Free radicals, symbols, and identities.
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Clark",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/10878.jpg",keywords:"Preimplantation Genetic Diagnosis, Medical Futility, Definition of Death, Extraordinary/Ordinary Means, Need for New Antibiotics, Role of Big Pharma, Uterine Transplants, Face Transplants, Confidentiality, Ethical Decision Making, Harm Reduction Theory, Safe Injection Sites",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"February 8th 2021",dateEndSecondStepPublish:"March 8th 2021",dateEndThirdStepPublish:"May 7th 2021",dateEndFourthStepPublish:"July 26th 2021",dateEndFifthStepPublish:"September 24th 2021",remainingDaysToSecondStep:"12 days",secondStepPassed:!1,currentStepOfPublishingProcess:2,editedByType:null,kuFlag:!1,biosketch:"A faculty member for medical residents, medical students, and undergraduate students and a researcher in issues that challenge the national and global arenas. 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He is the author of To Treat or Not To Treat and Death With Dignity and has published numerous peer-reviewed articles in national and international medical and ethical journals.",institutionString:"Saint Joseph's University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"3",totalChapterViews:"0",totalEditedBooks:"2",institution:{name:"Saint Joseph's University",institutionURL:null,country:{name:"United States of America"}}}],coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"16",title:"Medicine",slug:"medicine"}],chapters:null,productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"346794",firstName:"Mia",lastName:"Miskulin",middleName:null,title:"Ms.",imageUrl:"https://mts.intechopen.com/storage/users/346794/images/15795_n.png",email:"mia@intechopen.com",biography:"As an Author Service Manager my responsibilities include monitoring and facilitating all publishing activities for authors and editors. From chapter submission and review, to approval and revision, copyediting and design, until final publication, I work closely with authors and editors to ensure a simple and easy publishing process. I maintain constant and effective communication with authors, editors and reviewers, which allows for a level of personal support that enables contributors to fully commit and concentrate on the chapters they are writing, editing, or reviewing. I assist authors in the preparation of their full chapter submissions and track important deadlines and ensure they are met. I help to coordinate internal processes such as linguistic review, and monitor the technical aspects of the process. As an ASM I am also involved in the acquisition of editors. 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Venkateswarlu",coverURL:"https://cdn.intechopen.com/books/images_new/371.jpg",editedByType:"Edited by",editors:[{id:"58592",title:"Dr.",name:"Arun",surname:"Shanker",slug:"arun-shanker",fullName:"Arun Shanker"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},chapter:{item:{type:"chapter",id:"41538",title:"The Role of Cyclooxygenase-2, Epidermal Growth Factor Receptor and Aromatase in Malignant Mesothelioma",doi:"10.5772/50674",slug:"the-role-of-cyclooxygenase-2-epidermal-growth-factor-receptor-and-aromatase-in-malignant-mesotheliom",body:'Malignant mesothelioma (MM) is a rare malignant disease originating from neoplastic mesothelial cells which compose the serous membranes of pleura, peritoneum, pericardium, or testis. Mesothelioma responds little to chemo and radiotherapy and is associated with a poor prognosis. In Western Europe, the incidence is increasing and is expected to peak in the year 2020 (Peto et al., 1999; Pelucchi et al., 2004) while in Japan and Australia, the peak is expected for 2025 and 2015 respectively. Thus in order to improve the clinical outcome in the pharmacological treatment of this refractory tumour, drugs directed against novel and/or characterized tumour-specific cellular targets are needed. Malignant pleural mesothelioma (MPM) originates from the pleural layers. Pleura is not just a limiting protective layer for lung, but a dynamic cellular structure regulating serial responses to injury, infection, and disease. Mesothelial cells are biologically active because they can sense and respond to signals within their microenvironment. The development of MM is associated in most patients with a history of asbestos exposure (Mossman et al., 1996). In addition, some investigations have implicated SV40 virus in the pathogenesis of a subset of mesotheliomas (Carbone et al., 2003). Exposure to asbestos typically occurs during mining and milling of the fibers or during industrial application of asbestos in textiles, insulation, shipbuilding, brake lining mechanics, and other areas. Non occupational exposure is usually related to asbestos fibers inadvertently released into the environment and transported by asbestos-contaminated clothing or other materials. After asbestos inhalation, fibers deposited in the lungs typically remain in close contact with lung epithelial cells. Since this fiber-cell interaction could potentially initiate or inhibit cellular functions, asbestos acts as a carcinogen by initiating the carcinogenic process. Carcinogens are known to modulate the transcription factors, anti-apoptotic proteins, proapoptotic proteins, protein kinases, cell cycle proteins, cell adhesion molecules, cyclooxygenase-2, and growth factor signaling pathways. Research has demonstrated that asbestos exposure generates reactive oxygen species and activates macrophages and other cell types to produce these compounds as well as cytokines and growth factors (Kamp & Weitzman, 1999). Furthermore, the deposition of insoluble amphibole fibers results in a chronic inflammatory state and increased rates of MM in exposed individuals (Mossman & Churg, 1998). This article reviews recent studies regarding some MM molecular targets involved in inflammation for not only prevention but also for therapy of this deadly cancer.
The existence of inflammation has been associated with up-regulation of the inducible cyclooxygenases-2 (COX-2), leading to an increase in its product prostaglandin-E2 (PGE-2) (Vane et al., 1994), and is associated with an increased risk of cancer (Ambs et al., 1999). Considerable evidence indicates that COX-2–derived PGE2 can activate epidermal growth factor receptor (EGFR) signaling and thereby stimulate cell proliferation. The mechanism(s) by which this occurs seem to be complex and context specific. Regardless of the precise mechanism for doing so, exposure to COX-2–derived PGE2 can initiate a positive feedback loop whereby activation of EGFR results in enhanced expression of COX-2 and increased synthesis of prostaglandins (Lippman et al., 2005). Although there is a crosstalk between EGFR and COX-2 in carcinogenesis it is important to stress that EGFR and its downstream effectors can be activated independently of COX-2/PGE2. For example, in MM, asbestos fibers activate the EGFR resulting in activation of extracellular signal regulated kinase downstream (Shukla et al., 2011). Similarly, COX-2/PGE2 and its downstream effectors can be regulated independently of EGFR signaling. For example, PGE2 is able to rapidly stimulate Erk phosphorylation in a subset of non–small cell lung cancer (NSCLC) cell lines via intracellular activation of kinase cascades independently of the proteolytic release of EGFR ligands via Src. (Gutkind, 1998; Krysan et al., 2005). These findings have provided the underpinnings for developing agents targeting EGFR or COX-2. A recent study with COX-2 and EGFR inhibitors in MM has shown that the differences in the susceptibility to drugs could be due to the differences in the signalling pathways affected, in addition to the responses that may depend on cell type. In particular it was demonstrated in the Ist-Mes-2 MM cell line a synergistic effect on the inhibition of cell growth between the active small molecule inhibitor of EGFR, gefitinib and rofecoxib, a drug that specifically targets COX-2. Interestingly, the other two cell lines sensitive to treatment with single drugs Ist-Mes-1 and MPP89, did not display this synergistic effect. Only in Ist-Mes-2, the cell line where p-AKT was not detectable, did the combination of rofecoxib and gefitinib result in a synergistic effect. This study suggests that identifying the mechanisms that underlie these differences in sensitivity of cell lines of MM single agents and their combinations, can help us to explore new proteins involved in drug resistance. (Stoppoloni et al., 2010). Lately a new therapeutic target, the Aromatase (CYP19A1), has been identified in MM. This new discovery has highlighted the possibility that there may be in MM as well as in breast cancer a relationship between inflammation, COX-2, EGFR and Aromatase (Fig.1)(Chumsri et al. 2011. These key molecules and pathways that connect chronic inflammation with inflammation associated oncogenic transformation will be described. We emphasize how the increased understanding of the role of COX-2, EGFR and CYP19A1 in MM may provide novel preventive, diagnostic and therapeutic strategies for MM.
Posible relationship among inflammation, COX-2, EGFR and Aromatase.
Arachidonic acid (AA) metabolic pathway can be activated by inflammation (Stimulus). AA is released from membrane phospholipids by a phospholipase named phospholipase A2 (PLA-2) enzyme and converted to bioactive PGE-2 by COX-2. PGE2 is an important regulator of CYP19A1 gene expression and stimulates CYP19A1 activity to increase localized estrogen 17-beta-estradiol (E2). The E2 binds to the classical estrogen receptor (ER) to promote its dimerization and translocation to the nucleus where it modulates the expression of estrogen target genes (COX-2). The interaction of E2 with ER-alpha also activates signaling cascades that promote cell proliferation, such as the activation of of c-Src tyrosine kinase (Src). Src can also be activated by binding of PGE2 to its receptor (EP). Src activation induces the EGFR phosphorilation and stimulates the matrix metalloproteinase cascade which culminates in the liberation of epidermal growth factor (EGF). Free EGF ligand binds to EGFR family receptors that activates extracellular-signal-regulate- kinase (ERK). Cytosolic phospholipase A2 (cPLA) is a substrate for ERK and phosphorylation of cPLA (cPLAp) promotes its association with intracellular membranes such as those of the endoplasmic reticulum and mitochondria and releases lysophospholipids and AA from these membranes. COX-2 catalyses the conversion of AA into PGE-2.
COXs, also known as prostaglandin-endoperoxide synthases, are key regulatory enzymes in the biosynthesis of prostanoids, a class of hormones including prostaglandins, prostacyclins, and thromboxanes responsible for multiple inflammatory mitogenic, and angiogenic activities in various tissue and organ systems. Increasing interest on COXs is due to the many evidences showing the involvement of these enzymes not only in physiologic but even in pathophysiologic processes such as development and progression of cancer. Two COX isoforms have been identified as COX-1 and COX-2. COX-1 is expressed constitutively in several cell types of normal mammalian tissues, where it is involved in the maintenance of tissue homeostasis. In contrast, COX-2 is an inducible enzyme responsible for PGE2 production at sites of inflammation (Harris, 2007). The mechanism through which COX-2 exherts its tumorigenic action can be directly mediated by the enzyme or due to effects of its products. COX-2 is an oxygenase and its intermediates are highly reactive. It is possible that these compounds may cause free radical damage, for example, against DNA molecule (Cardillo et al., 2005). There is considerable evidence that prostaglandins, participate both in normal growth responses and in aberrant growth, including carcinogenesis (Greenhough et al., 2009). PGE2 exerts its autocrine/paracrine effects on target cells by binding to four types of membrane-bound, G protein-coupled receptors termed as EP1, EP2, EP3, and EP4 (E-series prostanoid receptors ) (Narumiya et al. 1999). These receptors are often coexpressed in the same cell type and use different, and in some cases, opposing intracellular signalling pathways (Breyer et al. 2001).Following ligand binding, the EP receptors activate different signal transduction pathways. EP1 raises intracellular Ca2_, whereas EP3 reduces or increases cyclic -adenosin monophosphate (cAMP) by activating inhibitory G (Gi) or stimulatory G (Gs) proteins depending on the particular splice variant expressed by the cell (Kotani, M et al. 1995). The EP2 and EP4 receptors increase intracellular cAMP by activating adenylate cyclase via Gs proteins. However, differences in the strength of Gs coupling, activation of other signal transduction pathways, agonist-induced desensitization, and agonist-induced internalization result in a differential response of the target cell to a ligand-induced activation of the EP2 or EP4 receptors (Akaogi et al. 2006).It was shown that PGE2 stimulation of both EP2 and EP4 receptors involves transactivation of the epidermal growth factor receptor (EGFR) signaling pathway to promote tumorigenesis (Buchanan et al.; Pai et al 2003; Sale set al. 2005 ). PGE-2 promotes tumor growth with subsequent enhancement of cellular proliferation, promotion and angiogenesis, stimulation of invasion/mobility, suppression of immune responses and inhibitiuon of programmed cell death by inducing expression of the Bcl-2 protooncogene (which can suppress apoptosis) (Cardillo et al.,2005) (Fig.2).
PGE2 in carcinogenesis
For several types of cancer the real risk factor seems to be chronic inflammation (Prescott & Fitzpatrick, 2000) that maintains high level of COX-2 and increase events that promote tumor formation. A tragic example of this mechanism is MM. Although molecular mechanisms of asbestos tumorigenicity have not been elucidated, research has shown that deposition of insoluble amphibole fibers results in a chronic inflammatory state (Mossman & Churg, 1998) and that this state generates reactive oxygen and nitrogen species, as well as cytokines and growth factors, through the activation of macrophages and other cell types (Kamp & Weitzman, 1999).
As expected, the prolonged inflammation causes the increase of COX-2 level, that is actually recognized as an important MM prognostic factor (Edwards et al., 2002; Mineo et al., 2010). A study clearly demonstrated that COX-2 expression is a strong prognostic factor in human mesothelioma, which contributes independently to the other clinical and histopathologic factors in determining a short survival (Edwards et al., 2002). Although the regulation of mRNA stability appears to be the most important regulatory step for COX-2 expression, several studies have reported that other mechanisms, such as transcriptional control or hypermethylation (Dixon et al., 2000), also are involved in the regulation of COX-2 expression. In cancer cells, it was demonstrated previously that altered post-transcriptional regulation of COX-2 is mediated by increased cytoplasmic mRNA binding of the mRNA stability factor HuR (Dixon et al., 2001). In MM, the cytoplasmic expression of HuR was correlated significantly with high COX-2 expression and with poor survival (Stoppoloni et al.,2008). Finally, COX-2 has been proposed to exert its influence on mesangial cell proliferation in vitro by a novel mechanism involving the tumor suppressor p53 and the cell cycle inhibitors p21 and p27 (Zahner et al., 2002). Interestingly, several studies have investigated the potential prognostic value of p53, p21 and p27 in malignant mesotheliomas, thus reinforcing the evidence of a primary role of COX-2 in the pathogenesis and progression of MM (Bongiovanni et al., 2001; Baldi et al., 2002). Due to the lack of a reliable treatment capable of achieving long-term control in mesothelioma patients, these enzymes are becoming more and more appealing as potential therapeutic targets (Veltman et al., 2010; Stoppoloni et al., 2010; O\'Kane et al., 2010)
The epidermal growth factor receptor (EGFR) is the cell-surface receptor for members of the epidermal growth factor family (EGF-family) of extracellular protein ligands (Herbst, 2004). Upon activation by its growth factor ligands, EGFR undergoes a transition from an inactive monomeric form to an active homodimer. In addition, EGFR may pair with another member of the ErbB receptor family, such as ErbB2/Her2/neu, to create an activated heterodimer. EGFR dimerization stimulates its intrinsic intracellular protein-tyrosine kinase activity. As a result, autophosphorylation of several tyrosine residues in the C-terminal domain of EGFR occurs (P-EGFR). This autophosphorylation leads to the activation of downstream signalling cascades including the RAS/extracellular signal regulated kinase (ERK) pathway, the phosphatidylinositol 3-kinase/AKT (PI3K/AKT) pathway and the Janus kinase/Signal transducer and activator of transcription (JAK/ STAT) pathway (Fig.3).
Activation of downstream signaling cascade by P-EGFR
These pathways act in a coordinated manner to promote cell survival (Oda et al., 2005). Such proteins modulate phenotypes such as cell migration, adhesion, and proliferation. EGFR is reportedly over-expressed in a wide variety of malignancies. Various studies suggest that receptor tyrosine kinase activation participates in the oncogenic progression of non neoplastic mesothelial progenitor cells to malignant mesothelioma. Asbestos fiber interact with the external domain of the EGFR to cause dimerization, activation and increased EGFR mRNA and protein levels in rat and human SV-40 immortalized mesothelial cells (Shukla et al., 2011). Up-regulated EGFR and resulting tyrosine phosphorylation leads to the Ras activation which phosphorylates directly and activates Raf (Rapidly Accelerated Fibrosarcoma). Raf is responsible for phosphorylation of the mitogen associated / extracellular regulated kinase-1 (MEK) which in turn phosphorylates extracellular regulated kinases (ERK) on specific residues of threonine and tyrosine (Ras-Raf-MEK-ERK mitogen activated protein kinase (MAPK) pathway). ERK activates a variety of substrates involved in cell cycle. The ERK family consists of at least seven isoforms, and little is known about their regulation and function. ERK1/2 phosphorylation by asbestos, is dependent on phosphorylation of the EGFR. Moreover, has been shown that ERK5, a redox-sensitive kinase known to mediate c-jun proto-oncogene expression is activated by asbestos. ERK1/2 and ERK5 are all important in asbestos-induced proliferation and this may be the result of increases in the mRNA levels of AP-1 family members. The ERK5 pathway may be contributing selectively to the regulation of c-jun, whereas ERK1/2 pathways may regulate c-fos, fra-1 and c-jun. Has been linked ERK1/2-dependent fra-1 expression to mesothelial cell transformation by asbestos and the protracted expression of this gene may be a result of initial increases in c-fos and c-jun (Scapoli et al., 2004). The phosphoinositide 3-kinase (PI3K)/AKT pathway, plays a critical role for the cell cycle progression in human MM cells [ Altomare et al.,2005). AKT, and the downstream mTOR are involved in cell growth and survival, and they are often found to be activated in MM (Carbone et al., 2012). It was reported previously that STAT1 and STAT3 are deregulated MM (Kothmaier et al., 2008).The JAK/STAT signalling pathway is the principal signalling mechanism for growth factors in mammals. JAK activation induces a variety of biological responses such as cell proliferation, diff erentiation and cell migration. In addition, MM cell lines are reported to express EGFR and transforming growth factor-α (TGF-α), suggesting an autocrine role for EGFR in MM (Cai et al., 2004; Jänne et al., 2002). EGFR immunopositivity has been indicated as a poor prognostic factor in many solid tumors in the past (Nicholson et al., 2001). The EGFR expression in MM has been previously reported, with controversial results, possibly due to the lack of standardized method for EGFR detection and quantification (Dazzi et al., Destro et al., 2006; 1990; Govindan et al., 2005; Ramael et al., 1991; Trupiano et al., 2004). Until now, the role of immunohistochemistry (IHC) EGFR positive staining in influencing prognosis of MM is not clear. Some authors did not find differences in survival when IHC EGFR positive or negative staining were compared (Destro et al., 2006; Okuda et al., 2008). This is because only few reports analyzed the effect of IHC EGFR positive status and cell subtype in MM patients. Recently EGFR overexpression is identified by IHC in 52% of epithelial MM and is demonstrated to be a factor negatively affecting prognosis (Rena et al., 2011). In view of these studies, EGFR was targeted for MM therapy, but despite the high expression of EGFR not all cells are sensitive to EGFR inhibitors (Garland et al., 2007). Many efforts are now directed to understand the lack of sensitivity of MM to EGFR inhibitors. In one such study, EGFR mutations were found in 31% (9 of 29) of malignant mesothelioma cases. Seven of these mutations were novel, and one was the L858R mutation described in NSCLC (Foster et al., 2009). Activating EGFR mutations in MM associated with optimal resectability and prolonged survival. Clinically these mutations may ultimately have utility in patient selection for surgery, systemic therapy, and selection for EGFR-TKI (tyrosine kinase inhibitor). The clinical course of MM patients with EGFR mutant tumors appear to share same \'relative\' improved clinical outcome like mutant EGFR-NSCLC (Foster et al., 2010. Study shows the ineffectiveness of the EGFR inhibitors due to coactivation of multiple receptor tyrosine kinase (EGFR, ERBB3, MET, and AXL) in individual mesothelioma cell lines (Ou et al., 2011) Thus, a combination therapy, could be a winning strategy in the treatment of mesothelioma.
A novel marker of MM recently identified is the CYP19A1 (Stoppoloni et al., 2011). CYP19A1 is the cytochrome P450 enzyme complex that converts C19 androgens to C18 estrogens. The human CYP19A1 gene, located in the 21.2 region on the long arm of chromosome 15 (15q21.2), spans a region that consists of a 30 kb coding region and a 93 kb regulatory region. Its regulatory region contains at least 10 distinct promoters regulated in a tissue- or signalling pathway-specific manner. Each promoter is regulated by a distinct set of regulatory sequences in DNA and transcription factors that bind to these specific sequences. These partially tissue-specific promoters are used in the gonads, bone, brain, vascular tissue, adipose tissue, skin, foetal liver, and placenta for estrogen biosynthesis necessary for human physiology (Bulun et al., 2004). Estrogens contribute to differentiation and maturation in normal lung (Patrone et al., 2003) and also stimulate growth and progression of lung tumors (Stabile et al., 2002; Pietras et al., 2005). Two major pathways, generally termed genomic and non-genomic, are known to mediate estradiol effects on cells. (Fig.4)
Estrogen Receptor fuction: Genomic (Nuclear ER) and Non Genomic (Membrane ER) action
Estradiol has traditionally been described to mediate its effects via intracellular receptors located in the cytoplasm or on the nuclear membrane and thus studies have investigated the effect of estradiol on transcription factors in the regulation of target genes. Estradiol also acts on the plasma membrane to initiate signaling pathways in the cytoplasm and regulate cellular functions, which is called the non-genomic pathway (Simoncini et al., 2004; Simoncini & Genazzani, 2003). PGE2 is thought to be an important regulator of CYP19A1 gene expression (Zhao et al., 1996). PGE2 increased CYP19A1 activity level in MM cell lines (Stoppoloni et al., 2011). Over the last decade many studies have been carried out to identify potential CYP19A1 stimulatory factors: IL-6 was the most potent factor detected that could stimulate CYP19A1 activity (Reed et al., 1992). The MM cell lines were capable of releasing a constitutively high amount of IL-6 (>1,100 pg.mL supernatant-1 of confluent cultures) (Orengo et al., 1999). This could explain the presence of CYP19A1 in MM cells. Furthermore, estrogen receptor (ER) were also detected in MM cell lines by western blot. The classic 67 kDa and a variant 46 kDa of ERα and 59 kDa of ERβ were expressed in MM cell lines. In support of these results there are recent literature data pointing to a role for estrogens in MM pathogenesis. Epidemiologic studies have identified female gender as a positive prognostic factor for MM (Pinton et al., 2009), although no experimental explanation of this finding has been provided thus far. CYP19A1 was expressed in the majority of samples from patients with MM. Cytoplasmic expression of CYP19A1 significantly correlated with poor survival (Stoppoloni et al., 2011). The World Health Organization classifies MM into epithelial, sarcomatoid, and biphasic types, each of which can be subdivided further (Travis et al., 1999). This classification has implications for both diagnosis and prognosis. Prognosis is poor for all MMs, but sarcomatoid MMs have a particularly poor response rate to treatment (Neragi-Miandoab et al., 2008). A significant association between high expression of CYP19A1 and sarcomatoid MMs was found (Stoppoloni et al., 2011). These observations strongly suggest that CYP19A1 plays a role in tumour progression in MM. MM cell proliferation was significantly reduced by exemestane (aromatase inhibitor) treatment. Treatment of MM cells with exemestane led to significant reduction of tumor cell growth, perturbation of cell cycle, caspase activation, PARP cleavage, down-regulation of p-AKT and Bcl-xL.. Since Akt pathway as well as Bcl-xL are implicated in conferring resistance to conventional chemotherapy exemestane could open new treatment strategies to be associated with standard therapy for patients afflicted with MM (Stoppoloni et al., 2011).
COX-2, EGFR and CYP19A1 are investigational at the present time. The cross-talk between markers that have been described and their value as prognostic indicators will need to be validated in prospective studies in larger patient populations. Their role at the present time is to give us direction towards development of newer therapies in this very resistant tumor. The standard of care at the present time for malignant mesothelioma does not involve checking for these markers and making patient care decisions based on them. But we hope that in the near future this would become a reality with a better treatment approach and prognosis for these patients. Furthermore the possibility of using natural anti-inflammatory products in the chemoprevention of people at risk of MM can not exclude.
Free radicals are formed during the reactions required for the maintenance of normal metabolism and energy formation in biological systems. Under normal conditions, the most significant source of free radicals in cells is the leakage of electrons into molecular oxygen from electron flow in the mitochondria and endoplasmic reticulum during oxidative respiration. The superoxide anion formed in this way is converted into hydrogen peroxide, a reactive oxygen type. Hydrogen peroxide forms the peroxyl radical, which is the most reactive radical type in the organism in the presence of transition metal ions. When free radicals cannot be removed from the environment, they cause damage at the cell, tissue, and organ level by disrupting the structure of biomolecules such as lipids, proteins, and nucleic acids due to their high reactivity. Lipid peroxidation begins when polyunsaturated fatty acids (PUFAs), which are in the structure of membrane lipids in cells, are affected by free radicals. If peroxyl radicals are not cleaned, a chain reaction starts affecting the intact PUFA. Lipid peroxidation is damaging as it is a self-sustaining chain reaction. When lipid peroxides (LOOH) are broken down, aldehydes are formed, many of which are biologically active. These compounds are either metabolized at the cellular level or diffuse from their initial domains and spread damage to other parts of the cell. When peroxidation of fatty acids containing three or more double bonds. Malondialdehyde (MDA) arises following the peroxidation of fatty acids comprised of three or more double bonds and appears in blood and urine. Due to its ability to corelate well with the degree of which lipid peroxidation occurs despite not being a specific or quantitative indicator of fatty acid oxidation, the measurement of MDA in biological material is used as an indicator of lipid peroxide levels. Nonenzymatic lipid peroxidation is a very harmful chain reaction. It both damages the membrane structure directly and also damages other cell components indirectly with the reactive aldehydes it produces. Thus, it causes tissue damage and many subsequent diseases.
\nAccording to quantum chemistry, only two electrons can enter the structure of a bond together. Electron pairs exist in a very stable state. Electrons in the human body exist almost entirely in electron pairs. When a bond breaks, the two electrons are either separated but remain in the same atom or both remain in the atom separately. If they remain together, the atom formed becomes an ion, and when they leave, the atom formed becomes a free radical [15]. Atoms or compounds that contain the unpaired electron in their final orbital are defined as free radicals. In other words, they are atoms or molecules that have an open electron shell configuration and contain an odd number of electrons in their structure [39]. The term Reactive Oxygen Species (ROS) is more commonly used in place of the term free oxygen radical as it includes molecules that are radical and are not actually radical, but that cause the formation of oxygen radicals with their reactions [15].
\nDespite oxygen being crucial for life, in some cases it can also damage cells. This damage is caused by increased oxygen-induced ROS production. The amounts of ROS produced under normal physiological conditions do not exceed the capacity of the natural antioxidant defense systems in the body. ROSs are chemical derivatives with unpaired high energy electrons in their outer orbits. In order to stabilize, ROS interact with any molecule they can find in their vicinity and exchange electrons. Molecules that react with free radicals turn into free radicals and initiate the damage chain reaction. These radicals react with organic and inorganic chemicals such as protein, lipid, and carbohydrate. When radicals occur in cells, they react with nucleic acids and various membrane molecules and break them down. While radicals affect intracellular organelles, they also create distant effects by passing to the extracellular compartment [15]. Although oxygen is crucial for human life, some ROS that occur during normal metabolism have the potential to cause great harm to the body. Compared to normal oxygen molecules, ROS, which are mostly composed of free radicals, appear as oxygen forms with higher chemical reactivity [36].
\nFree radicals are any atom or molecule with one or more unpaired electrons produced in many physiological or pathological conditions. These molecules, also known as oxidant molecules or reactive oxygen particles, easily exchange electrons with other molecules [13]. A compound can return to a free radical by losing an electron (reduction) or gaining an additional electron (oxidation). Free radicals can be part of a larger structure, as well as in immobile or small and freely spreading species [11, 26, 37, 45]. Free radicals are frequently produced by the mitochondria during the body’s normal use of oxygen. These free radicals, which are formed as a result of energy production, can change the structure of lipids, proteins, and nucleic acids. Free radicals are produced from many endogenous and exogenous sources as well as mitochondria and cause a variety of damage alongside their benefits. The benefits of free radicals only occur when they are of low concentration. Low concentration free radicals are involved in the activation of cellular signals such as calcium release from intracellular stores, and the activation of tyrosine phosphating and growth factor signals, along with defense functions such as defense against infections, the killing cancer cells and detoxification of xenobiotics [28].
\nCommon biochemical events, such as those which occur during normal respiration, cause reduction–oxidation (redox) reactions. The molecular oxygen in mitochondria is gradually diminished with the adding of four electrons to form water. Several toxic intermediate derivatives occur during this event. These include superoxide radicals (O−2), hydrogen peroxide (H2O2) and hydroxyl (OH−). In addition, some intracellular oxidases such as xanthine oxidase directly form superoxide radicals as a result of their activities. It catalyzes the formation of free radicals (Fe+++ H2O2 → Fe++++ OH− + OH−) as in the Fenton reaction by exchanging free electrons during some intracellular reactions in exchange metals such as copper and iron. To play a part in the Fenton reaction, the intracellular free iron, occuring in the ferric state (Fe+++), must initially be reduced to its ferrous (Fe++) form. Iron and superoxide are both required for maximum oxidative cell damage as the reduction is amplified by the superoxide ion.
\nBy absorption of radiant energy (such as ultraviolet light, X-rays): For example, water can be hydrolyzed to hydroxyl (OH−) and hydrogen (H+) free radicals with ionizing radiation.
\nBy the intracellular enzymatic metabolism of external chemicals or drugs: For example, CCl3 free radical is formed as a result of the intracellular metabolism of carbon tetrachloride (CCl4).
\nNitric oxide (NO), an important chemical mediator normally synthesized in various cell types, reacts with oxygen, especially non-radical peroxynitrite, a type of free oxygen that inhibits mitochondrial respiration, as well as the radical nitrogen dioxide (NO2) and nitrogen trioxide (NO3) [15]. Common free radicals, their symbols and identities are shown in the table below (Table 1):
\nFree radical | \nSymbol | \nIdentity | \n
---|---|---|
Hydrogen | \nH | \nThe simplest radical. | \n
Superoxide | \nO2˙−\n | \nThe first intermediate product of oxygen metabolism. | \n
Hydroxyl | \nOH˙ | \nThe most toxic (reactive) oxygen metabolite radical. | \n
Hydrogen peroxide | \nH2O2\n | \nReactivity is very low, molecular damage ability is poor. | \n
Singlet oxygen | \nO2\n−\n | \nStrong oxidative form of oxygen with fast half-life. | \n
Perhydroxy radical | \nHO2˙ | \nRapidly dissolves in lipids and increases lipid peroxidation. | \n
Peroxide radical | \nROO−\n | \nis less effective than perhydroxyl, localized to lipids. | \n
Trichloromethyl | \nCCl3\n | \nCCl4 is a radical produced in the liver, the product of metabolism. | \n
Thiyl radical | \nRS˙ | \nGeneral name for sulfurous and unpaired electron-containing species. | \n
Alkoxyl | \nRO˙ | \nOxygen metabolite produced by the breakdown of organic peroxides. | \n
Nitrogen oxide | \nNO | \nis produced in vivo from the amino acid NO L- arginine. | \n
Nitrogen dioxide | \nNO2\n | \nis produced by the reaction of NO with oxygen [21]. | \n
Free radicals, symbols, and identities.
The most important free radicals that occur are:
Superoxide radical (O2\n−).
Hydrogen peroxide (H2O2).
Hydroxyl radical (HO−).
The superoxide anion radical (O2\n−) is produced by the single electron reduction of oxygen which acts as an intermediate in a number of biochemical reactions in body [40] and is a weak oxidant that cannot cause serious cell damage by itself.
\nHowever, it may lead to the initiation of a series of reactions that can lead to oxidative stress [9, 26, 42]. One of the main points of superoxide production is Coenzyme Q, and this anion is formed at other points in the electron transport chain as well as in the mitochondrial electron transport chain. Another ROS is produced by the O2\n− radical, which does not leak far from where it originates [38, 44].
\nThe OH− radicals produced are highly reactive and can cause significant damage by reacting with structures such as DNA [26, 46, 49].
\nThe half-lives of superoxide radicals that produce H2O2 and oxygen by the dismutation reaction are quite short. This reaction occurs spontaneously and is catalyzed by the Superoxide Dismutase (SOD) enzyme [26].
\nIn natural conditions, O2\n− can be produced in muscle tissues in a variety of ways. One of the sources of O2 in muscle tissues are various components of the electron transport chain in mitochondria, such as NADPH-linked dehydrogenase and ubiquinone, which can leak electrons into O2. Autoxidation of heme proteins [6, 7] and metabolic enzymes such as xanthine oxidase [33] are other sources of O2. With the ingestion of bacteria, the activation of several leukocytes in the vasculature of the muscle tissue causes the production of O2\n−, one of the major bactericides [35].
\nAerobic cells naturally contain low concentrations of hydrogen peroxide (H2O2) as a metabolite. In an O2 forming system, it is expected to give H2O2 catalyzed by nonenzymatic or superoxide dismutase (SOD) [27]. Although it is not free radical, hydrogen peroxide reacts with a transition metal (e.g. Fe+2) to form a free radical [44].
\nH2O2 production has been detected in mitochondria, microsomes, peroxisomes and phagocytic cells. Also, many enzymes, such as xanthine oxidase, aldehyde oxidase, urate oxidase, glucose oxidase, glycolate oxidase, and D-amino acid oxidase, can directly produce H2O2 [27]. It has been reported that H2O2 is produced at a hemoglobin rate of approximately 3.9 × 10-9 M/hg and the concentration of H2O2 in red blood cells in a steady state is 2 × 10-10 M [19]. It has been reported that H2O2 formed during oxidation of oxymyoglobin plays an important role in lipid peroxidation [10]. Furthermore, it was reported that turkey muscle tissues stored at 37°C for 30 minutes produced approximately 14.0 nmol H2O2 per gram fresh weight, and its formation increased with storage at 4°C [22].
\nH2O2, which lacks unpaired electrons, is not a radical and, unlike charged O2, shows limited reactivity and permeability to the membrane [23]. Nevertheless, H2O2 can have devastating effects by generating more reactive species such as OH by catalysis of Fe (II) [30]. In addition, H2O2, depending on its concentration, can denature heme proteins to release iron and heme group or to convert heme protein to ferryl or perferryl radical [7].
\nThe hydroxyl radical (OH) is the most reactive oxygen radical [24]. It is the most powerful free radical hydroxyl radical found in biological systems. In tissues exposed to radiation, a large part of the energy is absorbed by the water inside the cell and the radiation creates a covalent bond between oxygen and hydrogen, forming hydrogen (H−) and hydroxyl radical (OH−).
\nOH− radicals, which can provide radical formation and participate in a series of reactions, cause strand breaks in DNA by joining the structure of bases in DNA and RNA, which they do by causing a lot of damage to the bases and sugars of DNA. If the damage is very severe, it may not be repaired by cellular protective systems and as a result, mutations and cell death occur [9, 14, 46].
\nThe steady-state concentration of the OH− radical in vivo is zero because it reacts with every molecule in the living cell, such as DNA, protein, phospholipid, amino acid, and sugar, at or near the place of formation. The high reactivity of the OH− radical is thought to result from the extraordinary combination of three properties. These properties include high electrophilicity, high thermochemical reactivity, and the ability to form near target molecules [32]. OH− formation was achieved in living erythrocytes under the effect of adriamycin using the spin trap electron paramagnetic resonance (EPR) technique [8]. Most of the OH− produced in vivo or in situ was obtained from the decomposition of H2O2 [29] by Fe (II) catalysis. Additionally, OH− can be produced by various sources: sunlight (Joseph JM, Aravindakumar), ultraviolet radiation [16], ionizing irradiation [34], reaction of hypochlorous acid with O2- [18] and sonolysis of water (ultrasound) [25].
\nThe reaction of the OH− radical can be inhibited by OH− scavengers such as methanol, ethanol, 1-butanol, mannitol, formate, thiourea, dimethylthiourea, glucose, tris-buffer, or sorbitol [27]. Although OH− scavengers prevent OH− from reacting with other molecules, including lipid molecules, they are not always effective. There are several reasons to consider:
\nReaction of the OH− radical with a scavenger can create scavenger radicals that can react with other molecules in the system [31].
\nMore attention has been paid to the possibility of a metal-mediated mechanism [30]: OH− produced by the reaction of H2O2 with metal ions bound to macromolecules can react with metal-binding molecules. It has been reported that as a result of the formation of the Fe (II) ion and 2-deoxyreebose complex, the Fe (II) ion that binds to DNA interacts with H2O2 to form OH−, which instantly damages DNA [3]. It was determined that the Fe (III) ion binds to the membrane and then forms free radicals in the binding site. It has been suggested that iron is accepted as the main binding site of the sulfone group with the carboxyl groups of sialic acids to the membrane, the sulfate group of glycolipids and the phosphate head group of glycoproteins and phospholipids [4]. On the other hand, it has also been reported that OH− scavengers effectively inhibit OH− formation in the presence of EDTA. Indeed, EDTA allows Fe (II) ions to be removed from these binding sites [20]. Thus, the toxicity of O2 and H2O2 may be due to the presence and distribution of metal ion catalysts to form OH− in cells.
\nSinglet oxygen is the name given to the excited form of oxygen; it is a reactive oxygen type with a very high non-radical reactivity. By directly reacting with unsaturated fatty acids, it forms the peroxyl radical and initiates a lipid peroxidation as strong as the hydroxyl radical [21].
\nContinuously produced SR in the cell and in the environment can be generated by both endogenous and exogenous sources.
\nEndogenous (Natural) Sources:
Oxygen catalyzed by the electron transport system during oxygen respiration in mitochondria produces free radicals as a by-product.
In case of inflammation, cytokines are released and as a result neutrophils and macrophages begin to produce free radicals.
Free radicals can originate from a variety of sources such as lipid peroxidation, xanthine oxidase, and mitochondrial cytochrome oxidase.
Free radicals can be produced by smooth muscle cells, platelets, and arachidonic acid metabolism.
It may occur as a result of electron leaks in the Cytocom p450 system in the endoplasmic reticulum with enzymes such as xanthine oxidase (XO) and nicotinamide adenine dinucleotide phosphate (NADPH) oxidase during autooxidation reactions.
Stress from mental stress or body fatigue can create free radicals as a toxic by-product. In addition, hormones such as cortisol and catecholamine can cause stress reactions in the body, and these hormones themselves can turn into free radicals.
Immune system cells can generate ROS and oxy-radicals in response to pathogens.
Exogenous Sources:
X-rays, UV rays, microwave rays, gamma rays.
Burning organic materials during cooking.
Volcanic activities, forest fires.
Pollutants such as benzene, asbestos, formaldehyde, carbon monoxide, toluene, and ozone.
Chemicals such as glue, cleaning products, thinner, paint, pesticides, and perfumes.
Water contaminants such as chloroform and other trihalomethanes.
Cigarette smoke, exhaust smoke, alcohol and cigarette use can contribute to the production of free radical exogenously [5, 28, 41, 43, 48].
As a result of the damaging effects of free radicals on cells, the cell’s plasma and organelle membranes lose their continuity. As a result, sodium and calcium ions enter the cell in addition to water. Morphologically recognized by their pale granular cytoplasm, these cells swell. Over time, this structural defect leads to irreversible changes in the cell0, followed eventually by death [15].
\nLipids are the most sensitive biomolecules to the effects of free radicals, and the unsaturated bonds of fatty acids and cholesterol in cell membranes react very easily with free radicals to form peroxidation products. The oxidative breakdown of polyunsaturated fatty acids, known as lipid peroxidation and which is highly harmful, proceeds as a self-sustaining chain reaction [1, 46]. Lipid peroxides, which are an important component of cell membranes, form RS- and ROO- radicals with the presence of transition metals such as Fe and Cu. In this way, Fe and Cu salts increase the rate of lipid peroxidation and consequently reduce the fluidity and permeability of the cell membrane and cause the disruption of membrane integrity [26, 46, 47].
\nLipid peroxidation is a free radical chain reaction that is comprised of three primary steps: initiation, propagation, and termination. Highly reactive radicals, such as the hydroxyl radical, attack polyunsaturated fatty acids, causing a hydrogen atom to be removed from the methylene (—CH2—) group and, thus, initiate lipid peroxidation. Polyunsaturated fatty acids are very sensitive to peroxidation, as the number of double bonds in the fatty acid side chain increases, the hydrogen atom cleavage becomes easier [40]. Conjugated dienes will, however, react to one another in the bounds of the membranes or other membrane components such as protein and cholesterol under conditions when O2 is extremely restricted [17]. The creation of conjugated dienes is followed by changes in the structure of the double bond from cis to trans form, which may facilitate tighter packing of the unsaturated fatty acids, contributing to the development of more rigid domains inside the bilayer of oxidized lipid [12].
\nWhen the hydrogen atom leaves the molecule by acquiring an electron, only one electron remains in the carbon of the fatty acid; In order to eliminate the weakening of the C-H bond in the carbon atom adjacent to the double bond, the carbon-centered radical forms the conjugated diene. Conjugated diene reacts with oxygen, causing the lipid peroxyl radical (LOO•); the lipid radical formed in this step is important because it starts a chain reaction by removing the hydrogen atom from another fatty acid. Peroxyl radicals show less reactive properties than •OH; however, they can reach farther regions. Peroxyl radicals can react with each other, attack membrane proteins or break hydrogen atoms from neighboring fatty acid chains, leading to the progression of lipid peroxidation chain reaction. Lipid peroxidation in biological membranes can lead to decreased membrane fluidity and membrane potential, increased permeability to H+ and other ions, and disruption of organelle or cell integrity [40].
\nThe termination process is the last stage of lipid peroxidation. During this process, LOOs either undergo a reciprocal causal nexus or self-destruct and in this way go on to form non-radical products. Despite their potential to breakdown when exposed to high temperatures or by contact with transitional metal ions, LOOH is a compound which remains stable at physiological temperatures [27]. The formed free radicals (LO•, LOO•) and electrophilic products (e.g. 4-hydroxynonenal) can react with neighboring membrane proteins as well as diffuse with distant molecules such as DNA [40].
\n"I work with IntechOpen for a number of reasons: their professionalism, their mission in support of Open Access publishing, and the quality of their peer-reviewed publications, but also because they believe in equality. Throughout the world, we are seeing progress in attracting, retaining, and promoting women in STEMM. IntechOpen are certainly supporting this work globally by empowering all scientists and ensuring that women are encouraged and enabled to publish and take leading roles within the scientific community." Dr. Catrin Rutland, University of Nottingham, UK
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\n\n"In developing countries until now, advancement in science has been very limited, because insufficient economic resources are dedicated to science and education. These limitations are more marked when the scientists are women. In order to develop science in the poorest countries and decrease the gender gap that exists in scientific fields, Open Access networks like IntechOpen are essential. Free access to scientific research could contribute to ameliorating difficult life conditions and breaking down barriers." Marquidia Pacheco, National Institute for Nuclear Research (ININ), Mexico
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