DAMPs

Damage associated molecular pattern molecules (DAMPs) are molecules that can initiate and perpetuate immune response in the noninfectious inflammatory response. (In contrast, Pathogen-associated molecular pattern molecules (PAMPs) initiate and perpetuate the infectious pathogen inflammatory response.)^[1] Many DAMPs are nuclear or cytosolic proteins. When released outside the cell or exposed on the surface of the cell following tissue injury, they move from a reducing to an oxidizing milieu, which results in their denaturation ^[2]. Also, following necrosis (a kind of cell death), tumor DNA is released outside the nucleus, and outside the cell, and becomes a DAMP^[3].

History

Two papers appearing in the same year presaged the deeper understanding of innate immune reactivity, dictating the subsequent nature of the adaptive immune response. The first ^[4] came from transplant surgeons who conducted a prospective randomized double-blind placebo-controlled trial. Administration of recombinant human superoxide dismutatase (rh-SOD) in recipients of cadaveric renal allografts demonstrated prolonged patient and graft survival with improvement in both acute and chronic rejection events. They speculated that the effect was related to its antioxidant action on the initial ischemia/reperfusion injury of the renal allograft, thereby reducing the immunogenicity of the allograft and the “grateful dead” or stressed cells. Thus free radical-mediated reperfusion injury-was seen to contribute to the process of innate and subsequent adaptive immune responses. The second^[5], suggested the possibility that the immune system detected “danger”, through a series of what we would now call damage associated molecular pattern molecules (DAMPs), working in concert with both positive and negative signals derived from other tissues. Thus these two papers together presaged the modern sense of the role of DAMPs and redox reviewed here, important apparently for both plant and animal resistance to pathogens and the response to cellular injury or damage. Although many immunologists have noticed that various "Danger signal" could initiate innate immune responses, the "DAMP" was described by Seong and Matzinger in 2004 for the first time^[6].

Examples of DAMPs

DAMPs vary greatly depending on the type of cell (epithelial or mesenchymal) and injured tissue. Protein DAMPs include intracellular proteins, such as heat-shock proteins ^[7] or HMGB1 ^[8] (high-mobility group box 1), and proteins derived from the extracellular matrix that are generated following tissue injury, such as hyaluronan fragments ^[9]. Examples of non-protein DAMPs include ATP ^[10][11], uric acid ^[12], heparin sulfate and DNA ^[3].

HMGB1

The chromatin-associated protein high-mobility group box 1 (HMGB1) is a prototypical leaderless secreted protein [LSP] secreted by hematopoietic cells through a lysosome-mediated pathway ^[13]. It is a major mediator of endotoxin shock ^[14] and acts on several immune cells to trigger inflammatory responses as a DAMP ^[8]. Known receptors for HMGB1 include TLR2, TLR4 and RAGE (Receptor for Advanced Glycation Endproducts). HMGB1 can induce Dendritic Cell Maturation via upregulation of CD80, CD83, CD86 and CD11c, induce production of other pro-inflammatory cytokines in myeloid cells (IL-1, TNF-a, IL-6, IL-8) as well as upregulate expression of cell adhesion molecules (ICAM-1, VCAM-1) on endothelial cells.

DNA

The presence of DNA anywhere other than the nucleus or mitochondria is perceived as a DAMP and triggers responses mediated by TLR9 and DAI that drive cellular activation and immunoreactivity. Interestingly, some tissues such as the gut are inhibited by DNA in their immune response.

S100 Molecules

S100 is a multigenic family of calcium modulated proteins involved in intracellular and extracellular regulatory activities with a connection to cancer as well as tissue, particularly neuronal, injury ^{[15][16][17][18][19]}.

Purine Metabolites [ATP, adenosine, uric acid]

Nucleotides (such as ATP) and nucleosides (such as adenosine) that have reached the extracellular space can also serve as ‘‘danger’’signals ^[20]. ATP and adenosine are released in high concentrations after catastrophic disruption of the cell, as occurs in necrotic cell death ^[21]. The immunobiology of these molecules once released into the extracellular milieu is complex. At lower concentrations, extracellular ATP serves as a chemoattractant for immature DCs as well as a maturation signal to upregulate co-stimulatory molecules. At higher concentrations, ATP blocks the synthesis of pro-inflammatory cytokines^[22][23][24]. Similarly, adenosine has dual effects on the function of the plasmacytoid DC. Uric acid is also an endogenous danger signal released by injured cells ^[25]

Clinical Targets in Various Disorders

[arthritis, cancer, ischemia-reperfusion, myocardial infarction, stroke] The application of therapeutics in this area could imaginatively include:

1. preventing DAMP release [proapoptotic therapies; platinums; ethyl pyruvate];
2. neutralizing or blocking DAMPs extracellularly [anti-HMGB1; rasburicase; sRAGE, etc.];
3. blocking the DAMP receptors or their signaling [RAGE small molecule antagonists; TLR4 antagonists; antibodies to DAMP-R.

External links

• Garg AD, Nowis D, Golab J, Vandenabeele P, Krysko DV, Agostinis P (January 2010). "Immunogenic cell death, DAMPs and anticancer therapeutics: An emerging amalgamation". Biochim. Biophys. Acta - Rev. Cancer 1805 (1): 53–71. doi:10.1016/j.bbcan.2009.08.003. PMID 19720113. 
• Garg AD, Krysko DV, Vandenabeele P, Agostinis P (May 2011). "DAMPs and PDT-mediated photo-oxidative stress: exploring the unknown". Photochem. Photobiol. Sci. 10 (5): 670–680. doi:10.1039/C0PP00294A. PMID 21258717. 
• Krysko DV, Agostinis P, Krysko O, Garg AD, Bachert C, Lambrecht BN, Vandenabeele P Emerging role of damage-associated molecular patterns derived from mitochondria in inflammation. Trends Immunol 32 4 157-64 2011 April 21334975 doi:10.1016/j.it.2011.01.005
• Damage Associated Molecular Pattern Molecules Group at University of Pittsburgh
• Lotze MT, Deisseroth A, Rubartelli A (July 2007). "Damage associated molecular pattern molecules". Clin. Immunol. 124 (1): 1–4. doi:10.1016/j.clim.2007.02.006. PMC 2000827. PMID 17468050. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2000827. 
• High-mobility group box 1 protein (HMGB1): nuclear weapon in the immune arsenal in Nature Review Immunology

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