<?xml version="1.0" encoding="UTF-8" standalone="no"?>
<!DOCTYPE article PUBLIC "-//NLM//DTD Journal Publishing DTD v2.3 20070202//EN" "journalpublishing.dtd">
<article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" article-type="research-article" dtd-version="2.3" xml:lang="EN">
<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Immunol.</journal-id>
<journal-title>Frontiers in Immunology</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Immunol.</abbrev-journal-title>
<issn pub-type="epub">1664-3224</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3389/fimmu.2024.1401527</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Immunology</subject>
<subj-group>
<subject>Original Research</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>Haptoglobin buffers lipopolysaccharides to delay activation of NF&#x3ba;B</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author" equal-contrib="yes">
<name>
<surname>Zein</surname>
<given-names>Laura</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<xref ref-type="author-notes" rid="fn003">
<sup>&#x2020;</sup>
</xref>
<xref ref-type="author-notes" rid="fn004">
<sup>&#x2021;</sup>
</xref>
<role content-type="https://credit.niso.org/contributor-roles/visualization/"/>
<role content-type="https://credit.niso.org/contributor-roles/methodology/"/>
<role content-type="https://credit.niso.org/contributor-roles/investigation/"/>
<role content-type="https://credit.niso.org/contributor-roles/formal-analysis/"/>
<role content-type="https://credit.niso.org/contributor-roles/data-curation/"/>
<role content-type="https://credit.niso.org/contributor-roles/conceptualization/"/>
<role content-type="https://credit.niso.org/contributor-roles/writing-review-editing/"/>
</contrib>
<contrib contrib-type="author" equal-contrib="yes">
<name>
<surname>Grossmann</surname>
<given-names>Josina</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<xref ref-type="author-notes" rid="fn003">
<sup>&#x2020;</sup>
</xref>
<xref ref-type="author-notes" rid="fn004">
<sup>&#x2021;</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/2363485"/>
<role content-type="https://credit.niso.org/contributor-roles/visualization/"/>
<role content-type="https://credit.niso.org/contributor-roles/validation/"/>
<role content-type="https://credit.niso.org/contributor-roles/resources/"/>
<role content-type="https://credit.niso.org/contributor-roles/methodology/"/>
<role content-type="https://credit.niso.org/contributor-roles/investigation/"/>
<role content-type="https://credit.niso.org/contributor-roles/formal-analysis/"/>
<role content-type="https://credit.niso.org/contributor-roles/data-curation/"/>
<role content-type="https://credit.niso.org/contributor-roles/conceptualization/"/>
<role content-type="https://credit.niso.org/contributor-roles/writing-review-editing/"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Swoboda</surname>
<given-names>Helena</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<role content-type="https://credit.niso.org/contributor-roles/writing-review-editing/"/>
<role content-type="https://credit.niso.org/contributor-roles/data-curation/"/>
<role content-type="https://credit.niso.org/contributor-roles/formal-analysis/"/>
<role content-type="https://credit.niso.org/contributor-roles/investigation/"/>
<role content-type="https://credit.niso.org/contributor-roles/resources/"/>
<role content-type="https://credit.niso.org/contributor-roles/supervision/"/>
<role content-type="https://credit.niso.org/contributor-roles/validation/"/>
<role content-type="https://credit.niso.org/contributor-roles/visualization/"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Borgel</surname>
<given-names>Christina</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/2357575"/>
<role content-type="https://credit.niso.org/contributor-roles/visualization/"/>
<role content-type="https://credit.niso.org/contributor-roles/validation/"/>
<role content-type="https://credit.niso.org/contributor-roles/methodology/"/>
<role content-type="https://credit.niso.org/contributor-roles/investigation/"/>
<role content-type="https://credit.niso.org/contributor-roles/formal-analysis/"/>
<role content-type="https://credit.niso.org/contributor-roles/data-curation/"/>
<role content-type="https://credit.niso.org/contributor-roles/writing-review-editing/"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Wilke</surname>
<given-names>Bernhard</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<role content-type="https://credit.niso.org/contributor-roles/writing-review-editing/"/>
<role content-type="https://credit.niso.org/contributor-roles/data-curation/"/>
<role content-type="https://credit.niso.org/contributor-roles/investigation/"/>
<role content-type="https://credit.niso.org/contributor-roles/methodology/"/>
<role content-type="https://credit.niso.org/contributor-roles/resources/"/>
<role content-type="https://credit.niso.org/contributor-roles/supervision/"/>
<role content-type="https://credit.niso.org/contributor-roles/validation/"/>
<role content-type="https://credit.niso.org/contributor-roles/visualization/"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Awe</surname>
<given-names>Stephan</given-names>
</name>
<xref ref-type="aff" rid="aff3">
<sup>3</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/2528301"/>
<role content-type="https://credit.niso.org/contributor-roles/methodology/"/>
<role content-type="https://credit.niso.org/contributor-roles/investigation/"/>
<role content-type="https://credit.niso.org/contributor-roles/writing-review-editing/"/>
<role content-type="https://credit.niso.org/contributor-roles/conceptualization/"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Nist</surname>
<given-names>Andrea</given-names>
</name>
<xref ref-type="aff" rid="aff4">
<sup>4</sup>
</xref>
<role content-type="https://credit.niso.org/contributor-roles/writing-review-editing/"/>
<role content-type="https://credit.niso.org/contributor-roles/data-curation/"/>
<role content-type="https://credit.niso.org/contributor-roles/investigation/"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Stiewe</surname>
<given-names>Thorsten</given-names>
</name>
<xref ref-type="aff" rid="aff4">
<sup>4</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/2527729"/>
<role content-type="https://credit.niso.org/contributor-roles/data-curation/"/>
<role content-type="https://credit.niso.org/contributor-roles/writing-review-editing/"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Stehling</surname>
<given-names>Oliver</given-names>
</name>
<xref ref-type="aff" rid="aff5">
<sup>5</sup>
</xref>
<xref ref-type="aff" rid="aff6">
<sup>6</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/2280894"/>
<role content-type="https://credit.niso.org/contributor-roles/methodology/"/>
<role content-type="https://credit.niso.org/contributor-roles/conceptualization/"/>
<role content-type="https://credit.niso.org/contributor-roles/writing-review-editing/"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Freibert</surname>
<given-names>Sven-Andreas</given-names>
</name>
<xref ref-type="aff" rid="aff5">
<sup>5</sup>
</xref>
<xref ref-type="aff" rid="aff6">
<sup>6</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/1590816"/>
<role content-type="https://credit.niso.org/contributor-roles/supervision/"/>
<role content-type="https://credit.niso.org/contributor-roles/methodology/"/>
<role content-type="https://credit.niso.org/contributor-roles/formal-analysis/"/>
<role content-type="https://credit.niso.org/contributor-roles/data-curation/"/>
<role content-type="https://credit.niso.org/contributor-roles/writing-review-editing/"/>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name>
<surname>Adhikary</surname>
<given-names>Till</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<xref ref-type="author-notes" rid="fn001">
<sup>*</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/397768"/>
<role content-type="https://credit.niso.org/contributor-roles/conceptualization/"/>
<role content-type="https://credit.niso.org/contributor-roles/data-curation/"/>
<role content-type="https://credit.niso.org/contributor-roles/formal-analysis/"/>
<role content-type="https://credit.niso.org/contributor-roles/investigation/"/>
<role content-type="https://credit.niso.org/contributor-roles/methodology/"/>
<role content-type="https://credit.niso.org/contributor-roles/project-administration/"/>
<role content-type="https://credit.niso.org/contributor-roles/resources/"/>
<role content-type="https://credit.niso.org/contributor-roles/supervision/"/>
<role content-type="https://credit.niso.org/contributor-roles/validation/"/>
<role content-type="https://credit.niso.org/contributor-roles/visualization/"/>
<role content-type="https://credit.niso.org/contributor-roles/writing-original-draft/"/>
<role content-type="https://credit.niso.org/contributor-roles/writing-review-editing/"/>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name>
<surname>Chung</surname>
<given-names>Ho-Ryun</given-names>
</name>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<xref ref-type="author-notes" rid="fn001">
<sup>*</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/2032735"/>
<role content-type="https://credit.niso.org/contributor-roles/supervision/"/>
<role content-type="https://credit.niso.org/contributor-roles/software/"/>
<role content-type="https://credit.niso.org/contributor-roles/resources/"/>
<role content-type="https://credit.niso.org/contributor-roles/project-administration/"/>
<role content-type="https://credit.niso.org/contributor-roles/methodology/"/>
<role content-type="https://credit.niso.org/contributor-roles/investigation/"/>
<role content-type="https://credit.niso.org/contributor-roles/funding-acquisition/"/>
<role content-type="https://credit.niso.org/contributor-roles/formal-analysis/"/>
<role content-type="https://credit.niso.org/contributor-roles/data-curation/"/>
<role content-type="https://credit.niso.org/contributor-roles/conceptualization/"/>
<role content-type="https://credit.niso.org/contributor-roles/writing-review-editing/"/>
<role content-type="https://credit.niso.org/contributor-roles/writing-original-draft/"/>
<role content-type="https://credit.niso.org/contributor-roles/visualization/"/>
</contrib>
</contrib-group>
<aff id="aff1">
<sup>1</sup>
<institution>Institute for Molecular Biology and Tumor Research, Center for Tumor Biology and Immunology, Philipps University Marburg</institution>, <addr-line>Marburg</addr-line>, <country>Germany</country>
</aff>
<aff id="aff2">
<sup>2</sup>
<institution>Institute for Medical Bioinformatics and Biostatistics, Philipps University Marburg</institution>, <addr-line>Marburg</addr-line>, <country>Germany</country>
</aff>
<aff id="aff3">
<sup>3</sup>
<institution>Institute for Molecular Biology and Tumor Research, Biomedical Research Center, Philipps University Marburg</institution>, <addr-line>Marburg</addr-line>, <country>Germany</country>
</aff>
<aff id="aff4">
<sup>4</sup>
<institution>Genomics Core Facility, Center for Tumor Biology and Immunology, Philipps University Marburg</institution>, <addr-line>Marburg</addr-line>, <country>Germany</country>
</aff>
<aff id="aff5">
<sup>5</sup>
<institution>Protein Biochemistry and Spectroscopy Core Facility, Center for Synthetic Microbiology, Philipps University Marburg</institution>, <addr-line>Marburg</addr-line>, <country>Germany</country>
</aff>
<aff id="aff6">
<sup>6</sup>
<institution>Institute of Cytobiology, Center for Synthetic Microbiology, Philipps University Marburg</institution>, <addr-line>Marburg</addr-line>, <country>Germany</country>
</aff>
<author-notes>
<fn fn-type="edited-by">
<p>Edited by: Jiakai Hou, University of Houston, United States</p>
</fn>
<fn fn-type="edited-by">
<p>Reviewed by: Turner H. Swartz, South Dakota State University, United States</p>
<p>Barry J. Bradford, Michigan State University, United States</p>
<p>Anja Serap Sipka, Cornell University, United States</p>
</fn>
<fn fn-type="corresp" id="fn001">
<p>*Correspondence: Till Adhikary, <email xlink:href="mailto:adhikary@imt.uni-marburg.de">adhikary@imt.uni-marburg.de</email>; Ho-Ryun Chung, <email xlink:href="mailto:ho.chung@staff.uni-marburg.de">ho.chung@staff.uni-marburg.de</email>
</p>
</fn>
<fn fn-type="present-address" id="fn003">
<p>&#x2020;Present address: Laura Zein, Institute for Experimental Cancer Research in Pediatrics, Goethe University Frankfurt, Frankfurt, Germany Josina Grossmann, Mammalian Cell Cycle Control Mechanisms Group, German Cancer Research Center, Heidelberg, Germany</p>
</fn>
<fn fn-type="equal" id="fn004">
<p>&#x2021;These authors have contributed equally to this work</p>
</fn>
</author-notes>
<pub-date pub-type="epub">
<day>02</day>
<month>10</month>
<year>2024</year>
</pub-date>
<pub-date pub-type="collection">
<year>2024</year>
</pub-date>
<volume>15</volume>
<elocation-id>1401527</elocation-id>
<history>
<date date-type="received">
<day>15</day>
<month>03</month>
<year>2024</year>
</date>
<date date-type="accepted">
<day>05</day>
<month>09</month>
<year>2024</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#xa9; 2024 Zein, Grossmann, Swoboda, Borgel, Wilke, Awe, Nist, Stiewe, Stehling, Freibert, Adhikary and Chung</copyright-statement>
<copyright-year>2024</copyright-year>
<copyright-holder>Zein, Grossmann, Swoboda, Borgel, Wilke, Awe, Nist, Stiewe, Stehling, Freibert, Adhikary and Chung</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/">
<p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</p>
</license>
</permissions>
<abstract>
<p>It has remained yet unclear which soluble factors regulate the anti-inflammatory macrophage phenotype observed in both homeostasis and tumourigenesis. We show here that haptoglobin, a major serum protein with elusive immunoregulatory properties, binds and buffers bacterial lipopolysaccharides to attenuate activation of NF&#x3ba;B in macrophages. Haptoglobin binds different lipopolysaccharides with low micromolar affinities. Given its abundance, haptoglobin constitutes a buffer for serum-borne lipopolysaccharides, shielding them to safeguard against aberrant inflammatory reactions by reducing the amount of free lipopolysaccharides available for binding to TLR4. Concordantly, NF&#x3ba;B activation by haptoglobin-associated lipopolysaccharides was markedly delayed relative to stimulation with pure lipopolysaccharide. Our findings warrant evaluation of therapeutic benefits of haptoglobin for inflammatory conditions and re-evaluation of purification strategies. Finally, they allow to elucidate mechanisms of enhanced immunosuppression by oncofetal haptoglobin.</p>
</abstract>
<kwd-group>
<kwd>LPS</kwd>
<kwd>lipopolysaccharide</kwd>
<kwd>haptoglobin</kwd>
<kwd>NFkB</kwd>
<kwd>LPS buffering</kwd>
<kwd>TLR4</kwd>
</kwd-group>
<counts>
<fig-count count="4"/>
<table-count count="0"/>
<equation-count count="0"/>
<ref-count count="64"/>
<page-count count="10"/>
<word-count count="4498"/>
</counts>
<custom-meta-wrap>
<custom-meta>
<meta-name>section-in-acceptance</meta-name>
<meta-value>Cytokines and Soluble Mediators in Immunity</meta-value>
</custom-meta>
</custom-meta-wrap>
</article-meta>
</front>
<body>
<sec id="s1" sec-type="intro">
<title>Introduction</title>
<p>Macrophages are cells of the innate immune system which control inflammation, wound healing, and homeostasis. The abundance of tumour-associated macrophages (TAMs) is correlated with poor prognosis in several tumour types (<xref ref-type="bibr" rid="B1">1</xref>). We compared <italic>ex vivo</italic> (freshly isolated) TAMs from ascites of ovarian carcinoma with <italic>ex vivo</italic> peritoneal macrophages from tumour-free patients and found them to be highly similar; both display a predominantly immunosuppressive phenotype according to RNA-seq and flow cytometry. Discernible differences are limited to (i) TAM quantity&#x2014;vastly outnumbering other immunocompetent populations&#x2014;and (ii) expression of rather small sets of genes. These sets contain either pro-tumourigenic genes involved in extracellular matrix remodelling, which is a hallmark of the resolution phase of inflammation that is also observed in wound healing, or genes regulated by anti-tumourigenic interferon signalling. In contrast, we found that macrophages differentiated <italic>in vitro</italic> have very different transcriptomes (<xref ref-type="bibr" rid="B2">2</xref>, <xref ref-type="bibr" rid="B3">3</xref>), showing that <italic>in vitro</italic> polarisation does not recapitulate the <italic>ex vivo</italic> state. It is therefore of particular interest which factors are present <italic>in vivo</italic> that modulate expression of inflammation-related genes to shift the balance between pro- and anti-inflammatory macrophage phenotypes in health and disease.</p>
<p>The nuclear factor &#x3ba;&#x3b2; (NF&#x3ba;B) pathway regulates immune cell function. NF&#x3ba;B signalling is stimulated by pathogen recognition receptors (PRRs), such as the Toll-like receptors (TLRs), and by other receptor families including specific cytokine receptors. TLR4 is the archetypical PRR. TLR4 is expressed on monocytes, macrophages, dendritic cells, B cells, adipocytes, endothelial cells, and on Paneth cells of the intestinal epithelium. Together with its co-receptors CD14 and MD2, TLR4 activates the canonical NF&#x3ba;B pathway after binding of its agonist, lipopolysaccharide (LPS) (<xref ref-type="bibr" rid="B4">4</xref>). Canonical NF&#x3ba;B signalling culminates in phosphorylation of inhibitor of &#x3ba;B (I&#x3ba;B) proteins, their subsequent ubiquitination and degradation. This frees transcriptional activators referred to as NF&#x3ba;B which then translocate to the nucleus and induce transcription of their target genes (<xref ref-type="bibr" rid="B5">5</xref>). The temporal dynamics of NF&#x3ba;B nuclear translocation encode for ligand and dose to determine biological responses (<xref ref-type="bibr" rid="B6">6</xref>). NF&#x3ba;B targets include many pro-inflammatory genes, but NF&#x3ba;B also regulates differentiation and homeostasis (<xref ref-type="bibr" rid="B5">5</xref>). A major subset of NF&#x3ba;B target genes in macrophages, including <italic>IL1B</italic>, <italic>IL12B</italic>, and <italic>TNF</italic>, is involved in pro-inflammatory processes, whereas another major subset exemplified by <italic>IL6</italic>, <italic>IL10</italic>, and <italic>PTGS2</italic> (encoding for cyclooxygenase 2) mediates immunosuppression in homeostasis, wound healing, and neoplasia. Most NF&#x3ba;B target genes including <italic>IL1B</italic>, <italic>IL6</italic>, <italic>IL10</italic>, and <italic>PTGS2</italic> are expressed in <italic>ex vivo</italic> ovarian carcinoma TAMs and in <italic>ex vivo</italic> peritoneal macrophages (<xref ref-type="bibr" rid="B2">2</xref>, <xref ref-type="bibr" rid="B3">3</xref>, <xref ref-type="bibr" rid="B7">7</xref>). This raises the question which endogenous factors regulate NF&#x3ba;B signalling in macrophages <italic>in vivo</italic> to achieve an anti-inflammatory, homeostatic macrophage polarisation state.</p>
<p>Haptoglobin (HP) is an acute phase protein with concentrations of 0.3&#x2013;2 g/l in adult human serum (<xref ref-type="bibr" rid="B8">8</xref>). HP sequesters free haemoglobin (HB) to prevent oxidative tissue damage upon haemolysis. Uptake of HB-HP complexes is mediated by the scavenger receptor CD163 that is expressed exclusively on monocytic cells (<xref ref-type="bibr" rid="B9">9</xref>). HP as well as the heme-binding protein hemopexin antagonise NF&#x3ba;B activation by free heme that is TLR4-dependent but LPS-independent (<xref ref-type="bibr" rid="B10">10</xref>).</p>
<p>Conflicting HB-independent functions of HP were reported. Haptoglobin-deficient mice are prone to autoimmune inflammation (<xref ref-type="bibr" rid="B11">11</xref>), and dampening of LPS-induced cytokine expression by Hp was observed <italic>in vivo</italic> (<xref ref-type="bibr" rid="B12">12</xref>), which implicates an anti-inflammatory function of haptoglobin. In a murine haemolysis model, cytoprotection by Hp <italic>via</italic> induction of heme oxygenase 1 was described, and diminished NF&#x3ba;B activation after infusion of human HP was observed (<xref ref-type="bibr" rid="B13">13</xref>). On the other hand, HP was reported to activate NF&#x3ba;B signalling through TLR4-dependent (<xref ref-type="bibr" rid="B14">14</xref>) and Tlr4-independent mechanisms (<xref ref-type="bibr" rid="B15">15</xref>). Modulation of TLR4-dependent cytokine expression again suggests involvement of NF&#x3ba;B, a pivotal regulator of inflammation. Taken together, it has remained yet unclear how HP regulates inflammatory processes qualitatively as well as mechanistically.</p>
<p>LPS, alternatively called endotoxin, is an outer membrane component of Gram-negative bacteria. LPS molecules are large and heterogeneous glycans composed of a lipid A moiety, a core oligosaccharide moiety, and a repeating polysaccharide O antigen (<xref ref-type="bibr" rid="B16">16</xref>). The human gut contains approximately 1 g of LPS. Intestinal permeability allows LPS to traverse into the bloodstream (<xref ref-type="bibr" rid="B17">17</xref>, <xref ref-type="bibr" rid="B18">18</xref>), and LPS is present in amounts of 1&#x2013;200 pg/ml in human serum (<xref ref-type="bibr" rid="B17">17</xref>). High-fat meals are known to induce endotoxemia and inflammatory markers (<xref ref-type="bibr" rid="B19">19</xref>). Notably, elevated LPS concentrations in human serum have been reported in obesity and diabetes (<xref ref-type="bibr" rid="B20">20</xref>), ethanol abuse (<xref ref-type="bibr" rid="B21">21</xref>), and neurodegenerative disorders (<xref ref-type="bibr" rid="B22">22</xref>). In animal models, exposure to LPS induces obesity, diabetes, and neurodegeneration (<xref ref-type="bibr" rid="B23">23</xref>). The involvement of LPS in the genesis of cancer has been implicated frequently (<xref ref-type="bibr" rid="B24">24</xref>). These data collectively suggest that endotoxemia is causal for different pathophysiologies. LPS has also been implicated in tumourigenesis; however, its role in the tumour microenvironment needs to be clarified (<xref ref-type="bibr" rid="B25">25</xref>).</p>
<p>Notably, LPS molecules from bacterial species and strains differ in their molecular composition, and some do not activate NF&#x3ba;B. This is exemplified by LPS-Rs from <italic>Rhodobacter sphaeroides</italic>, which competitively antagonises TLR4-dependent NF&#x3ba;B activation by other LPS species (<xref ref-type="bibr" rid="B26">26</xref>, <xref ref-type="bibr" rid="B27">27</xref>). The molecular basis for these observations is that TLR4 binds to the lipid A moiety (<xref ref-type="bibr" rid="B27">27</xref>) invariably present in all LPS molecules which hence is the immunogenic part of LPS.</p>
<p>
<italic>Per se</italic>, LPS is not a toxin; it elicits a TLR4-mediated cytotoxic host response in mammals. LPS availability needs to be tightly controlled to prevent acute inflammation. Proteins which specifically bind to LPS include soluble CD14, LPS-binding protein (LBP), BPI, APOE, adiponectin, &#x3b1;-defensins, surfactant proteins, and lactoferrin (<xref ref-type="bibr" rid="B28">28</xref>). Genetic deletion of LBP causes susceptibility to endotoxemia in mice (<xref ref-type="bibr" rid="B29">29</xref>). The need for adequate buffering of LPS was proposed (<xref ref-type="bibr" rid="B28">28</xref>). The presence of endogenous stores, dedicated carriers, the TLR4 receptor complex, and mechanisms which specifically counteract the response to LPS in mammals underscores the involvement of LPS in homeostasis and resulted in designation of LPS as an exogenous hormone (<xref ref-type="bibr" rid="B30">30</xref>). This is in line with the unique role of TLR4: It is the only TLR that recruits all four adaptor proteins MYD88, TIRAP, TRAM, and TRIF to elicit a distinct gene expression profile (<xref ref-type="bibr" rid="B31">31</xref>).</p>
<p>Our starting point was the question which endogenous factors regulate NF&#x3ba;B target gene expression in freshly isolated human macrophages. This is based on previous studies where one of the authors was involved (<xref ref-type="bibr" rid="B2">2</xref>, <xref ref-type="bibr" rid="B3">3</xref>). We pursued HP as a candidate due to its documented role in modulation of NF&#x3ba;B activity. Here, we show that the conflicting functions of HP in TLR4-NF&#x3ba;B signalling are explainable by HP&#x2019;s ability to bind and buffer LPSs, which results in shielding of LPS from TLR4 and delayed NF&#x3ba;B activation.</p>
</sec>
<sec id="s2" sec-type="results">
<title>Results</title>
<sec id="s2_1">
<title>Haptoglobin isolated from human serum induces NF&#x3ba;B target gene expression through TLR4</title>
<p>HP purified from human serum induced the expression of the NF&#x3ba;B target gene <italic>IL1B</italic> (&gt;1,000-fold; <xref ref-type="fig" rid="f1">
<bold>Figure&#xa0;1A</bold>
</xref>) in monocyte-derived macrophages (MDMs). By contrast, HB alone did not induce <italic>IL1B</italic> expression (<xref ref-type="fig" rid="f1">
<bold>Figure&#xa0;1A</bold>
</xref>), which together with the fact that the HP preparation contained only spurious amounts of HB (<xref ref-type="fig" rid="f1">
<bold>Figure&#xa0;1B</bold>
</xref>) indicates that HB is dispensable for <italic>IL1B</italic> induction by HP. Transcriptome analysis of HP-treated versus control MDMs identified differentially expressed genes that are typical for an NF&#x3ba;B-dependent response (<xref ref-type="fig" rid="f1">
<bold>Figure&#xa0;1C</bold>
</xref>).</p>
<fig id="f1" position="float">
<label>Figure&#xa0;1</label>
<caption>
<p>Purified haptoglobin induces NF&#x3ba;B-dependent transcription through TLR4. <bold>(A)</bold> MDMs from blood donors (N=3) were treated with 100 ng/ml <italic>E.coli</italic> LPS or HB (25 &#xb5;g/ml), mixed type HP (25 &#xb5;g/ml), or both for six hours. Expression of <italic>IL1B</italic> was measured by RT-qPCR. Error bars represent standard deviations. Bonferroni-corrected significance (unpaired <italic>t</italic> test): **, p&lt;0.01; *, p&lt;0.05; n.s., not significant. <bold>(B)</bold> ELISA analyses of the haemoglobin content of HB and HP. Nominal protein concentration is 10 mg/ml each. <bold>(C)</bold> Volcano plot of RNA-seq data; HP treatment of MDMs from three donors (HP; 25 &#xb5;g/ml for 4 h <italic>vs.</italic> solvent control). Table inlay: Top ten GO terms assigned by the DAVID database to the top 50 upregulated genes. <bold>(D)</bold> HEK293 cells were transfected as indicated and treated with either solvent, <italic>E.coli</italic> LPS (100 ng/ml), or HP (25 &#xb5;g/ml) for 6 h, and <italic>IL8</italic> expression was monitored by RT-qPCR. This is representative of three independent experiments. <bold>(E)</bold> HEK293 cells were transfected as in A plus an NF&#x3ba;B firefly luciferase reporter plasmid (5&#xd7;NF&#x3ba;B-luc) and a constitutive <italic>Renilla</italic>-luc reporter and treated as in <bold>(A)</bold> Representative of two independent experiments. <bold>(D, E)</bold>: Error bars represent standard deviations from three technical replicates.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fimmu-15-1401527-g001.tif"/>
</fig>
<p>The NF&#x3ba;B-type transcriptomic response led to the idea that HP activates NF&#x3ba;B via TLR4. To test this, we performed a synthetic complementation assay in HEK293 cells (<xref ref-type="bibr" rid="B32">32</xref>), which do not express TLR4 (<xref ref-type="bibr" rid="B32">32</xref>, <xref ref-type="bibr" rid="B33">33</xref>). Here, only the forced expression of TLR4, CD14, and MD2 led to induction of <italic>IL8</italic> by purified HP (<xref ref-type="fig" rid="f1">
<bold>Figure&#xa0;1D</bold>
</xref>) indicating that TLR4, CD14, and MD2 together are sufficient to confer sensitivity to HP. In line with this idea, an NF&#x3ba;B-responsive reporter was induced by HP only when we complemented TLR4, CD14, and MD2 in HEK293 cells (<xref ref-type="fig" rid="f1">
<bold>Figure&#xa0;1E</bold>
</xref>), demonstrating that purified HP activates NF&#x3ba;B-dependent transcription <italic>via</italic> TLR4.</p>
</sec>
<sec id="s2_2">
<title>Haptoglobin isolated from human serum is associated with lipopolysaccharides</title>
<p>Since HP binds to TLR4 (<xref ref-type="bibr" rid="B14">14</xref>), we reasoned that HP directly activates NF&#x3ba;B-dependent transcription via TLR4. To test this hypothesis, we enzymatically digested HP using proteinase K. Unexpectedly, we found that proteolysis did not abolish NF&#x3ba;B-dependent transcription (<xref ref-type="fig" rid="f2">
<bold>Figure&#xa0;2A</bold>
</xref>). Thus, HP protein is dispensable for the activation of NF&#x3ba;B-dependent transcription via TLR4.</p>
<fig id="f2" position="float">
<label>Figure&#xa0;2</label>
<caption>
<p>Haptoglobin is dispensable for NF&#x3ba;B-dependent transcription. <bold>(A)</bold> Mixed type HP was treated with proteinase K. An aliquot was ultrafiltrated with a 10 kDa cutoff; FT, flow through; SN, supernatant. THP-1 cells were treated for 6 h with these preparations as indicated or with 100 ng/ml <italic>E.coli</italic> O111:B4 LPS, and RT-qPCR of the <italic>IL8</italic> transcript was performed. *, <italic>p&lt;</italic>0.05 relative to the corresponding negative control (unpaired <italic>t</italic> test). Error bars represent SD. One of two independent experiments is shown. <bold>(B)</bold> THP-1 cells were treated as in A with or without the TLR4 antagonist LPS-Rs (10 &#xb5;g/ml). Error bars represent SEM (N=6). ***, <italic>p&lt;</italic>0.001; *, <italic>p&lt;</italic>0.05 relative to the corresponding sample without LPS-Rs (unpaired <italic>t</italic> test). <bold>(C)</bold> THP-1 cells were treated for 6 h with <italic>E.coli</italic> LPS, HP, or HP repurified by gel filtration in the presence of 500 mM NaCl, and RT-qPCR of the <italic>CXCL10</italic> and <italic>IL1B</italic> transcripts was performed. Error bars represent SD from three technical replicates. n.s., not significant.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fimmu-15-1401527-g002.tif"/>
</fig>
<p>The stimulus remained in the supernatant after ultrafiltration of protease-treated samples with a 10 kDa cutoff (<xref ref-type="fig" rid="f2">
<bold>Figure&#xa0;2A</bold>
</xref>). We then checked whether the TLR4 antagonist LPS-Rs (from <italic>R.sphaeroides</italic>) competes with the non-protein factor in the HP preparation. LPS-Rs led to reduced <italic>IL8</italic> induction in response to HP (<xref ref-type="fig" rid="f2">
<bold>Figure&#xa0;2B</bold>
</xref>), indicating the presence of TLR4 agonists. To further substantiate the claim that co-purified TLR4 agonists rather than the HP protein activate NF&#x3ba;B-dependent transcription <italic>via</italic> TLR4, we treated THP-1 cells with HP protein repurified by gel filtration under high-salt conditions. Repurification abrogated induction of NF&#x3ba;B target genes by HP (<xref ref-type="fig" rid="f2">
<bold>Figure&#xa0;2C</bold>
</xref>). Together, these data indicate that not HP itself but a separable, non-protein TLR4 agonist is responsible for induction of NF&#x3ba;B target gene expression by HP preparations.</p>
<p>The canonical agonists of TLR4 are LPSs; we therefore speculated that HP is associated with LPSs. To test this, we used a sensitive silver stain to detect LPSs (<xref ref-type="bibr" rid="B34">34</xref>) in digested HP. The assay revealed distinct high molecular weight bands, which are regularly observed in LPS preparations from different bacteria [especially in clinical isolates (<xref ref-type="bibr" rid="B35">35</xref>)] and indicate the presence of long-chain &#x201c;smooth&#x201d; LPSs (<xref ref-type="fig" rid="f3">
<bold>Figure&#xa0;3A</bold>
</xref>). Slower migration of discernible leading bands suggests that the lipid A and inner core moieties of the LPSs differ from the <italic>E.coli</italic> reference, which exhibits a ladder of regularly increasing chain lengths. Thus, the detected LPSs largely originate from various bacterial species other than <italic>E.coli</italic>.</p>
<fig id="f3" position="float">
<label>Figure&#xa0;3</label>
<caption>
<p>Haptoglobin is associated with and binds lipopolysaccharides. <bold>(A)</bold> Upper panel: Silver stain of the indicated samples after deoxycholate-urea PAGE under reducing conditions. HP was digested with proteinase K for 2 h at 55 &#xb0;C or not as indicated. Digestion of the protein was complete as indicated by immunoblotting against the HP &#x3b2; chain (lower panel). <bold>(B)</bold> A LAL assay was conducted with HP1-1 (from homozygous carriers of allele 1, resulting in dimer formation), HP2-2 (oligomeric HP from homozygous carriers of allele 2), and mixed type HP from heterozygous carriers (N=1 each). Error bars represent SD calculated from three technical replicates. EU, endotoxin units. <bold>(C)</bold> Calculated ratios of free <italic>vs.</italic> HP-bound LPS at the indicated <italic>K</italic>
<sub>d</sub> values. The 1 nM value is purely hypothetical and is included to illustrate that a nanomolar affinity would result in full sequestration of all LPS. Physiological HP concentrations range from 0.3&#x2013;2 g/l. At 1 g/l, HP concentration per &#x3b1;&#x3b2;-subunit is 20 &#xb5;M. Table inlay: MST (microscale thermophoresis) binding data obtained with mixed type HP repurified using gel filtration and titrations of ultrapure LPS preparations from the indicated bacterial strains. MST measurements were performed with three HP preparations each.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fimmu-15-1401527-g003.tif"/>
</fig>
<p>Two main <italic>HP</italic> alleles exist in humans. HP from allele 1 harbours one multimerisation domain, and homozygous carriers express HP1-1 dimers. Allele 2 encodes for two multimerisation domains due to a duplication of two exons, resulting in oligomer formation (<xref ref-type="bibr" rid="B8">8</xref>). A <italic>Limulus</italic> amoebocyte lysate (LAL) assay detected 40&#x2013;1000 endotoxin units (EU)/&#xb5;g protein in HP preparations of the three isotypes (dimeric HP1-1, oligomeric HP2-2, and mixed type). One EU is equivalent to 0.1&#x2013;0.2 ng LPS&#x2014;at 1 mg/ml HP in serum, this translates into &gt;4 &#xb5;g/ml LPS, which is &gt;1.000-fold above reported serum LPS levels of 1&#x2013;200 pg/ml (<xref ref-type="bibr" rid="B17">17</xref>) but in line with the strong staining we observed (<xref ref-type="fig" rid="f3">
<bold>Figure&#xa0;3B</bold>
</xref>). Since the LPSs are heterogeneous and different from <italic>E.coli</italic> LPS (<xref ref-type="fig" rid="f3">
<bold>Figure&#xa0;3A</bold>
</xref>), contamination of the HP preparations seems unlikely. A more parsimonious explanation for large amount of LPSs in the preparations is given by the fact that LPS and LPS-bound proteins are selectively precipitated by ethanol (<xref ref-type="bibr" rid="B36">36</xref>, <xref ref-type="bibr" rid="B37">37</xref>). It is therefore conceivable that the widely used Cohn cold ethanol serum fractionation protocol leads to enrichment of LPS-bound HP.</p>
</sec>
<sec id="s2_3">
<title>Haptoglobin binds different lipopolysaccharides with micromolar affinities leading to delayed activation of NF&#x3ba;B</title>
<p>Microscale thermophoresis (MST) with LPS-free HP (repurified by gel filtration in high-salt buffer) indicates <italic>K</italic>
<sub>d</sub> values &lt;10 &#xb5;M for LPSs from three bacterial species (<xref ref-type="fig" rid="f3">
<bold>Figure&#xa0;3C</bold>
</xref>) that represent different lipid A structures (<xref ref-type="bibr" rid="B16">16</xref>). The <italic>S.minnesota</italic> strain R595 produces rough LPS (lacking the repeating oligosaccharide units O antigen) exclusively; binding of this molecule with comparable affinity establishes that HP interacts with the lipid A or inner core moiety (or both). The law of mass action dictates that the bulk of LPS in serum is bound by HP in the physiological range of HP levels&#x2014;1 g/l of HP corresponds to a molarity of 20 &#xb5;M per HP &#x3b1;&#x3b2; subunit, which is well above the <italic>K</italic>
<sub>d</sub> values we obtained for different LPSs. The fraction of HP-bound LPS at different values of <italic>K</italic>
<sub>d</sub> is illustrated in <xref ref-type="fig" rid="f3">
<bold>Figure&#xa0;3C</bold>
</xref>.</p>
<p>These results show that commercially available HP contains LPSs. Addition of these HP preparations to cells leads to activation of TLR4. However, activation should be delayed due to limited LPS availability: HP competes with TLR4 for LPS. In line with this notion, we found that I&#x3ba;B&#x3b1; degradation (loss of unphosphorylated I&#x3ba;B&#x3b1;) induced by HP was delayed relative to high-dose and low-dose <italic>E.coli</italic> LPS (<xref ref-type="fig" rid="f4">
<bold>Figure&#xa0;4</bold>
</xref>). I&#x3ba;B&#x3b1; degradation kinetics depend on LPS concentration (<xref ref-type="bibr" rid="B38">38</xref>, <xref ref-type="bibr" rid="B39">39</xref>). Although the deployed HP should contain an amount of LPSs in the range of the <italic>E.coli</italic> LPS controls, I&#x3ba;B&#x3b1; degradation was much slower, indicating that only a comparably low amount of LPSs was released. In parallel, the phospho-shifted I&#x3ba;B&#x3b1; band was quantitated. While the signals were generally lower for phospho-I&#x3ba;B&#x3b1; that is marked for ubiquitination and proteasomal degradation, it shows the same trend as the unphosphorylated protein including a rise after one hour of high-dose LPS treatment. This indicates completion of the first oscillatory cycle of nuclear entry and exit of NF&#x3ba;B transcription factors (<xref ref-type="bibr" rid="B39">39</xref>, <xref ref-type="bibr" rid="B40">40</xref>) and is in line with a faster activation of NF&#x3ba;B by higher amounts of LPS (<xref ref-type="bibr" rid="B38">38</xref>, <xref ref-type="bibr" rid="B39">39</xref>) as well.</p>
<fig id="f4" position="float">
<label>Figure&#xa0;4</label>
<caption>
<p>NF&#x3ba;B activation is delayed in the presence of haptoglobin. MDMs were treated with <italic>E.coli</italic> LPS (100 ng/ml, 5 ng/ml) or mixed type HP (25 &#xb5;g/ml). I&#x3ba;B&#x3b1; levels were monitored by immunoblotting. Lower (unphosphorylated I&#x3ba;B&#x3b1;) and upper (phosphorylated I&#x3ba;B&#x3b1;) bands were quantitated and plotted separately. Chemoluminescence was quantitated with a CCD-based imaging system. Images of the bands are available in the Supplementary Data file. I&#x3ba;B&#x3b1; levels were normalised to &#x3b2;-actin. Dots indicate the calculated means (N=5). Error bars denote SEM. Significance relative to high-dose LPS (unpaired <italic>t</italic> test): ***, <italic>p&lt;</italic>0.001; **, <italic>p&lt;</italic>0.01; *, <italic>p&lt;</italic>0.05; n.s., not significant. Significance was Bonferroni-corrected for multiple hypothesis testing.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fimmu-15-1401527-g004.tif"/>
</fig>
</sec>
</sec>
<sec id="s3" sec-type="discussion">
<title>Discussion</title>
<p>We show that HP purified from human serum binds LPSs with low micromolar affinities. Our data thus provide a mechanistic explanation for conflicting observations on the role of HP in NF&#x3ba;B signalling (<xref ref-type="bibr" rid="B12">12</xref>, <xref ref-type="bibr" rid="B14">14</xref>, <xref ref-type="bibr" rid="B15">15</xref>). Moreover, they establish HP to function as a buffer for LPSs. This buffering function is relevant because the rate of change of stimulus concentration controls the NF&#x3ba;B response; in other words, the pathway differentiates the input signal (<xref ref-type="bibr" rid="B6">6</xref>, <xref ref-type="bibr" rid="B39">39</xref>, <xref ref-type="bibr" rid="B40">40</xref>).</p>
<p>These recent studies from the Tay and Hoffmann groups require rethinking of our understanding of NF&#x3ba;B: Negative feedback, which is mainly provided by the NF&#x3ba;B-induced A20 protein (encoded by <italic>TNFAIP3</italic>), restricts future activation of NF&#x3ba;B. Hence, the cell retains a memory of past activation which fades dependent on the half-lives of the <italic>TNFAIP3</italic> mRNA and the A20 protein. A consequence of this mechanism is that cultured cells devoid of NF&#x3ba;B-activating stimuli are acutely sensitive to experimental activation of NF&#x3ba;B. We speculate that most anti-inflammatory target genes have slower induction kinetics than pro-inflammatory target genes&#x2014;expression of the former is favoured under conditions of weak activation of the pathway and stable expression of A20 that is prevalent during homeostasis. As of now, we have no experimental confirmation of this hypothesis. It is however in line with our observation that most NF&#x3ba;B target genes, including <italic>IL10</italic>, a gene with anti-inflammatory, homeostatic function (<xref ref-type="bibr" rid="B41">41</xref>) and <italic>PTGS2</italic>, a driver of immunosuppression during the resolution phase of inflammation (<xref ref-type="bibr" rid="B42">42</xref>, <xref ref-type="bibr" rid="B43">43</xref>), are expressed in freshly isolated human macrophages (<xref ref-type="bibr" rid="B2">2</xref>, <xref ref-type="bibr" rid="B3">3</xref>). We hypothesise that the commonly observed overrepresentation of pro-inflammatory transcripts after NF&#x3ba;B activation in cultured cells, such as in our RNA-seq analyses shown in <xref ref-type="fig" rid="f1">
<bold>Figure&#xa0;1</bold>
</xref>, is a consequence of culture conditions that lack prior periodic activation of NF&#x3ba;B. Physiological periodic stimuli are provided <italic>in vivo</italic> by food (<xref ref-type="bibr" rid="B19">19</xref>) and circadian oscillations in cytokine expression (<xref ref-type="bibr" rid="B44">44</xref>, <xref ref-type="bibr" rid="B45">45</xref>). In the future, complex setups, e.g. involving precise temporal control of stimuli concentrations by microfluidics, may lead to improved model systems to study the dependency of target gene induction on the dynamics of stimuli.</p>
<p>HP dampens variations in LPS concentration by shielding LPS from TLR4, such that larger concentration changes are required to trigger an equivalent response. In agreement with this model of competition for LPS between HP and TLR4, HP reduces LPS-dependent pro-inflammatory cytokine expression in a dose-dependent manner (<xref ref-type="bibr" rid="B12">12</xref>). The amount of LPS in serum changes constantly; rising LPS levels are observed e.g. after meals (<xref ref-type="bibr" rid="B19">19</xref>). LPS is buffered by several serum proteins (<xref ref-type="bibr" rid="B28">28</xref>), showing that this function is common and beneficial. The current study adds the highly abundant HP to this list. LPS contributes to the formation of an immunosuppressive microenvironment in lung (<xref ref-type="bibr" rid="B46">46</xref>), pancreatic (<xref ref-type="bibr" rid="B47">47</xref>), and colorectal cancer (<xref ref-type="bibr" rid="B48">48</xref>). LPS buffering by HP may avoid acute inflammation and instead favour a chronic inflammatory state that promotes tumourigenesis. Moreover, as an acute phase protein, HP is dynamically upregulated several fold by stress-associated stimuli including infection (<xref ref-type="bibr" rid="B8">8</xref>). This again strongly implicates a role in limiting the inflammatory response to prevent sepsis and tissue damage.</p>
<p>Our data show that HP binds LPSs with low micromolar affinities. Given the law of mass action, the bulk of serum-borne LPS is thus bound by HP, but a minor fraction of LPS is free for binding other factors such as TLR4 at any given point in time due to the dynamic nature of the binding equilibrium. This &#x201c;mostly bound&#x201d; steady state results from the moderate affinity we measured. High-affinity binding would lead to full sequestration of LPS and render LPS sensing through TLR4 futile (<xref ref-type="fig" rid="f3">
<bold>Figure&#xa0;3C</bold>
</xref>, hypothetical <italic>K</italic>
<sub>d</sub> value of 1 nM) since essentially all LPS would be bound to HP. At micromolar affinity, LPS is never saturated with HP. This finding implicates a crucial role in controlling the inflammatory response to Gram-negative bacteria: At physiological concentrations, HP effectively modulates LPS-dependent NF&#x3ba;B activation by limiting the rate of change of free LPS concentrations. Our finding provides a mechanistic explanation for divergent observations (<xref ref-type="bibr" rid="B12">12</xref>, <xref ref-type="bibr" rid="B14">14</xref>, <xref ref-type="bibr" rid="B49">49</xref>) and gives rise to future directions.</p>
<p>HP is used therapeutically for haemolytic conditions (<xref ref-type="bibr" rid="B50">50</xref>). Our findings extend applications to inflammatory states induced by elevated LPS levels in chronic conditions such as neurodegeneration (<xref ref-type="bibr" rid="B23">23</xref>), psychiatric diseases, inflammatory bowel disease, and metabolic syndrome (<xref ref-type="bibr" rid="B18">18</xref>) as well as acute inflammation. It is noteworthy that the SARS-CoV2 spike protein binds to LPS and enhances the TLR4-dependent inflammatory response (<xref ref-type="bibr" rid="B51">51</xref>, <xref ref-type="bibr" rid="B52">52</xref>), and poor outcome in COVID19 is connected to elevated LPS levels (<xref ref-type="bibr" rid="B53">53</xref>, <xref ref-type="bibr" rid="B54">54</xref>). Increasing LPS buffering capacity by HP may therefore improve clinical outcomes in chronic and acute inflammation, COVID19, and other infectious diseases to limit deregulated LPS-dependent cytokine expression. Importantly, HP isolation procedures should avoid LPS enrichment.</p>
<p>The HP precursor expressed from allele 2, zonulin, increases intestinal permeability (<xref ref-type="bibr" rid="B55">55</xref>). Our findings raise the possibility that zonulin binds LPS. HB binds LPS and exacerbates its effects (<xref ref-type="bibr" rid="B37">37</xref>, <xref ref-type="bibr" rid="B56">56</xref>). Attenuation of LPS-dependent effects by HB-binding proteins like&#xa0;hemopexin (<xref ref-type="bibr" rid="B13">13</xref>, <xref ref-type="bibr" rid="B57">57</xref>) and HP (<xref ref-type="bibr" rid="B12">12</xref>, <xref ref-type="bibr" rid="B13">13</xref>) may be a recurrent antagonistic theme.</p>
<p>We found that HP purified from human serum is associated with LPS regardless of its oligomerisation state (<xref ref-type="fig" rid="f3">
<bold>Figure&#xa0;3B</bold>
</xref>) but consistently found less LPS associated with HP1-1 also in preparations purchased earlier (data not shown). This might indicate a lower affinity of dimeric <italic>vs.</italic> oligomeric HP towards LPS. If true, this could explain some of the observed functional differences between HP phenotypes in humans (<xref ref-type="bibr" rid="B8">8</xref>).</p>
<p>Elevated HP levels are negatively correlated with survival in ovarian carcinoma (<xref ref-type="bibr" rid="B58">58</xref>) and other solid tumours (<xref ref-type="bibr" rid="B59">59</xref>). &#x201c;Oncofetal&#x201d; HP, which is observed during neoplasia and pregnancy (<xref ref-type="bibr" rid="B8">8</xref>), is a much stronger immunosuppressant than normal adult HP (<xref ref-type="bibr" rid="B60">60</xref>); the mechanistic basis of enhanced immunosuppression remains unclear. Our findings suggest that the alternative glycosylation of oncofetal HP (<xref ref-type="bibr" rid="B61">61</xref>) potentially alters its affinity towards LPSs. Alternatively, oncofetal HP may regulate inflammation through LPS-independent mechanisms, which if true warrants separation of beneficial from malignant functions of HP.</p>
</sec>
<sec id="s4" sec-type="materials|methods">
<title>Materials and methods</title>
<sec id="s4_1">
<title>Cells and reagents</title>
<p>Buffy coats from anonymised healthy female donors were from the University Clinic Marburg blood bank. MDMs were differentiated as described (<xref ref-type="bibr" rid="B62">62</xref>). Mixed type HP (used for all experiments unless indicated otherwise) was from Sigma and USBio. HP1-1 and HP2-2 were from Sigma. Ultrapure LPSs from <italic>E.coli</italic> O111:B4, <italic>P.gingivalis</italic>, <italic>R.sphaeroides</italic>, and <italic>S.minnesota</italic> R595 were from Invivogen. Proteinase K was from Bioline. Amicon filters were from Merck-Millipore. The hTLR4 expression vector (Addgene 13086) was a gift from Ruslan Medzhitov. pcDNA3-CD14 (Addgene 13645) and pFlag-CMV1-hMD2 (Addgene 13028) were gifts from Doug Golenbock. pGL4.32[luc2P/NF&#x3ba;B-RE/Hygro] was from Promega. Antibodies were from Novus (&#x3b1;-HP JM10-79), Santa Cruz (&#x3b1;-I&#x3ba;B&#x3b1; sc-371), and Sigma (&#x3b1;&#x2013;&#x3b2;-actin AC-15). The HB ELISA was from Bethyl (E88-134). The LAL chromogenic endotoxin assay kit was from Pierce (A39552).</p>
</sec>
<sec id="s4_2">
<title>Transfection and Luciferase Reporter Assays</title>
<p>HEK293 cells were seeded in 6-well plates (2.5&#xd7;10<sup>5</sup> cells per well) in 2 ml DMEM (Dulbecco&#x2019;s modified Eagle medium with 25 mg/ml glucose) supplemented with 10% (v/v) foetal bovine serum, 100 units/ml penicillin, and 100 &#xb5;g/ml streptomycin (all from Sigma). On the next day, the medium was replaced with fresh medium [see above but with 2% (v/v) serum]. Polyethylenimine was used for transfection of the indicated vectors, and luciferase reporter assays were conducted essentially as described (<xref ref-type="bibr" rid="B63">63</xref>). The total amount of DNA per well was 5 &#xb5;g. Briefly, after 4 h, the medium was replaced with 2 ml of fresh medium with 10% (v/v) serum and antibiotics. Twenty-four hours after transfection, the cells were treated as indicated. After another 24&#xa0;h, lysates were prepared and measured according to the manufacturer&#x2019;s instructions (Beetle Juice Big and &#x3b2;-Gal Juice PLUS Kit for normalisation; pjk GmbH) with an Orion L luminometer (Berthold) for reporter gene assays. For expression analyses, the cells were directly harvested in the appropriate lysis buffer for RNA isolation (Macherey-Nagel Nucleospin RNA kit).</p>
</sec>
<sec id="s4_3">
<title>Expression analyses</title>
<p>Cells were treated with 100 ng/ml <italic>E.coli</italic> LPS (stock: 100 &#xb5;g/ml in PBS), with 25 &#xb5;g/ml mixed-type HP (stock: 10 mg/ml in H<sub>2</sub>O), or with the equivalent volume of solvent for 6 h unless noted otherwise. RT-qPCR and immunoblots were performed as described (<xref ref-type="bibr" rid="B62">62</xref>). Primer sequences are:</p>
<p>
<italic>CXCL10</italic>: AAGCAGTTAGCAAGGAAAGGTC GACATATACTCCATGTAGGGAAGTGA</p>
<p>
<italic>IL1B</italic>: TGAAAGCTCTCCACCTCCAGGGACA GAGGCCCAAGGCCACAGGTATTTTG</p>
<p>
<italic>IL8</italic>: AGCTCTGTGTGAAGGTGCAGT GATAAATTTGGGGTGGAAAGGT</p>
<p>
<italic>RPL27</italic>: AAAGCTGTCATCGTGAAGAAC GCTGTCACTTTGCGGGGGTAG</p>
<p>For transcriptome analyses, RNA was isolated using TRIfast (<xref ref-type="bibr" rid="B62">62</xref>) (Peqlab) with pre-isolation <italic>D.melanogaster</italic> Schneider S2 spike-in (1:10) and post-isolation ERCC spike-ins (Thermo Fisher) according to the manufacturer&#x2019;s instructions. Libraries were prepared with QuantSeq FWD (Lexogen). Sequencing was performed on a NextSeq 550 (Illumina).</p>
</sec>
<sec id="s4_4">
<title>Size exclusion chromatography and affinity measurements</title>
<p>1 mg HP was run on a Superdex 200 Increase 10/300 gel filtration column (Cytiva) with 500 mM NaCl in phosphate-buffered saline (PBS) on an &#xc4;kta Purifier 10 high-performance liquid chromatography system (GE Healthcare) to remove associated LPSs. The main protein peak fraction (at &#x3bb;=280 nm) was used for covalent labelling with RED-NHS dye, and MST was performed as published (<xref ref-type="bibr" rid="B64">64</xref>) with freshly labelled protein in PBS supplemented with 0.005% (v/v) Tween-20. Each LPS preparation was titrated in a 16-step 1:2 dilution series starting with a final assay concentration of 3.75 g/l. Average molecular weights for the LPS preparations were estimated after silver staining (<italic>E.coli</italic> O111:B4, 25 kDa; <italic>P.gingivalis</italic>, 30 kDa; <italic>S.minnesota</italic> R595, 2.5 kDa). A molecular weight of 50 kDa per HP &#x3b1;&#x3b2;-subunit was assumed.</p>
</sec>
<sec id="s4_5">
<title>Statistics</title>
<p>Unpaired, two-tailed <italic>t</italic> tests were used to calculate <italic>p</italic> values. Multiple hypothesis testing corrections were applied as indicated.</p>
</sec>
</sec>
</body>
<back>
<sec id="s5" sec-type="data-availability">
<title>Data availability statement</title>
<p>The datasets presented in this study can be found in online repositories. The names of the repository/repositories and accession number(s) can be found in the article/<xref ref-type="supplementary-material" rid="SM1">
<bold>Supplementary Material</bold>
</xref>.</p>
</sec>
<sec id="s6" sec-type="ethics-statement">
<title>Ethics statement</title>
<p>The studies involving human participants were reviewed and approved by the Ethics Committee of the Department of Medicine, Philipps University Marburg (reference number 205/10). Written informed consent to participate in this study was provided by the participants.</p>
</sec>
<sec id="s7" sec-type="author-contributions">
<title>Author contributions</title>
<p>LZ: Visualization, Methodology, Investigation, Formal analysis, Data curation, Conceptualization, Writing &#x2013; review &amp; editing. JG: Visualization, Validation, Resources, Methodology, Investigation, Formal analysis, Data curation, Conceptualization, Writing &#x2013; review &amp; editing. HS: Writing &#x2013; review &amp; editing, Data curation, Formal analysis, Investigation, Resources, Supervision, Validation, Visualization. CB: Visualization, Validation, Methodology, Investigation, Formal analysis, Data curation, Writing &#x2013; review &amp; editing. BW: Writing &#x2013; review &amp; editing, Data curation, Investigation, Methodology, Resources, Supervision, Validation, Visualization. SA: Methodology, Investigation, Writing &#x2013; review &amp; editing, Conceptualization. AN: Writing &#x2013; review &amp; editing, Data curation, Investigation. TS: Data curation, Writing &#x2013; review &amp; editing. OS: Methodology, Conceptualization, Writing &#x2013; review &amp; editing. S-AF: Supervision, Methodology, Formal analysis, Data curation, Writing &#x2013; review &amp; editing. TA: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Supervision, Validation, Visualization, Writing &#x2013; original draft, Writing &#x2013; review &amp; editing. H-RC: Supervision, Software, Resources, Project administration, Methodology, Investigation, Funding acquisition, Formal analysis, Data curation, Conceptualization, Writing &#x2013; review &amp; editing, Writing &#x2013; original draft, Visualization.</p>
</sec>
<sec id="s8" sec-type="funding-information">
<title>Funding</title>
<p>The author(s) declare financial support was received for the research, authorship, and/or publication of this article. Open Access funding provided by the Open Access Publishing Fund of Philipps-Universit&#xe4;t Marburg.</p>
</sec>
<ack>
<title>Acknowledgments</title>
<p>We gratefully acknowledge the contribution of the Protein Biochemistry and Spectroscopy Core Facility (Institute of Cytobiology, Center for Synthetic Microbiology, Philipps University Marburg) for help with MST analyses. We thank Margitta Alt and Silke Reinartz for providing cells purified from buffy coats. We thank Jonathan Lenz and Igor Ma&#x10d;inkovi&#x107; for Schneider S2 cells. We are grateful to Sovana Adhikary, Matthias Lauth, and Alexander Visekruna for critical reading of the manuscript. Funding was provided by Philipps University Marburg, Department of Medicine (to H-RC).</p>
</ack>
<sec id="s9" sec-type="COI-statement">
<title>Conflict of interest</title>
<p>The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
</sec>
<sec id="s10" sec-type="disclaimer">
<title>Publisher&#x2019;s note</title>
<p>All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.</p>
</sec>
<sec id="s11" sec-type="supplementary-material">
<title>Supplementary material</title>
<p>The Supplementary Material for this article can be found online at: <ext-link ext-link-type="uri" xlink:href="https://www.frontiersin.org/articles/10.3389/fimmu.2024.1401527/full#supplementary-material">https://www.frontiersin.org/articles/10.3389/fimmu.2024.1401527/full#supplementary-material</ext-link>
</p>
<supplementary-material xlink:href="Presentation1.pdf" id="SM1" mimetype="application/pdf"/>
</sec>
<ref-list>
<title>References</title>
<ref id="B1">
<label>1</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Condeelis</surname> <given-names>J</given-names>
</name>
<name>
<surname>Pollard</surname> <given-names>JW</given-names>
</name>
</person-group>. <article-title>Macrophages: obligate partners for tumor cell migration, invasion, and metastasis</article-title>. <source>Cell</source>. (<year>2006</year>) <volume>124</volume>:<page-range>263&#x2013;6</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.cell.2006.01.007</pub-id>
</citation>
</ref>
<ref id="B2">
<label>2</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Finkernagel</surname> <given-names>F</given-names>
</name>
<name>
<surname>Reinartz</surname> <given-names>S</given-names>
</name>
<name>
<surname>Lieber</surname> <given-names>S</given-names>
</name>
<name>
<surname>Adhikary</surname> <given-names>T</given-names>
</name>
<name>
<surname>Wortmann</surname> <given-names>A</given-names>
</name>
<name>
<surname>Hoffmann</surname> <given-names>N</given-names>
</name>
<etal/>
</person-group>. <article-title>The transcriptional signature of human ovarian carcinoma macrophages is associated with extracellular matrix reorganization</article-title>. <source>Oncotarget</source>. (<year>2016</year>) <volume>7</volume>:<page-range>75339&#x2013;52</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.18632/oncotarget.12180</pub-id>
</citation>
</ref>
<ref id="B3">
<label>3</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Adhikary</surname> <given-names>T</given-names>
</name>
<name>
<surname>Wortmann</surname> <given-names>A</given-names>
</name>
<name>
<surname>Finkernagel</surname> <given-names>F</given-names>
</name>
<name>
<surname>Lieber</surname> <given-names>S</given-names>
</name>
<name>
<surname>Nist</surname> <given-names>A</given-names>
</name>
<name>
<surname>Stiewe</surname> <given-names>T</given-names>
</name>
<etal/>
</person-group>. <article-title>Interferon signaling in ascites-associated macrophages is linked to a favorable clinical outcome in a subgroup of ovarian carcinoma patients</article-title>. <source>BMC Genomics</source>. (<year>2017</year>) <volume>18</volume>:<fpage>243</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1186/s12864-017-3630-9</pub-id>
</citation>
</ref>
<ref id="B4">
<label>4</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Takeda</surname> <given-names>K</given-names>
</name>
<name>
<surname>Kaisho</surname> <given-names>T</given-names>
</name>
<name>
<surname>Akira</surname> <given-names>S</given-names>
</name>
</person-group>. <article-title>Toll-like receptors</article-title>. <source>Ann Rev Immunol</source>. (<year>2003</year>) <volume>31</volume>:<page-range>335&#x2013;76</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1146/annurev.immunol.21.120601.141126</pub-id>
</citation>
</ref>
<ref id="B5">
<label>5</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Hoffmann</surname> <given-names>A</given-names>
</name>
<name>
<surname>Baltimore</surname> <given-names>D</given-names>
</name>
</person-group>. <article-title>Circuitry of nuclear factor &#x3ba;B signaling</article-title>. <source>Immunol Rev</source>. (<year>2006</year>) <volume>210</volume>:<page-range>171&#x2013;86</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1111/j.0105-2896.2006.00375.x</pub-id>
</citation>
</ref>
<ref id="B6">
<label>6</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Adelaja</surname> <given-names>A</given-names>
</name>
<name>
<surname>Taylor</surname> <given-names>B</given-names>
</name>
<name>
<surname>Sheu</surname> <given-names>KM</given-names>
</name>
<name>
<surname>Liu</surname> <given-names>Y</given-names>
</name>
<name>
<surname>Luecke</surname> <given-names>S</given-names>
</name>
<name>
<surname>Hoffmann</surname> <given-names>A</given-names>
</name>
</person-group>. <article-title>Six distinct NF&#x3ba;B signaling codons convey discrete information to distinguish stimuli and enable appropriate macrophage responses</article-title>. <source>Immunity</source>. (<year>2021</year>) <volume>54</volume>:<page-range>916&#x2013;30</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.immuni.2021.04.011</pub-id>
</citation>
</ref>
<ref id="B7">
<label>7</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Reinartz</surname> <given-names>S</given-names>
</name>
<name>
<surname>Finkernagel</surname> <given-names>F</given-names>
</name>
<name>
<surname>Adhikary</surname> <given-names>T</given-names>
</name>
<name>
<surname>Rohnalter</surname> <given-names>V</given-names>
</name>
<name>
<surname>Schumann</surname> <given-names>T</given-names>
</name>
<name>
<surname>Schober</surname> <given-names>Y</given-names>
</name>
<etal/>
</person-group>. <article-title>A transcriptome-based global map of signaling pathways in the ovarian cancer microenvironment associated with clinical outcome</article-title>. <source>Genome Biol</source>. (<year>2016</year>) <volume>17</volume>:<fpage>108</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1186/s13059-016-0956-6</pub-id>
</citation>
</ref>
<ref id="B8">
<label>8</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Dobryszycka</surname> <given-names>W</given-names>
</name>
</person-group>. <article-title>Biological functions of haptoglobin</article-title>. <source>Eur J Clin Chem Clin Biochem</source>. (<year>1997</year>) <volume>35</volume>:<page-range>647&#x2013;54</page-range>.</citation>
</ref>
<ref id="B9">
<label>9</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Kristiansen</surname> <given-names>M</given-names>
</name>
<name>
<surname>Graversen</surname> <given-names>JH</given-names>
</name>
<name>
<surname>Jacobsen</surname> <given-names>C</given-names>
</name>
<name>
<surname>Sonne</surname> <given-names>O</given-names>
</name>
<name>
<surname>Hoffman</surname> <given-names>H-J</given-names>
</name>
<name>
<surname>Law</surname> <given-names>SKA</given-names>
</name>
<etal/>
</person-group>. <article-title>Identification of the haemoglobin scavenger receptor</article-title>. <source>Nature</source>. (<year>2001</year>) <volume>409</volume>:<fpage>198</fpage>&#x2013;<lpage>201</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1038/35051594</pub-id>
</citation>
</ref>
<ref id="B10">
<label>10</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Belcher</surname> <given-names>JD</given-names>
</name>
<name>
<surname>Chen</surname> <given-names>C</given-names>
</name>
<name>
<surname>Nguyen</surname> <given-names>J</given-names>
</name>
<name>
<surname>Milbauer</surname> <given-names>L</given-names>
</name>
<name>
<surname>Abdulla</surname> <given-names>F</given-names>
</name>
<name>
<surname>Alayash</surname> <given-names>AI</given-names>
</name>
<etal/>
</person-group>. <article-title>Heme triggers TLR4 signaling leading to endothelial cell activation and vaso-occlusion in murine sickle cell disease</article-title>. <source>Blood</source>. (<year>2014</year>) <volume>123</volume>:<page-range>377&#x2013;90</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1182/blood-2013-04-495887</pub-id>
</citation>
</ref>
<ref id="B11">
<label>11</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Galicia</surname> <given-names>G</given-names>
</name>
<name>
<surname>Maes</surname> <given-names>W</given-names>
</name>
<name>
<surname>Verbinnen</surname> <given-names>G</given-names>
</name>
<name>
<surname>Kasran</surname> <given-names>A</given-names>
</name>
<name>
<surname>Bullens</surname> <given-names>D</given-names>
</name>
<name>
<surname>Arredouani</surname> <given-names>M</given-names>
</name>
<etal/>
</person-group>. <article-title>Haptoglobin deficiency facilitates the development of autoimmune inflammation</article-title>. <source>Eur J Immunol</source>. (<year>2009</year>) <volume>39</volume>:<page-range>3404&#x2013;12</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1002/eji.200939291</pub-id>
</citation>
</ref>
<ref id="B12">
<label>12</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Arredouani</surname> <given-names>MS</given-names>
</name>
<name>
<surname>Kasran</surname> <given-names>A</given-names>
</name>
<name>
<surname>Vanoirbeek</surname> <given-names>JA</given-names>
</name>
<name>
<surname>Berger</surname> <given-names>FG</given-names>
</name>
<name>
<surname>Baumann</surname> <given-names>H</given-names>
</name>
<name>
<surname>Ceuppens</surname> <given-names>JL</given-names>
</name>
</person-group>. <article-title>Haptoglobin dampens endotoxin-induced inflammatory effects both</article-title>. <source>Vitro vivo Immunol</source>. (<year>2005</year>) <volume>114</volume>:<page-range>263&#x2013;71</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1111/j.1365-2567.2004.02071.x</pub-id>
</citation>
</ref>
<ref id="B13">
<label>13</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Belcher</surname> <given-names>JD</given-names>
</name>
<name>
<surname>Chen</surname> <given-names>C</given-names>
</name>
<name>
<surname>Nguyen</surname> <given-names>J</given-names>
</name>
<name>
<surname>Abdulla</surname> <given-names>F</given-names>
</name>
<name>
<surname>Zhang</surname> <given-names>P</given-names>
</name>
<name>
<surname>Nguyen</surname> <given-names>H</given-names>
</name>
<etal/>
</person-group>. <article-title>Haptoglobin and hemopexin inhibit vaso-occlusion and inflammation in murine sickle cell disease: Role of heme oxygenase-1 induction</article-title>. <source>PloS One</source>. (<year>2018</year>) <volume>13</volume>:<elocation-id>e0196455</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.1371/journal.pone.0196455</pub-id>
</citation>
</ref>
<ref id="B14">
<label>14</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Kwon</surname> <given-names>J-O</given-names>
</name>
<name>
<surname>Jin</surname> <given-names>WJ</given-names>
</name>
<name>
<surname>Kim</surname> <given-names>B</given-names>
</name>
<name>
<surname>Ha</surname> <given-names>H</given-names>
</name>
<name>
<surname>Kim</surname> <given-names>H-H</given-names>
</name>
<name>
<surname>Lee</surname> <given-names>ZH</given-names>
</name>
</person-group>. <article-title>Haptoglobin acts as a TLR4 ligand to suppress osteoclastogenesis via the TLR4&#x2013;IFN-&#x3b2; Axis</article-title>. <source>J Immunol</source>. (<year>2019</year>) <volume>202</volume>:<page-range>3359&#x2013;69</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.4049/jimmunol.1800661</pub-id>
</citation>
</ref>
<ref id="B15">
<label>15</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Shen</surname> <given-names>H</given-names>
</name>
<name>
<surname>Song</surname> <given-names>Y</given-names>
</name>
<name>
<surname>Colangelo</surname> <given-names>CM</given-names>
</name>
<name>
<surname>Wu</surname> <given-names>T</given-names>
</name>
<name>
<surname>Bruce</surname> <given-names>C</given-names>
</name>
<name>
<surname>Scabia</surname> <given-names>G</given-names>
</name>
<etal/>
</person-group>. <article-title>Haptoglobin activates innate immunity to enhance acute transplant rejection in mice</article-title>. <source>J Clin Invest</source>. (<year>2011</year>) <volume>122</volume>:<page-range>383&#x2013;7</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1172/JCI58344</pub-id>
</citation>
</ref>
<ref id="B16">
<label>16</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Ogawa</surname> <given-names>T</given-names>
</name>
<name>
<surname>Asai</surname> <given-names>Y</given-names>
</name>
<name>
<surname>Makimura</surname> <given-names>Y</given-names>
</name>
<name>
<surname>Tamai</surname> <given-names>R</given-names>
</name>
</person-group>. <article-title>Chemical structure and immunobiological activity of <italic>Porphyromonas gingivalis</italic> lipid A</article-title>. <source>Front Biosci (Landmark Ed)</source>. (<year>2007</year>) <volume>12</volume>:<page-range>3795&#x2013;812</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.2741/2353</pub-id>
</citation>
</ref>
<ref id="B17">
<label>17</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Boroni Moreira</surname> <given-names>AP</given-names>
</name>
<name>
<surname>Salles Texeira</surname> <given-names>TF</given-names>
</name>
<name>
<surname>Barbosa Ferreira</surname> <given-names>A</given-names>
</name>
<name>
<surname>do Carmo Gouveia Peluzio</surname> <given-names>M</given-names>
</name>
<name>
<surname>de C&#xe1;ssia Gon&#xe7;alves Alfenas</surname> <given-names>R</given-names>
</name>
</person-group>. <article-title>Influence of a high-fat diet on gut microbiota, intestinal permeability and metabolic endotoxaemia</article-title>. <source>Br J Nutr</source>. (<year>2012</year>) <volume>108</volume>:<page-range>801&#x2013;9</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1017/S0007114512001213</pub-id>
</citation>
</ref>
<ref id="B18">
<label>18</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>de Punder</surname> <given-names>K</given-names>
</name>
<name>
<surname>Pruimboom</surname> <given-names>L</given-names>
</name>
</person-group>. <article-title>Stress induces endotoxemia and low-grade inflammation by increasing barrier permeability</article-title>. <source>Front Immunol</source>. (<year>2015</year>) <volume>6</volume>:<elocation-id>223</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.3389/fimmu.2015.00223</pub-id>
</citation>
</ref>
<ref id="B19">
<label>19</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Erridge</surname> <given-names>C</given-names>
</name>
<name>
<surname>Attina</surname> <given-names>T</given-names>
</name>
<name>
<surname>Spickett</surname> <given-names>CM</given-names>
</name>
<name>
<surname>Webb</surname> <given-names>DJ</given-names>
</name>
</person-group>. <article-title>A high-fat meal induces low-grade endotoxemia: evidence of a novel mechanism of postprandial inflammation</article-title>. <source>Am J Clin Nutr</source>. (<year>2007</year>) <volume>86</volume>:<page-range>1286&#x2013;92</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1093/ajcn/86.5.1286</pub-id>
</citation>
</ref>
<ref id="B20">
<label>20</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Lassenius</surname> <given-names>MI</given-names>
</name>
<name>
<surname>Pietil&#xe4;inen</surname> <given-names>KH</given-names>
</name>
<name>
<surname>Kaartinen</surname> <given-names>K</given-names>
</name>
<name>
<surname>Pussinen</surname> <given-names>PJ</given-names>
</name>
<name>
<surname>Syrj&#xe4;nen</surname> <given-names>J</given-names>
</name>
<name>
<surname>Forsblom</surname> <given-names>C</given-names>
</name>
<etal/>
</person-group>. <article-title>and finnDiane study group. Bacterial endotoxin activity in human serum is associated with dyslipidemia, insulin resistance, obesity, and chronic inflammation</article-title>. <source>Diabetes Care</source>. (<year>2011</year>) <volume>34</volume>:<page-range>1809&#x2013;15</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.2337/dc10-2197</pub-id>
</citation>
</ref>
<ref id="B21">
<label>21</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Fukui</surname> <given-names>H</given-names>
</name>
<name>
<surname>Brauner</surname> <given-names>B</given-names>
</name>
<name>
<surname>Bode</surname> <given-names>JC</given-names>
</name>
<name>
<surname>Bode</surname> <given-names>C</given-names>
</name>
</person-group>. <article-title>Plasma endotoxin concentrations in patients with alcoholic and non-alcoholic liver disease: reevaluation with an improved chromogenic assay</article-title>. <source>J Hepatol</source>. (<year>1991</year>) <volume>12</volume>:<page-range>162&#x2013;9</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/0168-8278(91)90933-3</pub-id>
</citation>
</ref>
<ref id="B22">
<label>22</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Nguyen</surname> <given-names>MD</given-names>
</name>
<name>
<surname>Julien</surname> <given-names>J-P</given-names>
</name>
<name>
<surname>Rivest</surname> <given-names>S</given-names>
</name>
</person-group>. <article-title>Innate immunity: the missing link in neuroprotection and neurodegeneration</article-title>? <source>Nat Rev Neurosci</source>. (<year>2002</year>) <volume>3</volume>:<page-range>216&#x2013;27</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1038/nrn752</pub-id>
</citation>
</ref>
<ref id="B23">
<label>23</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Brown</surname> <given-names>GC</given-names>
</name>
</person-group>. <article-title>The endotoxin hypothesis of neurodegeneration</article-title>. <source>JNI</source>. (<year>2019</year>) <volume>16</volume>:<fpage>180</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1186/s12974-019-1564-7</pub-id>
</citation>
</ref>
<ref id="B24">
<label>24</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Schwabe</surname> <given-names>RF</given-names>
</name>
<name>
<surname>Jobin</surname> <given-names>C</given-names>
</name>
</person-group>. <article-title>The microbiome and cancer</article-title>. <source>Nat Rev Cancer</source>. (<year>2013</year>) <volume>13</volume>:<page-range>800&#x2013;12</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1038/nrc3610</pub-id>
</citation>
</ref>
<ref id="B25">
<label>25</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Li</surname> <given-names>J</given-names>
</name>
<name>
<surname>Yang</surname> <given-names>F</given-names>
</name>
<name>
<surname>Wei</surname> <given-names>F</given-names>
</name>
<name>
<surname>Ren</surname> <given-names>X</given-names>
</name>
</person-group>. <article-title>The role of toll-like receptor 4 in tumor microenvironment</article-title>. <source>Oncotarget</source>. (<year>2017</year>) <volume>8</volume>:<page-range>66656&#x2013;67</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.18632/oncotarget.19105</pub-id>
</citation>
</ref>
<ref id="B26">
<label>26</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Golenbock</surname> <given-names>DT</given-names>
</name>
<name>
<surname>Hampton</surname> <given-names>RY</given-names>
</name>
<name>
<surname>Qureshi</surname> <given-names>N</given-names>
</name>
<name>
<surname>Takayama</surname> <given-names>K</given-names>
</name>
<name>
<surname>Raetz</surname> <given-names>CR</given-names>
</name>
</person-group>. <article-title>Lipid A-like molecules that antagonize the effects of endotoxins on human monocytes</article-title>. <source>J Biol Chem</source>. (<year>1991</year>) <volume>266</volume>:<page-range>19490&#x2013;8</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/S00219258(18)55023-7</pub-id>
</citation>
</ref>
<ref id="B27">
<label>27</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Lien</surname> <given-names>E</given-names>
</name>
<name>
<surname>Means</surname> <given-names>TK</given-names>
</name>
<name>
<surname>Heine</surname> <given-names>H</given-names>
</name>
<name>
<surname>Yoshimura</surname> <given-names>A</given-names>
</name>
<name>
<surname>Kusumoto</surname> <given-names>S</given-names>
</name>
<name>
<surname>Fukase</surname> <given-names>K</given-names>
</name>
<etal/>
</person-group>. <article-title>Toll-like receptor 4 imparts ligand-specific recognition of bacterial lipopolysaccharide</article-title>. <source>J Clin Invest</source>. (<year>2000</year>) <volume>105</volume>:<fpage>497</fpage>&#x2013;<lpage>504</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1172/JCI8541</pub-id>
</citation>
</ref>
<ref id="B28">
<label>28</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Moreno-Navarrete</surname> <given-names>JM</given-names>
</name>
<name>
<surname>Fern&#xe1;ndez-Real</surname> <given-names>JM</given-names>
</name>
</person-group>. <article-title>Antimicrobial-sensing proteins in obesity and type 2 diabetes</article-title>. <source>Diabetes Care</source>. (<year>2011</year>) <volume>34</volume>:<page-range>S335&#x2013;41</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.2337/dc11-s238</pub-id>
</citation>
</ref>
<ref id="B29">
<label>29</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Wurfel</surname> <given-names>MM</given-names>
</name>
<name>
<surname>Monks</surname> <given-names>BG</given-names>
</name>
<name>
<surname>Ingalls</surname> <given-names>RR</given-names>
</name>
<name>
<surname>Dedrick</surname> <given-names>RL</given-names>
</name>
<name>
<surname>Delude</surname> <given-names>R</given-names>
</name>
<name>
<surname>Zhou</surname> <given-names>D</given-names>
</name>
<etal/>
</person-group>. <article-title>Targeted deletion of the lipopolysaccharide (LPS)binding protein gene leads to profound suppression of LPS responses ex vivo, whereas in <italic>vivo</italic> responses remain intact</article-title>. <source>J Exp Med</source>. (<year>1997</year>) <volume>186</volume>:<page-range>5051&#x2013;6</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1084/jem.186.12.2051</pub-id>
</citation>
</ref>
<ref id="B30">
<label>30</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Marshall</surname> <given-names>JC</given-names>
</name>
</person-group>. <article-title>Lipopolysaccharide: an endotoxin or an exogenous hormone</article-title>? <source>Clin Infect Dis</source>. (<year>2005</year>) <volume>41</volume>:<page-range>S470&#x2013;80</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1086/432000</pub-id>
</citation>
</ref>
<ref id="B31">
<label>31</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Fitzgerald</surname> <given-names>KA</given-names>
</name>
<name>
<surname>Rowe</surname> <given-names>DC</given-names>
</name>
<name>
<surname>Barnes</surname> <given-names>BJ</given-names>
</name>
<name>
<surname>Caffrey</surname> <given-names>DR</given-names>
</name>
<name>
<surname>Visintin</surname> <given-names>A</given-names>
</name>
<name>
<surname>Latz</surname> <given-names>E</given-names>
</name>
<etal/>
</person-group>. <article-title>LPS-TLR4 signaling to IRF-3/7 and NF-kB involves the toll adapters TRAM and TRIF</article-title>. <source>J Exp Med</source>. (<year>2003</year>) <volume>198</volume>:<page-range>1043&#x2013;55</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1084/jem.20031023</pub-id>
</citation>
</ref>
<ref id="B32">
<label>32</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Coats</surname> <given-names>SR</given-names>
</name>
<name>
<surname>Pham</surname> <given-names>T-TT</given-names>
</name>
<name>
<surname>Bainbridge</surname> <given-names>BW</given-names>
</name>
<name>
<surname>Reife</surname> <given-names>RA</given-names>
</name>
<name>
<surname>Darveau</surname> <given-names>RP</given-names>
</name>
</person-group>. <article-title>MD-2 Mediates the Ability of TetraAcylated and Penta-Acylated Lipopolysaccharides to Antagonize Escherichia coli Lipopolysaccharide at the TLR4 Signaling Complex</article-title>. <source>J Immunol</source>. (<year>2005</year>) <volume>175</volume>:<page-range>4490&#x2013;8</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.4049/jimmunol.175.7.4490</pub-id>
</citation>
</ref>
<ref id="B33">
<label>33</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Hornung</surname> <given-names>V</given-names>
</name>
<name>
<surname>Rothenfusser</surname> <given-names>S</given-names>
</name>
<name>
<surname>Britsch</surname> <given-names>S</given-names>
</name>
<name>
<surname>Krug</surname> <given-names>A</given-names>
</name>
<name>
<surname>Jahrsd&#xf6;rfer</surname> <given-names>B</given-names>
</name>
<name>
<surname>Giese</surname> <given-names>T</given-names>
</name>
<etal/>
</person-group>. <article-title>Quantitative expression of toll-like receptor 1&#x2013;10 mRNA in cellular subsets of human peripheral blood mononuclear cells and sensitivity to cpG oligodeoxynucleotides</article-title>. <source>J&#xa0;Immunol</source>. (<year>2002</year>) <volume>168</volume>:<page-range>5120&#x2013;6</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.4049/jimmunol.168.9.4531</pub-id>
</citation>
</ref>
<ref id="B34">
<label>34</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Tsai</surname> <given-names>C-M</given-names>
</name>
<name>
<surname>Frasch</surname> <given-names>CE</given-names>
</name>
</person-group>. <article-title>A sensitive silver stain for detecting lipopolysaccharides in polyacrylamide gels</article-title>. <source>Anal Biochem</source>. (<year>1981</year>) <volume>119</volume>:<page-range>115&#x2013;9</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/0003-2697(82)90673-x</pub-id>
</citation>
</ref>
<ref id="B35">
<label>35</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Morgan</surname> <given-names>AP</given-names>
</name>
<name>
<surname>Helander</surname> <given-names>IM</given-names>
</name>
<name>
<surname>Kosunen</surname> <given-names>TU</given-names>
</name>
</person-group>. <article-title>Compositional analysis of <italic>Helicobacter pylori</italic> Rough-Form Lipopolysaccharides</article-title>. <source>J Bacteriol</source>. (<year>1992</year>) <volume>174</volume>:<page-range>1370&#x2013;7</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1128/jb.174.4.1370-1377.1992</pub-id>
</citation>
</ref>
<ref id="B36">
<label>36</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Bailey</surname> <given-names>SC</given-names>
</name>
<name>
<surname>Apirion</surname> <given-names>D</given-names>
</name>
</person-group>. <article-title>Identification of lipopolysaccharides and phospholipids of <italic>escherichia coli</italic> in polyacrylamide gels</article-title>. <source>J Bacteriol</source>. (<year>1977</year>) <volume>131</volume>:<page-range>347&#x2013;55</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1128/jb.131.1.347-355.1977</pub-id>
</citation>
</ref>
<ref id="B37">
<label>37</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Kaca</surname> <given-names>W</given-names>
</name>
<name>
<surname>Roth</surname> <given-names>RI</given-names>
</name>
<name>
<surname>Levin</surname> <given-names>J</given-names>
</name>
</person-group>. <article-title>Hemoglobin, a newly recognized lipopolysaccharide (LPS)-binding protein that enhances LPS biological activity</article-title>. <source>J Biol Chem</source>. (<year>1994</year>) <volume>269</volume>:<page-range>25078&#x2013;84</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/S0021-9258(17)31501-6</pub-id>
</citation>
</ref>
<ref id="B38">
<label>38</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Bagaev</surname> <given-names>AV</given-names>
</name>
<name>
<surname>Garaeva</surname> <given-names>AY</given-names>
</name>
<name>
<surname>Lebedeva</surname> <given-names>ES</given-names>
</name>
<name>
<surname>Pichugin</surname> <given-names>AV</given-names>
</name>
<name>
<surname>Ataullakhanov</surname> <given-names>RI</given-names>
</name>
<name>
<surname>Ataullakhanov</surname> <given-names>FI</given-names>
</name>
</person-group>. <article-title>Elevated pre-activation basal level of nuclear NF-&#x3ba;B in native macrophages accelerates LPS-induced translocation of cytosolic NF-&#x3ba;B into the cell nucleus</article-title>. <source>Sci Rep</source>. (<year>2019</year>) <volume>9</volume>:<fpage>4563</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1038/s41598-018-36052-5</pub-id>
</citation>
</ref>
<ref id="B39">
<label>39</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Cheng</surname> <given-names>QJ</given-names>
</name>
<name>
<surname>Ohta</surname> <given-names>S</given-names>
</name>
<name>
<surname>Sheu</surname> <given-names>KM</given-names>
</name>
<name>
<surname>Spreafico</surname> <given-names>R</given-names>
</name>
<name>
<surname>Adelaja</surname> <given-names>A</given-names>
</name>
<name>
<surname>Taylor</surname> <given-names>B</given-names>
</name>
<etal/>
</person-group>. <article-title>NF-kB dynamics determine the stimulus specificity of epigenomic reprogramming in macrophages</article-title>. <source>Science</source>. (<year>2021</year>) <volume>372</volume>:<page-range>1349&#x2013;53</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1126/science.abc0269</pub-id>
</citation>
</ref>
<ref id="B40">
<label>40</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Son</surname> <given-names>M</given-names>
</name>
<name>
<surname>Wang</surname> <given-names>AG</given-names>
</name>
<name>
<surname>Tu</surname> <given-names>H-L</given-names>
</name>
<name>
<surname>Oliver Metzig</surname> <given-names>M</given-names>
</name>
<name>
<surname>Patel</surname> <given-names>P</given-names>
</name>
<name>
<surname>Husain</surname> <given-names>K</given-names>
</name>
<etal/>
</person-group>. <article-title>NF-&#x3ba;B responds to absolute differences in cytokine concentrations</article-title>. <source>Sci Signaling</source>. (<year>2021</year>) <volume>14</volume>:<elocation-id>eaaz4382</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.1126/scisignal.aaz4382</pub-id>
</citation>
</ref>
<ref id="B41">
<label>41</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Pestka</surname> <given-names>S</given-names>
</name>
<name>
<surname>Krause</surname> <given-names>CD</given-names>
</name>
<name>
<surname>Sarkar</surname> <given-names>D</given-names>
</name>
<name>
<surname>Walter</surname> <given-names>MR</given-names>
</name>
<name>
<surname>Shi</surname> <given-names>Y</given-names>
</name>
<name>
<surname>Fisher</surname> <given-names>PB</given-names>
</name>
</person-group>. <article-title>Interleukin-10 and related cytokines and receptors</article-title>. <source>Annu Rev Immunol</source>. (<year>2004</year>) <volume>22</volume>:<page-range>929&#x2013;79</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1146/annurev.immunol.22.012703.104622</pub-id>
</citation>
</ref>
<ref id="B42">
<label>42</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Gilroy</surname> <given-names>DW</given-names>
</name>
<name>
<surname>Colville-Nash</surname> <given-names>PR</given-names>
</name>
<name>
<surname>Willis</surname> <given-names>D</given-names>
</name>
<name>
<surname>Chivers</surname> <given-names>J</given-names>
</name>
<name>
<surname>Paul-Clark</surname> <given-names>MJ</given-names>
</name>
<name>
<surname>Willoughby</surname> <given-names>DA</given-names>
</name>
</person-group>. <article-title>Inducible cyclooxygenase may have anti-inflammatory properties</article-title>. <source>Nat Med</source>. (<year>1999</year>) <volume>5</volume>:<fpage>698</fpage>&#x2013;<lpage>701</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1038/9550</pub-id>
</citation>
</ref>
<ref id="B43">
<label>43</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Chan</surname> <given-names>MM-Y</given-names>
</name>
<name>
<surname>Rossi Moore</surname> <given-names>A</given-names>
</name>
</person-group>. <article-title>Resolution of inflammation in murine autoimmune arthritis is disrupted by cyclooxygenase-2 inhibition and restored by prostaglandin E2-mediated lipoxin A4 production</article-title>. <source>J Immunol</source>. (<year>2010</year>) <volume>184</volume>:<page-range>6418&#x2013;26</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.4049/jimmunol.0903816</pub-id>
</citation>
</ref>
<ref id="B44">
<label>44</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Gibbs</surname> <given-names>JE</given-names>
</name>
<name>
<surname>Blaikley</surname> <given-names>J</given-names>
</name>
<name>
<surname>Beesley</surname> <given-names>S</given-names>
</name>
<name>
<surname>Matthews</surname> <given-names>L</given-names>
</name>
<name>
<surname>Simpson</surname> <given-names>KD</given-names>
</name>
<name>
<surname>Boyce</surname> <given-names>SH</given-names>
</name>
<etal/>
</person-group>. <article-title>The nuclear receptor REV-ERB&#x3b1; mediates circadian regulation of innate immunity through selective regulation of inflammatory cytokines</article-title>. <source>Proc Natl Acad Sci USA</source>. (<year>2012</year>) <volume>109</volume>:<page-range>582&#x2013;7</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1073/pnas.1106750109</pub-id>
</citation>
</ref>
<ref id="B45">
<label>45</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Narasimamurthy</surname> <given-names>R</given-names>
</name>
<name>
<surname>Hatori</surname> <given-names>M</given-names>
</name>
<name>
<surname>Nayak</surname> <given-names>SK</given-names>
</name>
<name>
<surname>Liu</surname> <given-names>F</given-names>
</name>
<name>
<surname>Panda</surname> <given-names>S</given-names>
</name>
<name>
<surname>Verma</surname> <given-names>IM</given-names>
</name>
</person-group>. <article-title>Circadian clock protein cryptochrome regulates the expression of proinflammatory cytokines</article-title>. <source>Proc Natl Acad Sci USA</source>. (<year>2012</year>) <volume>109</volume>:<page-range>12662&#x2013;7</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1073/pnas.1209965109</pub-id>
</citation>
</ref>
<ref id="B46">
<label>46</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Liu</surname> <given-names>C-H</given-names>
</name>
<name>
<surname>Chen</surname> <given-names>Z</given-names>
</name>
<name>
<surname>Chen</surname> <given-names>K</given-names>
</name>
<name>
<surname>Liao</surname> <given-names>F-T</given-names>
</name>
<name>
<surname>Chung</surname> <given-names>C-E</given-names>
</name>
<name>
<surname>Liu</surname> <given-names>X</given-names>
</name>
<etal/>
</person-group>. <article-title>Lipopolysaccharide-mediated chronic inflammation promotes tobacco carcinogen-induced lung cancer and determines the efficacy of immunotherapy</article-title>. <source>Cancer Res</source>. (<year>2021</year>) <volume>81</volume>:<page-range>144&#x2013;57</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1158/0008-5472.CAN-201994</pub-id>
</citation>
</ref>
<ref id="B47">
<label>47</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Yin</surname> <given-names>H</given-names>
</name>
<name>
<surname>Pu</surname> <given-names>N</given-names>
</name>
<name>
<surname>Chen</surname> <given-names>Q</given-names>
</name>
<name>
<surname>Zang</surname> <given-names>J</given-names>
</name>
<name>
<surname>Zhao</surname> <given-names>G</given-names>
</name>
<name>
<surname>Xu</surname> <given-names>X</given-names>
</name>
<etal/>
</person-group>. <article-title>Gut-derived lipopolysaccharide remodels tumoral microenvironment and synergizes with PD-L1 checkpoint blockade via TLR4/MyD88/AKT/NF-kB pathway in pancreatic cancer</article-title>. <source>Cell Death Dis</source>. (<year>2021</year>) <volume>12</volume>:<fpage>1033</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1038/s41419021-04293-4</pub-id>
</citation>
</ref>
<ref id="B48">
<label>48</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Sulit</surname> <given-names>AK</given-names>
</name>
<name>
<surname>Daigneault</surname> <given-names>M</given-names>
</name>
<name>
<surname>Allen-Vercoe</surname> <given-names>E</given-names>
</name>
<name>
<surname>Silander</surname> <given-names>OK</given-names>
</name>
<name>
<surname>Hock</surname> <given-names>B</given-names>
</name>
<name>
<surname>McKenzie</surname> <given-names>J</given-names>
</name>
<etal/>
</person-group>. <article-title>Bacterial lipopolysaccharide modulates immune response in the colorectal tumor microenvironment</article-title>. <source>NPJ Biofilms Microbes</source>. (<year>2023</year>) <volume>9</volume>:<fpage>59</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1038/s41522-023-00429-w</pub-id>
</citation>
</ref>
<ref id="B49">
<label>49</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Raju</surname> <given-names>SM</given-names>
</name>
<name>
<surname>Kumar</surname> <given-names>AP</given-names>
</name>
<name>
<surname>Yadav</surname> <given-names>AN</given-names>
</name>
<name>
<surname>Rajkumar</surname> <given-names>K</given-names>
</name>
<name>
<surname>Sandhya</surname> <given-names>MVS</given-names>
</name>
<name>
<surname>Burgula</surname> <given-names>S</given-names>
</name>
</person-group>. <article-title>Haptoglobin improves acute phase response and endotoxin tolerance in response to bacterial LPS</article-title>. <source>Immunol Lett</source>. (<year>2019</year>) <volume>207</volume>:<fpage>17</fpage>&#x2013;<lpage>27</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.imlet.2019.01.002</pub-id>
</citation>
</ref>
<ref id="B50">
<label>50</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Schaer</surname> <given-names>DJ</given-names>
</name>
<name>
<surname>Buehler</surname> <given-names>PW</given-names>
</name>
<name>
<surname>Alayash</surname> <given-names>AI</given-names>
</name>
<name>
<surname>Belcher</surname> <given-names>JD</given-names>
</name>
<name>
<surname>Vercellotti</surname> <given-names>GM</given-names>
</name>
</person-group>. <article-title>Hemolysis and free hemoglobin revisited: exploring hemoglobin and hemin scavengers as a novel class of therapeutic proteins</article-title>. <source>Blood</source>. (<year>2013</year>) <volume>121</volume>(<issue>8</issue>):<page-range>1276&#x2013;84</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1182/blood-2012-11-451229</pub-id>
</citation>
</ref>
<ref id="B51">
<label>51</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Petruk</surname> <given-names>G</given-names>
</name>
<name>
<surname>Puthia</surname> <given-names>M</given-names>
</name>
<name>
<surname>Petrlova</surname> <given-names>J</given-names>
</name>
<name>
<surname>Samsudin</surname> <given-names>F</given-names>
</name>
<name>
<surname>Str&#xf6;mdahl</surname> <given-names>A-C</given-names>
</name>
<name>
<surname>Cerps</surname> <given-names>S</given-names>
</name>
<etal/>
</person-group>. <article-title>SARS-CoV-2 spike protein binds to bacterial lipopolysaccharide and boosts proinflammatory activity</article-title>. <source>J Mol Cell Biol</source>. (<year>2020</year>) <volume>12</volume>:<page-range>916&#x2013;32</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1093/jmcb/mjaa067</pub-id>
</citation>
</ref>
<ref id="B52">
<label>52</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Tumpara</surname> <given-names>S</given-names>
</name>
<name>
<surname>Gr&#xfc;nding</surname> <given-names>AR</given-names>
</name>
<name>
<surname>Sivaraman</surname> <given-names>K</given-names>
</name>
<name>
<surname>Wrenger</surname> <given-names>S</given-names>
</name>
<name>
<surname>Olejnicka</surname> <given-names>B</given-names>
</name>
<name>
<surname>Welte</surname> <given-names>T</given-names>
</name>
<etal/>
</person-group>. <article-title>Boosted pro-inflammatory activity in human PBMCs by lipopolysaccharide and SARS-coV-2 spike protein is regulated by &#x3b1;-1 antitrypsin</article-title>. <source>Int J Mol Sci</source>. (<year>2021</year>) <volume>22</volume>:<elocation-id>7941</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.3390/ijms22157941</pub-id>
</citation>
</ref>
<ref id="B53">
<label>53</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Kruglikov</surname> <given-names>IK</given-names>
</name>
<name>
<surname>Scherer</surname> <given-names>PE</given-names>
</name>
</person-group>. <article-title>Preexisting and inducible endotoxemia as crucial contributors to the severity of COVID-19 outcomes</article-title>. <source>PloS Pathog</source>. (<year>2021</year>) <volume>17</volume>:<elocation-id>e1009306</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.1371/journal.ppat.1009306</pub-id>
</citation>
</ref>
<ref id="B54">
<label>54</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Assimakopoulos</surname> <given-names>SF</given-names>
</name>
<name>
<surname>Mastronikolis</surname> <given-names>S</given-names>
</name>
<name>
<surname>de Lastic</surname> <given-names>A-L</given-names>
</name>
<name>
<surname>Aretha</surname> <given-names>D</given-names>
</name>
<name>
<surname>Papageorgiou</surname> <given-names>D</given-names>
</name>
<name>
<surname>Chalikidi</surname> <given-names>T</given-names>
</name>
<etal/>
</person-group>. <article-title>Intestinal barrier biomarker ZO1 and endotoxin are increased in blood of patients with COVID-19-associated pneumonia</article-title>. <source>In Vivo</source>. (<year>2021</year>) <volume>35</volume>::<page-range>2483&#x2013;8</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.21873/invivo.12528</pub-id>
</citation>
</ref>
<ref id="B55">
<label>55</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Tripathi</surname> <given-names>A</given-names>
</name>
<name>
<surname>Lammers</surname> <given-names>KM</given-names>
</name>
<name>
<surname>Goldblum</surname> <given-names>S</given-names>
</name>
<name>
<surname>Shea-Donahue</surname> <given-names>T</given-names>
</name>
<name>
<surname>Netzel-Arnett</surname> <given-names>S</given-names>
</name>
<name>
<surname>Buzza</surname> <given-names>MS</given-names>
</name>
<etal/>
</person-group>. <article-title>Identification of human zonulin, a physiological modulator of tight junctions, as prehaptoglobin-2</article-title>. <source>Proc Natl Acad Sci</source>. (<year>2009</year>) <volume>106</volume>:<fpage>39</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1073/pnas.0906773106</pub-id>
</citation>
</ref>
<ref id="B56">
<label>56</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Su</surname> <given-names>D</given-names>
</name>
<name>
<surname>Roth</surname> <given-names>RI</given-names>
</name>
<name>
<surname>Yoshida</surname> <given-names>M</given-names>
</name>
<name>
<surname>Levin</surname> <given-names>J</given-names>
</name>
</person-group>. <article-title>Hemoglobin increases mortality from bacterial endotoxin</article-title>. <source>Infect Immun</source>. (<year>1997</year>) <volume>65</volume>:<page-range>1258&#x2013;66</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1128/iai.65.4.1258-1266.1997</pub-id>
</citation>
</ref>
<ref id="B57">
<label>57</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Lin</surname> <given-names>T</given-names>
</name>
<name>
<surname>Kwak</surname> <given-names>YH</given-names>
</name>
<name>
<surname>Sammy</surname> <given-names>F</given-names>
</name>
<name>
<surname>He</surname> <given-names>P</given-names>
</name>
<name>
<surname>Thundivalappil</surname> <given-names>S</given-names>
</name>
<name>
<surname>Sun</surname> <given-names>G</given-names>
</name>
<etal/>
</person-group>. <article-title>Synergistic inflammation is induced by blood degradation products with microbial Toll-like receptor agonists and is blocked by hemopexin</article-title>. <source>J Infect Dis</source>. (<year>2010</year>) <volume>202</volume>:<page-range>624&#x2013;32</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1086/654929</pub-id>
</citation>
</ref>
<ref id="B58">
<label>58</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Nakamura</surname> <given-names>M</given-names>
</name>
<name>
<surname>Bax</surname> <given-names>HJ</given-names>
</name>
<name>
<surname>Scotto</surname> <given-names>D</given-names>
</name>
<name>
<surname>Amiri Souri</surname> <given-names>E</given-names>
</name>
<name>
<surname>Sollie</surname> <given-names>S</given-names>
</name>
<name>
<surname>Harris</surname> <given-names>RJ</given-names>
</name>
<etal/>
</person-group>. <article-title>Immune mediator expression signatures are associated with improved outcome in ovarian carcinoma</article-title>. <source>OncoImmunology</source>. (<year>2019</year>) <volume>8</volume>:<fpage>e1593811</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1080/2162402X.2019.1593811</pub-id>
</citation>
</ref>
<ref id="B59">
<label>59</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Tai</surname> <given-names>C-S</given-names>
</name>
<name>
<surname>Lin</surname> <given-names>Y-R</given-names>
</name>
<name>
<surname>Teng</surname> <given-names>T-H</given-names>
</name>
<name>
<surname>Lin</surname> <given-names>P-Y</given-names>
</name>
<name>
<surname>Tu</surname> <given-names>S-J</given-names>
</name>
<name>
<surname>Huang</surname> <given-names>Y-R</given-names>
</name>
<etal/>
</person-group>. <article-title>Haptoglobin expression correlates with tumor differentiation and five-year overall survival rate in hepatocellular carcinoma</article-title>. <source>PloS One</source>. (<year>2017</year>) <volume>12</volume>:<elocation-id>e0171269</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.1371/journal.pone.0171269</pub-id>
</citation>
</ref>
<ref id="B60">
<label>60</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Oh</surname> <given-names>S-K</given-names>
</name>
<name>
<surname>Very</surname> <given-names>DL</given-names>
</name>
<name>
<surname>Walker</surname> <given-names>J</given-names>
</name>
<name>
<surname>Raam</surname> <given-names>S</given-names>
</name>
<name>
<surname>Ju</surname> <given-names>ST</given-names>
</name>
</person-group>. <article-title>An analogy between fetal haptoglobin and a potent immunosuppressant in cancer</article-title>. <source>Cancer Res</source>. (<year>1987</year>) <volume>47</volume>:<page-range>5120&#x2013;6</page-range>.</citation>
</ref>
<ref id="B61">
<label>61</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Okuyama</surname> <given-names>N</given-names>
</name>
<name>
<surname>Ide</surname> <given-names>Y</given-names>
</name>
<name>
<surname>Nakano</surname> <given-names>M</given-names>
</name>
<name>
<surname>Nakagawa</surname> <given-names>T</given-names>
</name>
<name>
<surname>Yamanaka</surname> <given-names>K</given-names>
</name>
<name>
<surname>Morikawi</surname> <given-names>K</given-names>
</name>
<etal/>
</person-group>. <article-title>Fucosylated haptoglobin is a novel marker for pancreatic cancer: A detailed analysis of the oligosaccharide structure and a possible mechanism for fucosylation</article-title>. <source>Int J Cancer</source>. (<year>2006</year>) <volume>118</volume>:<page-range>2803&#x2013;8</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1002/ijc.21728</pub-id>
</citation>
</ref>
<ref id="B62">
<label>62</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Unger</surname> <given-names>A</given-names>
</name>
<name>
<surname>Finkernagel</surname> <given-names>F</given-names>
</name>
<name>
<surname>Hoffmann</surname> <given-names>N</given-names>
</name>
<name>
<surname>Neuhaus</surname> <given-names>F</given-names>
</name>
<name>
<surname>Joos</surname> <given-names>B</given-names>
</name>
<name>
<surname>Nist</surname> <given-names>A</given-names>
</name>
<etal/>
</person-group>. <article-title>Chromatin binding of <italic>c</italic>-REL and p65 is not limiting for macrophage <italic>IL12B</italic> transcription during immediate suppression by ovarian carcinoma ascites</article-title>. <source>Front Immunol</source>. (<year>2018</year>) <volume>9</volume>:<elocation-id>1425</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.3389/fimmu.2018.01425</pub-id>
</citation>
</ref>
<ref id="B63">
<label>63</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Schumann</surname> <given-names>T</given-names>
</name>
<name>
<surname>Adhikary</surname> <given-names>T</given-names>
</name>
<name>
<surname>Wortmann</surname> <given-names>A</given-names>
</name>
<name>
<surname>Lieber</surname> <given-names>S</given-names>
</name>
<name>
<surname>Schnitzer</surname> <given-names>E</given-names>
</name>
<name>
<surname>Legrand</surname> <given-names>N</given-names>
</name>
<etal/>
</person-group>. <article-title>Deregulation of PPAR&#x3b2;/&#x3b4; target genes in tumor-associated macrophages by fatty acid ligands in the ovarian cancer microenvironment</article-title>. <source>Oncotarget</source>. (<year>2015</year>) <volume>6</volume>:<page-range>13416&#x2013;33</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.18632/oncotarget.3826</pub-id>
</citation>
</ref>
<ref id="B64">
<label>64</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Freibert</surname> <given-names>S-A</given-names>
</name>
<name>
<surname>Boniecki</surname> <given-names>MT</given-names>
</name>
<name>
<surname>St&#xfc;mpfig</surname> <given-names>C</given-names>
</name>
<name>
<surname>Schulz</surname> <given-names>V</given-names>
</name>
<name>
<surname>Krapoth</surname> <given-names>N</given-names>
</name>
<name>
<surname>Winge</surname> <given-names>DR</given-names>
</name>
<etal/>
</person-group>. <article-title>N-terminal tyrosine of ISCU2 triggers [2Fe-2S] cluster synthesis by ISCU2 dimerization</article-title>. <source>Nat Commun</source>. (<year>2021</year>) <volume>12</volume>:<fpage>6902</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1038/s41467-021-27122-w</pub-id>
</citation>
</ref>
</ref-list>
</back>
</article>