator protein-1 signaling pathways, and block atherogenic core formation accordingly. This novel proposed immune gene therapy can be applied to atherosclerosis treatment in a trial study. In this hypothesis, Interleukin-38 gene is transferred into bone marrow Mesenchymal Stem Cells of atherosclerotic mouse model Apo E-/- via an adenoviral vector. It is expected that Interleukin-38 gene expression by Mesenchymal Stem Cells can efficiently remedy atherosclerosis without the side effects of statins. Introduction lesion of Apo-E knocked-out mice, and inactivation of TNF-α diminishes lesion size in both nutritional and genetic model of atherosclerosis [10]. Atherosclerosis, which impacts large- and medium-sized arteries, is In addition, an increase in IL-6 production is also associated with a chronic immune-mediated inflammatory disease [1]. It is the major atherosclerosis and cardiovascular mortality [8,11]. Up-regulation of T- cause of myocardial infarction (MI), stroke, angina (chest pain) and helper17 (Th17) is increased during atherosclerosis [12]. IL-17, a heart failure. So it is one of the leading cause of death all over the world principal pro-inflammatory cytokine, is produced by Th17 and also and the incidence is rising as a result of unhealthy lifestyles [2,3]. other types of cells such as Natural Killer cells (NK cells), T cells and Atherosclerosis is a kind of multifactorial disease. According to epide- lymph tissue inducer cells [9]. IL-17 stimulates the production of TNF- miological studies, atherosclerosis is associated with both genetic α, IL-6 and Monocyte Chemoattractant Protein-1 (MCP-1), thus induces (susceptibility or resistance of artery to atherosclerosis) and environ- inflammation [9]. First step in the formation of an atheromatous plaque mental risk factors including hypertension, diabetes, tobacco smoking is the entrance of Low Density Lipoprotein (LDL) particles and their and blood flow pattern [4,5]. This causes altered cell metabolism and derivatives from blood to intima, where they accumulate. Then LDL gene expression and also pro-inflammatory cytokines secretion by en- particles will be modified by enzymes like myeloperoxidase, sphingo- dothelial cells [6].Inflammation has a key role in the initiation and myelinase and secretory phospholipase which in turn will activate in- development of atherosclerosis; great number of immune cells and nate inflammatory system [4,5].Inflammation initiates when En- immune mediators are involved in atherogenesis process [7–9]. Pro- dothelial Cells (ECs) are activated in lesion-prone sites [5]. Activated inflammatory cytokines like IL-6 and Tumor Necrosis Factor-α (TNF-α) ECs express adhesion molecules like Vascular Cell Adhesion Molecule-1 contribute to atheromatous plaque formation [8]. As reported by Ca- (VCAM-1), E-selectin, P-selectin [13] and Intercellular Adhesion Mo- nault M. et al., TNF-α induces inflammatory reactions in atheromatous lecule-1 (ICAM-1) [14] which recruit monocytes [13]. ⁎ Corresponding author at: Department of Immunology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran (A. Esmaeilzadeh). E-mail address: [email protected] (A. Esmaeilzadeh). https://doi.org/10.1016/j.mehy.2019.02.048 Received 31 July 2018; Accepted 27 February 2019 0306-9877/ © 2019 Published by Elsevier Ltd. A. Esmaeilzadeh, et al. Medical Hypotheses 125 (2019) 139–143 Intimal macrophages replicate and also secrete some cytokines and it can influence the pro-inflammatory function of IL-36 [26,33], but it Growth factors which contribute in atheromatous lesion complication doesn’t bind to the immobilized IL-1RI, IL-18R and IL-1R accessory [13]. Primarily, researchers had supposed that macrophages were the proteins (IL-1RAP, IL-1RAcP) [29]. IL-1RI was once supposed to be a only leukocytes which are present in an atheromatous plaque, but receptor for IL-38 based on IL-38 amino acid homology to IL-1Ra further studies indicated that other immune cells including regulatory [27,30]. However, its binding affinity is significantly lower than IL-1Ra T-cells (T-regs), CD4+ T cells, myeloid cells and mast cells during and IL-1β. So the anti-inflammatory functions of IL-38 are related to atherosclerosis should also be considered [15]; MCP-1 (which is im- blocking IL-1R and IL-36R pathways [33]. However, the exact mole- portant in initial steps), MCP-4, MIP-1a, Macrophage Inflammatory cular mechanism by which IL-38 controls inflammation is still dis- Protein-1b (MIP-1b), IL-8 are a few examples [14]. Interferons (IFN) putable and further studies are needed [34]. A novel study has illu- which guide T-cells and monocytes to the lesion site and increase T- strated that IL-38 inhibited Candida Albicans-induced Th17 (IL-17 and helper 1 promoting cytokines secretion, TNF- (which have an important IL-22) production in Peripheral Blood Mononuclear Cells (PBMCs). This role in early stages of atherosclerosis by stimulating monocytes to inhibition was absent in IFN-γ (Th1 cytokine). By comparison, LPS-in- collect oxidized LDL (ox-LDL) and forming foam cells) [9]. In addition, duced IL-6 production was notably higher in the presence of IL-38 (26, IL-4 and IL-6 levels are raised in patients with cardiovascular diseases 28). Van de Veerdonk, has reported that it is unlikely that IL-38 sup- [16]. According to the role of inflammation in atherosclerosis, some presses IL-17 by affecting IL-18 or its receptor [33]. Quoted from Xianli novel anti-inflammatory therapies are introduced as potential adjunct Yuan, IL-38 gene polymorphisms are associated with psoriatic arthritis drugs to current therapy [17]. For example, Canakinumab which acts as (PsA), ankylosing spondylitis and cardiovascular disease suggesting IL-1 β neutralizing monoclonal antibody [18,19], Adalimumab which is that IL-38 is strongly correlated with these inflammatory diseases [28]. a TNF-α blocker antibody [18–20], Darapladib which is a phospholi- Recent studies have demonstrated a correlation between IL-38 and pase A2 (PLA2) inhibitor [21] and other drugs like Methotrexate, Col- autoimmune diseases like rheumatoid arthritis [35]. IL-38 also takes chicine, Ustekinumab, briakinumab, varespladib and terutroban can be part in immune regulation and is involved in MAPK activation. Re- considered as such. There are also some drugs on clinical trial [18] like cently, Kazuki takada, indicated that “IL-38 is involved in carcinogen- Anakinra or interleukin-1 receptor antagonist (IL-1Ra) which reduces esis and tumor progression through the regulation of tumor associated IL-6 and C-Reactive Protein (CRP) levels [17,22]. Other drugs with no transcriptional factors” [36]. Contrary to biological effects of IL-38 as anti-inflammatory effect are Statins. The most common and best-selling an inhibitor of IL-22 and IL-17 production, IL-38 is not a classic receptor drug (in the USA) in treating cardiovascular diseases and athero- antagonist in comparison with IL-1Ra. Notably, IL-36Ra is not a classic sclerosis, is HMG-CoA reductase which is a statin [23,24]. Statins have receptor antagonist, as well. These data indicate that IL-36Ra and IL-38 these pleiotropic effects [13]; they reduce atherogenic lipoprotein le- are partial receptor antagonists which act as antagonists when their vels [4], stabilize plaque and retard plaque progression [5]. They also concentration is high. Furthermore, above linking to IL-36R, the co- reduce leukocyte adhesion, and prevent macrophages from activation receptor that IL-38 and IL-36Ra recruit are different at high and low and proliferation. Additionally, statins prevent Matrix MetalloProtei- concentrations; as we see an inhibitory co-receptor at low concentra- nase (MMP) production by macrophages. Similar to any drug, statins tions and a signaling co-receptor at high concentrations [33]. As a re- have some side effects [23], where it inhibits HMG-CoA reductase at an sult, IL-38 may have dose-dependent effects, i.e. the efficacy of IL-38 at early stage in the mevalonate pathway. In addition to cholesterol, other low concentrations were more than high concentrations [26,28]. Some products are generated by this pathway, too including heme-A, coen- effects of IL-38 and IL-36Ra is still unclear; for instance, it is yet am- zyme Q10, isoprenylated proteins, which have vital roles in natural biguous why they increase pro-inflammatory cytokines in dendritic physiology of body. cells whereas decrease pro-inflammatory cytokines in peripheral blood Above this, cholesterol is not solely a final product, but also a mononuclear cells [27].
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