The Journal of Experimental Medicine
JEM © The Rockefeller University Press $8.00
Vol. 203, No. 8, August 7, 2006 1951–1961 www.jem.org/cgi/doi/10.1084/jem.20060943
Acute respiratory distress syndrome after resus-
citated hemorrhagic shock in trauma patients
is an important contributor to late morbid-
ity and mortality (1, 2). It has been suggested
that shock/resuscitation (S/R) promotes organ
injury by priming cells of the innate immune
system for excessive responsiveness to a subse-
quent proinfl ammatory stimulus (3, 4). Several
groups, including our own, have modeled this
“two-hit” phenomenon both in vivo and in
vitro to gain insight into the pathophysiologi-
cal mechanisms underlying the priming events.
Our previous work has defi ned a central role for
activated alveolar macrophages (AMs) in aug-
mented lung injury after S/R. AMs recovered
from resuscitated animals exhibited exagger-
ated LPS responsiveness with excessive genera-
tion of proinfl ammatory molecules, including
cytokine-induced neutrophil chemoattractant,
the rodent ortholog of IL-8, and TNF-α (5, 6).
Increased expression of these proteins was due
to enhanced gene transcription, a result of
earlier and heightened nuclear translocation
of the transcription factor NF-κB in response
to LPS. Further, oxidative stress during ische-
mia/reperfusion appeared to be responsible
for this priming phenomenon, as inclusion of
the antioxidant N-acetylcysteine (NAC) in the
resuscitation fl uid prevented the increased re-
sponsiveness to LPS. To date, the mechanisms
responsible for the ability of oxidative stress to
prime for increased LPS responsiveness are not
One potential mechanism of S/R-induced
priming for enhanced infl ammatory response
is through potentiation of various components
of LPS-induced signaling. Several intracellu-
lar pathways whereby LPS stimulation leads to
dissociation of NF-κB from the cytosolic IκB/
NF-κB complex and translocation of NF-κB
into the nucleus have been described. Recent
studies have identifi ed the Toll-like receptor 4
(TLR4) as the main upstream sensor for LPS
both in vitro and in vivo. Optimal activation of
the TLR4 signaling pathway by LPS involves
the formation of an LPS signaling complex con-
sisting of surface molecules, such as CD14 and
MD2, as well as intracellular adaptor molecules,
Oxidative stress generated by hemorrhagic
shock recruits Toll-like receptor 4
to the plasma membrane in macrophages
Kinga A. Powers, Katalin Szászi, Rachel G. Khadaroo, Patrick S. Tawadros,
John C. Marshall, András Kapus, and Ori D. Rotstein
Departments of Surgery, St. Michael’s Hospital and University Health Network, and Department of Surgery, University of
Toronto, Toronto, Ontario, M5G 2C1, Canada
Oxidative stress generated by ischemia/reperfusion is known to prime infl ammatory cells
for increased responsiveness to subsequent stimuli, such as lipopolysaccharide (LPS). The
mechanism(s) underlying this effect remains poorly elucidated. These studies show that
alveolar macrophages recovered from rodents subjected to hemorrhagic shock/resuscitation
expressed increased surface levels of Toll-like receptor 4 (TLR4), an effect inhibited by
adding the antioxidant N-acetylcysteine to the resuscitation fl uid. Consistent with a role
for oxidative stress in this effect, in vitro H2O2 treatment of RAW 264.7 macrophages
similarly caused an increase in surface TLR4. The H2O2-induced increase in surface TLR4
was prevented by depleting intracellular calcium or disrupting the cytoskeleton, suggesting
the involvement of receptor exocytosis. Further, fl uorescent resonance energy transfer
between TLR4 and the raft marker GM1 as well as biochemical analysis of the raft compo-
nents demonstrated that oxidative stress redistributes TLR4 to lipid rafts in the plasma
membrane. Preventing the oxidant-induced movement of TLR4 to lipid rafts using methyl-
훃-cyclodextrin precluded the increased responsiveness of cells to LPS after H2O2 treatment.
Collectively, these studies suggest a novel mechanism whereby oxidative stress might prime
the responsiveness of cells of the innate immune system.
Ori D. Rotstein:
Abbreviations used: AM, alveo-
lar macrophage; BAPTA/AM,
acid tetra(acetoxymethyl) ester;
CTxB, cholera toxin B; FRET,
fl uorescent resonance energy
transfer; MβCD, methyl-β-
cyclodextrin; MyD88, myeloid
diff erentiation primary response
gene 88; NAC, N-acetylcysteine;
S/R, shock/resuscitation; TLR4,
Toll-like receptor 4.
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1952 OXIDATIVE STRESS RECRUITS TLR4 TO THE MEMBRANE | Powers et al.
including myeloid diff erentiation primary response gene 88
(MyD88) and IRAK (7). Recently, several factors have been
identifi ed that contribute to the responsiveness of TLR4. These
include receptor dimerization, mobilization to lipid rafts, and
formation of a TLR4 activation cluster including other pro-
teins, such as heat shock proteins 70 and 90, chemokine re-
ceptor 4, and growth diff erentiation factor 5 (8, 9). The total
number of functional TLR4 molecules expressed on the cell
surface may also infl uence LPS response. Cells lacking TLR4
or expressing a mutant receptor exhibit marked hyporespon-
siveness to LPS (10), and overexpression of surface TLR4 was
shown to augment LPS responsiveness (11, 12). Collectively,
these observations imply that physiological/pathophysiological
alterations in the expression of surface TLR4 in vivo may be
one mode of infl uencing LPS responsiveness. In this regard,
Nomura et al. (13) reported that induction of LPS tolerance
in peritoneal macrophages correlated with the ability of LPS
to down-regulate surface TLR4. We have previously reported
that S/R prevented the LPS-induced reduction in TLR4 pro-
tein and mRNA levels in whole lung tissue (14). However,
TLR4 levels did not exceed baseline in shock plus LPS-treated
animals, making it unlikely that total cellular TLR4 per se in-
fl uenced LPS reactivity. These observations raised the hypo-
thesis that S/R might alter cellular distribution of the TLR4
receptor complex as a mechanism underlying increased re-
sponsiveness to LPS.
In these studies, we demonstrate that S/R causes trans-
location of TLR4 in AMs from the cytoplasm to the plasma
membrane, thus elevating TLR4 surface expression. The
central role of oxidative stress in this process was shown by
the ability of NAC to prevent this translocation in vivo and
by the ability of exogenously added H2O2 to recapitulate the
translocation in RAW 264.7 cells in vitro. We also show that
TLR4 is mobilized into lipid rafts and that this is essential for
oxidant-induced translocation. Finally, the ability of oxida-
tive stress to induce the formation of a surface TLR4 recep-
tor complex within lipid rafts contributed to the augmented
responsiveness to LPS. Collectively, these fi ndings suggest
a novel mechanism whereby oxidative stress generated dur-
ing S/R, a form of global ischemia/reperfusion, might prime
the innate immune system for an exaggerated response to
infl ammatory stimuli and hence for increased tissue and
Resuscitated shock induces cell surface TLR4 expression
To determine the eff ect of resuscitated hemorrhagic shock
on TLR4 distribution, we isolated AMs from sham and S/R
rats. At the end of resuscitation, total cell numbers obtained
by bronchoalveolar lavage and percentage of macrophages
(>90%) did not diff er from sham animals (5). Phase micros-
copy shows that AMs from sham and S/R animals exhibited
similar morphology (Fig. 1 A). Immunofl uorescence staining
of permeabilized cells revealed that in sham cells, TLR4 was
distributed throughout the cytoplasm. In contrast, in cells
from S/R animals, there was peripheralization of TLR4 with
diminished cytoplasmic staining. This phenomenon was ob-
served in 58.2 ± 4.1% of cells from S/R animals compared
with <20% in sham groups (Fig. 1 B). The redistribution of
TLR4 to the periphery in S/R cells was confi rmed by con-
focal microscopy (Fig. 1 C, compare top row with middle
row). To confi rm specifi city of the TLR4 antibodies used in
our studies, we performed immunostaining on macrophages
from C57BL10/ScCr animals, known to be null for TLR4
expression. No fl uorescence was observed in these cells (not
depicted). In addition, on Western blot the H-80 antibody
reacted with a protein at the appropriate molecular mass of
TLR4 (not depicted). Fig. 1 E demonstrates that the observed
immunofl uorescence staining pattern was indeed due to
binding of the TLR4 antibody.
To determine TLR4 surface expression, TLR4 staining of
nonpermeabilized cells was quantifi ed using fl ow cytometry.
In a representative study (Fig. 2 A), there was a marked in-
crease in cell surface TLR4 in cells from S/R animals com-
pared with sham. Over several studies, TLR4 surface level in
S/R cells was signifi cantly elevated (Fig. 2 B). Collectively,
these fi ndings demonstrate that S/R induces redistribution of
Figure 1. Redistribution of TLR4 in AMs after resuscitated hemor-
rhagic shock. AMs were isolated from sham animals or from animals
that underwent hemorrhagic shock followed by resuscitation for 1 h (S/R).
Where indicated, 0.5 g/kg NAC or 10 mg/kg Trolox was present during
resuscitation (S/R+NAC, S/R+Trolox, respectively). Cells were allowed to
adhere to coverslips, fi xed, permeabilized, and stained with anti-TLR4.
(A and D) Typical phase contrast and fl uorescence microscopy images are
shown. (B) Peripheralization of TLR4 was quantifi ed by Scionimage soft-
ware as described in Materials and methods. (C) Pictures in rows show
confocal microscopic images of different focal planes of the same cell.
Bars, 10 μm. (E) Specifi city of the TLR4 antibody. Staining was performed
with (left) or without (right) anti-TLR4. Both samples were stained with
FITC-labeled secondary antibody.
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JEM VOL. 203, August 7, 2006
TLR4 from the cytoplasmic compartment to the periphery,
including onto the plasma membrane. Previous work from
several groups suggests that oxidative stress generated during
reperfusion of the gastrointestinal tract contributes to distant
cellular priming and activation. NAC supplementation in the
resuscitation fl uid prevented both the S/R-induced increase
of isoprostanes in the blood (a marker of oxidative stress) and
priming of AMs (5, 15). To test the role of oxidants in the
S/R-induced TLR4 redistribution, we added NAC to the
resuscitation fl uid. NAC blocked both the redistribution of
TLR4 after S/R (Fig. 1, A and C, bottom, and B, right bar)
and the increase in TLR4 cell surface expression (Fig. 2, A
and B). To further substantiate the role of oxidative stress, we
tested the eff ect of Trolox, a water-soluble vitamin E ana-
logue that is a well-established antioxidant agent. Similar to
NAC, Trolox added to the resuscitation fl uid prevented the
redistribution of TLR4 in AMs (Fig. 1 D). In addition, Tro-
lox impaired lung neutrophil sequestration to the same extent
as NAC (not depicted). We next asked whether exposure of
cells to oxidants could mimic the eff ect of S/R on TLR4
distribution. Fig. 3 A demonstrates that a 1-h treatment of
RAW 264.7 cells with 100 μM H2O2 induces peripheraliza-
tion of TLR4 in a pattern reminiscent of that observed in
bronchoalveolar lavage cells after S/R. Treatment with 50 μM
H2O2 appeared to accentuate a vesicular pattern of TLR4
distribution. By fl ow cytometry, H2O2 was shown to induce a
dose-dependent increase in surface expression of TLR4, with
modest eff ect at 50 μM and marked increase at 100–500 μM
(Fig. 3 B, representative study shown in the left panels).
Concentrations of H2O2 up to 200 μM did not induce cell
death as determined by trypan blue exclusion, whereas 500
μM caused ?50% cell death (not depicted). Quantitation of
several studies confi rmed the dose dependency (Fig. 3 B, right
panel). A time course shows that 100 μM H2O2 induces a pro-
gressive increase in cell surface TLR4 starting as early as 1–5
min and peaking at 30–120 min (Fig. 3 C). We also tested the
eff ect of alternative agents known to induce oxidative stress.
Menadione accumulates in the cells and induces intracellular
oxidative stress, whereas the xanthine/xanthine oxidase system
is able to produce extracellular oxidants. Both agents caused a
marked increase in TLR4 expression in the cell surface as
shown by fl ow cytometry (Fig. 3 D). In aggregate, these fi nd-
ings are consistent with a role for oxidative stress in the in-
creased surface expression of TLR4 after S/R. In subsequent
studies, a dose of 100 μM H2O2 for 1 h will be studied. This
protocol corresponds to conditions used in our previous stud-
ies showing that H2O2 primes RAW 264.7 cells for increased
responsiveness to LPS (16, 17).
Figure 2. Resuscitated hemorrhagic shock increases TLR4 surface
levels. AMs were stained live with anti-TLR4 and FITC-conjugated sec-
ondary antibody. Fluorescence was analyzed by fl ow cytometry as de-
scribed in Materials and methods. (A) Profi les of fl uorescence intensity of
TLR4 staining (black line) or controls (secondary antibody only, solid).
(B) Changes in TLR4 surface expression (mean channel fluorescence
[MCF]) after the indicated treatments. Data are mean ± SEM. n = 4
animals per group. *, P < 0.05 for S/R versus all other groups.
Figure 3. Oxidative stress induces increased TLR4 surface expres-
sion in RAW 264.7 cells. (A) RAW 264.7 cells, exposed to H2O2 for 1 h,
were stained with anti-TLR4/MD2-FITC antibody. Representative fl uores-
cence microscopy images (n = 4). (B and C) Dose and time dependence of
the H2O2 effect. Cells were treated with the indicated concentration of
H2O2 for 1 h (B) or with 100 μM H2O2 for the indicated time (C). TLR4
staining was analyzed using fl ow cytometry. In B, representative profi les
of fl uorescence intensity of TLR4 staining (gray solid) or unstained con-
trols (black line) are shown (left panels). (D) RAW cells were treated with
50 μM menadione (Mena) or 100 μM H202 or 0.1 mM xanthine and 3 U/ml
xanthine oxidase for 1 h. Surface TLR4 was measured as in B. The graphs
show mean ± SEM of n = 3 (for D) or 4 (for B and C). *, P < 0.05 for
points indicated versus control.
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1954 OXIDATIVE STRESS RECRUITS TLR4 TO THE MEMBRANE | Powers et al.
Effect of resuscitated hemorrhagic shock on localization
of TLR4 to lipid rafts
Lipid rafts are considered to be important contributors to
membrane recruitment and clustering of signaling molecules
(18). Recent studies have reported that clustering of the LPS
receptor complex upon LPS stimulation required lipid rafts
(19–22). Therefore, we next evaluated the role of lipid rafts
in the oxidative stress–induced TLR4 redistribution.
AMs from S/R animals were stained live using rhoda-
mine–cholera toxin B (CTxB), and then fi xed, permeabilized,
and stained for TLR4. As shown in Fig. 4 A, AMs from sham
animals displayed diff use intracellular TLR4 staining, whereas
GM1 ganglioside, a classical raft marker was mainly localized
to the cell surface with minimal colocalization with TLR4.
In contrast, TLR4 in cells from S/R animals displayed a pe-
ripheral staining (55 ± 2.3%, n = 3; Fig. 4 A, bottom row),
and it colocalized with GM1 as shown by the overlay image.
Supporting the critical role of oxidants in the eff ect, NAC
added in the resuscitation fl uid prevented TLR4 redistribu-
tion and its colocalization with GM1 (7.5 ± 0.5%, n = 3;
Fig. 4 A, right).
The eff ect of oxidant stress on localization of TLR4 in
lipid rafts was also examined in vitro by exposing RAW
264.7 cells to H2O2. Fig. 4 B illustrates that H2O2 induces
colocalization of TLR4 with GM1 in the plasma membrane.
We used methyl-β-cyclodextrin (MβCD) to deplete cellular
cholesterol and disrupt lipid rafts (23) before adding H2O2 to
RAW 264.7 cells. This treatment prevented movement of
TLR4 to the cell surface (Fig. 4 B, right). The inhibitory ef-
fect of cholesterol depletion was also confi rmed by fl ow cy-
tometry. Live cells treated with MβCD either before or after
H2O2 were stained with anti-TLR4/MD2. As shown in Fig.
4 C, when applied before H2O2 treatment, MβCD prevented
the oxidant-induced TLR4 surface up-regulation. However,
when oxidant exposure was performed before raft disruption
with MβCD, increased TLR4 levels persisted on the cell sur-
face (Fig. 4 C). MβCD may exert its eff ect through altering
cellular responsiveness to H2O2. To examine this possibility,
we tested the eff ect of H2O2 on p38 in MβCD-treated cells.
As shown in Fig. 4 D, cholesterol depletion did not prevent
H2O2-induced phosphorylation of p38. Although we cannot
rule out that cholesterol depletion might interfere with some
pathways, these data show that MβCD does not exert a global
inhibition of oxidant-induced signaling.
To substantiate lipid raft localization of TLR4, we iso-
lated raft fractions using discontinuous sucrose gradient
ultracentrifugation of RAW264.7 cells (24). Eff ective isolation
of membrane rafts was confi rmed by the presence of GM1
Figure 4. Oxidant stress induces clustering of TLR4 in plasma
membrane lipid rafts. (A). TLR4 and GM1 colocalization after oxidant
stress. AMs were plated on coverslips and stained live at 4°C with rhodamine-
CTxB. The cells were then fi xed, permeabilized, and stained with anti-TLR4.
Representative images are shown of TLR4 (green), rhodamine-CTxB staining
(red), or the merged image. (B) RAW 264.7 cells were treated with 100 μM
H2O2 for1 h. Where indicated, cells were depleted from cholesterol by incu-
bating with 10 mM MβCD for 30 min before H2O2. Cells were stained and
visualized as in A. (C) H2O2-induced increase in TLR4 surface level requires
lipid rafts. RAW264.7 cells were treated with 100 μM H2O2 for 1 h. Where
indicated, cells were depleted from cholesterol before or after treatment
with H2O2. TLR4 expression was analyzed by fl ow cyto metry. Data are
mean ± SEM (n = 4 per group). *, P < 0.05 for H2O2, H2O2 then MβCD
versus control and MβCD then H2O2. (D) Cholesterol depletion does not
interfere with H2O2-induced signaling. Cells were treated with 100 μM
H2O2 for 30 min and lysed. An equal amount of protein was loaded on
SDS gels, and phospho-p38 was detected using Western blotting. Where
indicated, cells were cholesterol depleted before H2O2 addition.
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JEM VOL. 203, August 7, 2006
ganglioside in the nonsoluble portion, fractions 1–3 of the
sucrose gradient (Fig. 5, top). H2O2 stimulation induced lo-
calization of TLR4 to raft fractions (Fig. 5, bottom). This
eff ect was prevented by pretreatment with MβCD.
Fluorescent resonance energy transfer (FRET) analy-
sis was applied to examine the spatial proximity of TLR4
to GM1 ganglioside in lipid rafts. TLR4 was labeled using
anti-TLR4 primary and an FITC-coupled Fab fragment sec-
ondary antibody, and GM1-ganglioside was stained with a
rhodamine-coupled CTxB. In the fi rst series of experiments,
we validated the system and determined how much of the
fl uorescence was due to other non-FRET–related factors to
correct for them. We considered two potential problems.
First, the excitation light used in these experiments (480 ±
5 nm) might also excite rhodamine and thus give a falsely
high quantitation of FRET. To test this possibility, we stained
cells with rhodamine-CTxB only and measured emission at
>590 nm after exciting with 480 ± 5 nm light (settings used
for FRET). Fig. 6 A shows that H2O2 treatment did not alter
the background fl uorescence of unstained cells. Emission in
the rhodamine-stained cells increased by 23 ± 4% compared
with unstained cells. However, this increase was identical
in the untreated and H2O2-treated cells. This verifi es that
H2O2 treatment does not interfere with the fl uorescent mea-
surements. To account for the fl uorescence resulting from
rhodamine excitation by the 480 ± 5 nm wavelength, the
emission measured in double-stained cells during the FRET
experiments was corrected by 23%. Second, we investigated
whether part of the fl uorescence detected at ≥590 nm could
originate from residual FITC emission at the rhodamine emis-
sion wavelength. Indeed, control experiments revealed a lin-
ear correlation between green fl uorescence intensity and the
resulting bleed through emission detected at ≥590 nm (not
depicted). Because H2O2 treatment increases TLR4 surface
expression, the bleed through can be diff erent in untreated
and treated cells. Therefore, we carefully compensated for
any bleed through of FITC into the emission wavelength
used for FRET. The fl uorescence of similarly treated single-
(FITC only) and double- (FITC and rhodamine) stained cells
was determined for each experiment under identical condi-
tions. To obtain the value of real FRET, we fi rst corrected
the fl uorescence of the double-stained cells by 23% (to com-
pensate for the emission of rhodamine excited by the 480 ±
5 nm light; see above). The diff erence between the corrected
fl uorescence of the double-stained cells and the fl uorescence
measured in single-stained cells (i.e., the bleed through of
FITC emission into ≥590 nm) is therefore attributed to the
FRET between FITC-labeled anti-TLR4 and rhodamine-
labeled GM1. Fig. 6 B illustrates that H2O2 treatment caused
an approximately fi vefold increase in FRET emission. This
result is consistent with the conclusion that treatment with
H2O2 induced molecular proximity of TLR4 with the raft
marker GM1 ganglioside. Collectively, these results provide
evidence that oxidant stress induces translocation of TLR4 to
plasmalemmal lipid rafts. Moreover, the integrity of lipid rafts
appears to be essential for this process.
Role of exocytosis in TLR4 translocation to the plasma
membrane after oxidative stress
Exocytosis represents a general mechanism for delivery of
molecules from cytoplasmic compartments to the plasma
membrane. To study the role of exocytosis in TLR4 up-
regulation after oxidative stress, we applied two strategies
to inhibit exocytosis. First, RAW 264.7 cells were exposed
to jasplakinolide, a marine sponge toxin that induces exces-
sive actin polymerization (25) and has been shown to physi-
cally interfere with exocytosis (26). Second, cytosolic Ca2+,
a requisite for exocytosis, was chelated by loading the cells
Figure 5. Recruitment of TLR4 into lipid rafts by oxidant stress.
RAW 264.7 cells, treated with 100 μM H2O2 for 1 h with or without MβCD
pretreatment, were lysed in 1% Triton X-100 and subjected to discontinu-
ous sucrose density gradient centrifugation as described in Materials and
methods. Fractions were analyzed by dot blotting using either CTxB conju-
gated to horseradish peroxidase (GM1, top) or anti-TLR4 primary and
peroxidase-coupled secondary antibody (bottom). Fractions 1–3 corre-
spond to lipid rafts. Representative blots of three separate experiments
Figure 6. FRET verifi es oxidant-induced molecular interaction
between TLR4 and GM1. (A) Controls for FRET. Untreated or H2O2-
treated (100 μM for 1 h) RAW 264.7 cells were either left unstained or
stained live at 4°C with rhodamine-CTxB. Fluorescence of individual cells
was determined using the excitation wavelength 480 ± 5 nm and emis-
sion was ≥590 nm as described in Materials and methods. The emission
of all groups was normalized to the unstained untreated cells (100%).
Data are mean ± SEM of n = 18 cells from three independent experi-
ments. (B) H2O2 induces FRET between rhodamine-CTxB (GM1) and anti–
TLR4-FITC. RAW 264.7 cells were left untreated or treated with 100 μM
H2O2 for 1 h and stained live at 4°C with rhodamine-CTxB, anti-TLR4, and
FITC-labeled secondary antibody. For control, identically treated cells were
stained only with FITC-labeled secondary antibody. To obtain the value of
FRET, non-FRET–related factors were corrected for as detailed in Results.
Data are normalized to the untreated cells (100%) and are mean ± SEM
of n = 24 cells, n = 4.
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1956 OXIDATIVE STRESS RECRUITS TLR4 TO THE MEMBRANE | Powers et al.
acid tetra(acetoxymethyl) ester (BAPTA/AM) in a Ca2+-free
medium (27). To verify that these manipulations indeed ab-
rogated exocytosis in cells, we tested the up- regulation of
CD11b, which is known to be delivered to the cell sur-
face through exocytosis. Fig. 7 (A and B) shows that both
jasplakinolide and BAPTA prevented the H2O2- and LPS-
induced CD11b up-regulation in RAW 264.7 cells. Next,
we examined the eff ect of these strategies on oxidative
stress– induced redistribution of TLR4. As shown in Fig. 7
(C and D), both jasplakinolide and calcium depletion pre-
vented H2O2-stimulated increase in TLR4 surface level.
Collectively, these fi ndings suggest a role for exocytosis in
the oxidant-induced increase in cell surface TLR4.
Effect of oxidant stress on the assembly of TLR4/MyD88
Formation of a multi-molecular signaling complex contain-
ing cell surface TLR4 and adaptor molecules such as MyD88
is an important early step in LPS-induced signaling leading to
downstream events, such as nuclear translocation of NF-κB
(28). Having shown that oxidative stress induces movement
of TLR4 to the plasma membrane, we examined whether
oxidative stress might cause colocalization of MyD88 with
TLR4 in a signaling complex, possibly in lipid rafts. Fig. 8 A
shows that similar to TLR4, S/R also causes peripheraliza-
tion of MyD88. Colocalization of Myd88 and TLR4 is indi-
cated by the fl uorescence overlay pictures. Further, inhibition
of MyD88 peripheralization by NAC confi rmed a role for
oxidative stress in the eff ect (Fig. 8 A, right panels). The ad-
dition of H2O2 to RAW 264.7 cells also caused translocation
of MyD88 to the membrane (Fig. 8 B). The specifi city of the
anti-MyD88 antibody was confi rmed using a blocking pep-
tide (Fig. 8 C). Next, recruitment of MyD88 into lipid rafts
was examined. As shown in Fig. 8 D, MyD88 was detected
in the raft fractions after H2O2 treatment, an eff ect that was
prevented by cholesterol depletion before oxidative stress.
The functional signifi cance of lipid raft integrity
in oxidative stress–induced macrophage priming
The LPS-induced aggregation of a signaling complex within
lipid rafts appears to be a prerequisite for LPS-mediated NF-
κB translocation in macrophages (21). We have shown that
oxidative stress primed macrophages for earlier and increased
responsiveness to subsequent LPS challenge (29). Therefore,
we hypothesized that induction of assembly of the LPS recep-
tor complex by oxidative stress might represent a mechanism
for the priming of macrophages to subsequent challenge with
LPS. We designed experiments to separate the role of TLR4
accumulation in lipid rafts in LPS signaling from the ability of
oxidant stress to mobilize TLR4 to lipid rafts as a priming
mechanism. In control studies, LPS caused a time-dependent
Figure 7. Role of exocytosis in TLR4 translocation to the plasma
membrane after oxidant stress. Raw 264.7 cells remained untreated
(control) or exposed to DMSO vehicle or 1 μM jaspakinolide (JAS) (A and C)
for 30 min or 10 μM BAPTA/AM for 10 min (B and D). Cells were then
exposed to 100 μM H2O2 for1 h or 0.1 μg/ml LPS for 30 min, followed by
staining live with anti–CD11b-FITC (A and B) or anti-TLR4/MD2-FITC at
4°C (C and D). Fluorescence was analyzed by fl ow cytometry. Data are
mean ± SEM of n = 4 per group. *, P < 0.05 for groups indicated versus
all other groups without an asterisk.
Figure 8. Oxidant stress induces colocalization of TLR4 and
MyD88 in the plasma membrane. (A) Oxidant-dependent colocalization
of TLR4 and MyD88 after S/R. AMs were stained with anti-TLR4 and anti-
MyD88 primary as well as the corresponding secondary antibodies. Repre-
sentative images (n = 4 experiments) are shown of TLR4 staining (red),
MyD88 staining (green), or merged images. (B) Colocalization of GM1 and
MyD88 after H2O2 treatment. RAW 264.7 cells, treated with 100 μM H2O2
for 1 h, were stained live at 4°C with rhodamine-CTxB, fi xed, permeabi-
lized, and stained with anti-MyD88 antibody as in A. Representative im-
ages (n = 3 experiments) of GM1 staining (red), MyD88 staining (green),
or merged image. (C) Specifi city of the anti-Myd88 antibody. RAW 264.7
cells were immunostained as in A. In the right image, the primary anti-
body was added in the presence of a specifi c blocking peptide (D). RAW
264.7 cells were exposed to 0.1 μg/ml LPS or 100 μM H2O2. Where indi-
cated, cells were pretreated with 10 mM MβCD. Lipid raft fractions were
isolated and analyzed by dot blotting using MyD88 primary and horserad-
ish peroxidase–coupled secondary antibody. Fractions 1–3 correspond to
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JEM VOL. 203, August 7, 2006
increase in NF-κB translocation with minimal translocation
observed by 15 min and >80% of cells showing transloca-
tion by 30 min (Fig. 9 B). MβCD treatment caused an almost
40% drop in the cellular cholesterol content (Fig. 9 A) and
prevented LPS-induced NF-κB translocation. Repletion
of membrane cholesterol restored LPS responsiveness (Fig. 9,
A and B). These studies established that cholesterol reple-
tion after antecedent MβCD treatment permitted normal
Consistent with our prior studies, Fig. 9 C shows that ox-
idative stress hastens NF-κB translocation in response to LPS,
occurring by 15 min (17, 29). To test whether lipid raft integ-
rity was required for this H2O2-induced priming, we treated
cholesterol-depleted cells with H2O2, where TLR4 move-
ment to lipid rafts was prevented. Next, we restored choles-
terol levels to permit normal LPS signaling (as shown in Fig.
9 B). As illustrated in Fig. 9 C, MβCD treatment before H2O2
exposure followed by cholesterol repletion prevented the
augmented p65 translocation by LPS observed in H2O2-
treated cells at 15 min. Moreover, this was comparable to the
eff ect of LPS alone added for 15 min. This was not due to
toxicity or a nonspecifi c eff ect of MβCD because by 30 min,
p65 translocation approximated that seen for the combined
H2O2/LPS treatment. Importantly, cholesterol measurements
showed that H2O2 treatment did not interfere with choles-
terol repletion (Fig. 9 A). Moreover, cholesterol depletion
does not interfere with H2O2-induced signaling (Fig. 4 D).
Thus, inhibition of TLR4 cell surface translocation by MβCD
appeared to prevent the primed macrophage phenotype.
These experiments strongly suggest that lipid rafts are not only
integral for LPS-mediated signaling but also critical for oxi-
dant-induced macrophage priming for LPS responsiveness.
The clinical scenario of resuscitated hemorrhagic shock is
known to render patients susceptible to the development
of a systemic infl ammatory response and organ dysfunction.
Although several mechanisms undoubtedly contribute to
this, the ability of antecedent S/R to prime infl ammatory
cells for increased responsiveness to a second stimulus, such
as Gram-negative bacterial LPS, has provided a mechanistic
framework for the investigation of post-resuscitation organ
injury. These studies focus on the regulation of surface TLR4
expression after ischemia/reperfusion, a pathological process
known to sensitize innate immune responses for enhanced
LPS signaling both in vitro and in the in vivo setting (4, 5,
30). These experiments demonstrate that S/R, through the
generation of oxidative stress, causes recruitment of TLR4
to the cell surface and that through the formation of these
TLR4-containing receptor complexes, the cell becomes
poised for increased responsiveness to LPS stimulation. These
studies are the fi rst to show that oxidative stress generated
during ischemia/reperfusion alters subcellular TLR4 distri-
bution in vivo, and thus they provide insights into the cellu-
lar mechanism whereby oxidative stress primes for enhanced
Recent reports have suggested an important role for lipid
rafts, detergent-insoluble cell membrane microdomains, in
LPS signaling. Specifi cally, the clustering of TLR4/MD2 and
other molecules, including CD14, heat shock proteins 70 and
90, the chemokine receptor CXCR4, and growth/diff eren-
tiation factor 5, within lipid rafts and their confi nement in
these microdomains were determined as early steps in LPS
signaling. Raft-disrupting agents, such as nystatin and MβCD,
inhibited both enrichment of TLR4 in lipid rafts and LPS-
stimulated downstream signaling via the MyD88/NF-κB
Figure 9. H202 treatment does not affect cholesterol depletion
and repletion. (A) Cells were incubated with 10 mM MβCD for 30 min.
Next, indicated samples were treated with 100 μM H202 for 1 h. Where
indicated, cholesterol levels were restored using MβCD plus cholesterol.
Total cellular cholesterol was measured. Data are normalized to control
levels (100%). Data represent mean ± SE (n = 3 experiments). (B and C)
Lipid raft integrity is required for oxidant-induced priming of LPS-stimulated
NF-κB activation. (B) Cholesterol depletion inhibits and cholesterol
repletion restores LPS-induced NF-κB nuclear translocation. RAW 264.7
cells were exposed to 0.1 μg/ml LPS for 15 or 30 min with or without
cholesterol depletion. Where indicated, cholesterol levels were restored
before the addition of LPS (MβCD+cholesterol). Cells were stained with
anti-p65. NF-κB nuclear translocation was analyzed by fl uorescence mi-
croscopy as described in Materials and methods. (C) Cholesterol depletion
before H2O2 prevents LPS-induced early p65 translocation. Control or
MβCD-treated cells were incubated with H2O2, followed by cholesterol
repletion and addition of LPS where indicated. NF-κB nuclear transloca-
tion was analyzed as in A. Data are mean ± SEM of n = 3. *, P < 0.05 for
groups indicated versus all other groups without an asterisk.
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Published July 17, 2006
1958 OXIDATIVE STRESS RECRUITS TLR4 TO THE MEMBRANE | Powers et al.
pathway (21). In these studies, we used both biochemical ap-
proaches and cell imaging techniques to demonstrate that
oxidative stress generated by S/R in vivo or by H2O2 in vitro
was able to induce migration of TLR4 into lipid rafts. Cou-
pled with the immunofl uorescence microscopy and the fl ow
cytometry data demonstrating increased surface TLR4 ex-
pression after oxidative stress, these fi ndings suggest move-
ment of TLR4 from the cytoplasmic compartment to lipid
rafts in the plasma membrane. Because lipid rafts are known
to be present in various intracellular compartments, such as
the Golgi apparatus or vesicles, it is possible that TLR4 may
fi rst move to one or more of these locations en route to the
plasma membrane. It also appears that the integrity of the
lipid raft microdomains is critical for TLR4 recruitment to
the plasma membrane because disruption of these domains
with MβCD prevented the oxidant-induced increase in
TLR4 cell surface expression. This observation is also consis-
tent with our fi nding that oxidant-induced exocytosis was
involved in the translocation of TLR4 to the plasmalemma.
Recent studies have reported that lipid rafts are involved in
regulated exocytosis in various cells types based on the obser-
vation that cholesterol depletion prevents exocytosis (31).
The mechanism of this raft-dependent exocytosis in part in-
volves the clustering of SNARE proteins within raft domains.
Conclusions regarding whether TLR4-containing vesicles
translocate to the plasmalemmal rafts directly or migrate to
the raft fraction after delivery to the plasma membrane will
require further investigation.
The data suggest that mobilization of TLR4 into cell sur-
face lipid rafts after oxidative stress plays an important role in
the augmented cellular responsiveness to LPS stimulation.
When oxidant-induced TLR4 mobilization to lipid rafts was
prevented using the cholesterol-depleting agent MβCD, the
increased responsiveness of the cells to LPS was prevented.
One alternate explanation is that H2O2 might act through the
activation of signaling cascades that are dependent on the
integrity of lipid rafts, and thus its inability to prime after
MβCD treatment may be due to an eff ect on H2O2-induced
signaling. Data regarding p38 kinase activation by H2O2 with
and without MβCD presented in Fig. 4 D demonstrate that
MβCD does not globally inhibit H2O2-induced signaling. In
addition, although these studies do not rule out every con-
ceivable pathway, wherein H2O2 might have infl uenced LPS
signaling in a raft-dependent manner, it does provide a clear
relationship between oxidative stress, increased surface TLR4,
involvement of lipid rafts in this TLR4 redistribution, and
priming for LPS signaling. Recruitment of TLR4 to plasma
membrane lipid rafts may have resulted in augmented signal-
ing by several distinct mechanisms. First, the number of sur-
face TLR4 molecules has been shown to generally correlate
with LPS responsiveness. Overexpression of TLR4 in trans-
genic mice amplifi es susceptibility to LPS treatment, both in
vivo and in vitro (11). In these studies, there was a substantial
increase in surface TLR4 expression after oxidative stress,
potentially accounting for the enhanced NF-κB translocation
after LPS treatment. Second, LPS-induced formation of the
receptor complex within lipid rafts appears to be necessary to
transduce the LPS signal. We propose that antecedent oxi-
dant stress induces formation of the complex, even before
exposure to LPS, such that the receptor complex is poised to
respond rapidly when exposed to LPS. Although we did not
measure the myriad of proteins known to localize in the LPS
receptor complex, the adaptor protein MyD88, known to be
enlisted to the complex during LPS signaling, was shown to
colocalize with both TLR4 and the lipid raft fraction after
oxidant exposure. Although early studies investigating an ef-
fect of oxidants on cellular activation clearly demonstrated
that oxidative stress was able to induce NF-κB nuclear trans-
location (32), enrichment of TLR4 as well as MyD88 in lipid
rafts in response to H2O2 treatment in these present studies
was not suffi cient to induce downstream signaling in the form
of increased NF-κB translocation (Fig. 9 C), despite the fact
that H2O2 was shown to activate other cell signaling path-
ways (Figs. 4 D and 7 A). This fi nding is likely due to the rel-
atively low dose of H2O2 used in these studies and the early
time course of observation for NF-κB. In our prior work, we
showed that 100 μM H2O2 was able to induce a modest rise
in NF-κB translocation at a delayed time point (1 h). This
dose was chosen because it had been shown to be a priming
dose for LPS stimulation in this system (17, 29). Similarly, the
oxidant-dependent NF-κB translocation occurring in the
lung after S/R is delayed and modest compared with LPS
or the combination of shock plus LPS (5). This is consistent
with the low-dose oxidant priming of AMs occurring in this
setting and the eff ects on TLR4 redistribution seen in these
studies. Besides the TLR4 redistribution per se, recent studies
evaluating the responsiveness of cells to LPS and its analogues
have also shown that the protein composition of the LPS re-
ceptor complex may vary depending on the stimulus and may
infl uence downstream signaling (9). Oxidative stress may
potentially induce an LPS receptor complex that diverts LPS
signaling along an alternative pathway, leading to enhanced
NF-κB translocation. In this regard, we recently reported
that exposure of RAW 264.7 cells to H2O2 reprogrammed
cells, such that LPS signaling was dependent on activation of
src family kinases and involved the PI3-kinase/Akt pathway
(17, 29). Src kinases are activated by oxidant stress (33) and
move into lipid rafts to facilitate signaling (34). Further inves-
tigation evaluating the signaling pathways required for the
oxidant-induced eff ects on TLR4 and the components of the
oxidant-induced LPS receptor complex will provide insight
into these possibilities.
The present studies demonstrate a marked change in
TLR4 receptor density and distribution after oxidative stress,
induced either by ischemia/reperfusion or by the addition of
H2O2. In various other cell systems, oxidative stress may con-
tribute to cell surface receptor density through altering the
stability of newly synthesized protein in the endoplasmic reticu-
lum, by inducing translocation of new proteins from the en-
doplasmic reticulum to the Golgi compartment and vesicular
transport to the plasmalemma. With respect to the latter of these
mechanisms, the glucose transporter GLUT4 is translocated
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Published July 17, 2006
JEM VOL. 203, August 7, 2006
from cytoplasmic vesicles to the cell surface by oxidative
stress (35). Ichimura et al. (36) demonstrated that oscillations
in calcium levels induced production of reactive oxygen
species, which in turn promoted exocytosis of P-selectin. In
pancreatic acinar cells, reactive oxygen species generated by
the hypoxanthine/xanthine oxidase system were able to in-
duce increased exocytosis of amylase (37). Consistent with
this mechanism, two distinct strategies aimed at preventing
exocytosis of CD11b-containing intracellular vesicular com-
partments in macrophages also precluded oxidant-induced
up-regulation of TLR4. Specifi cally, polymerization of the
actin cytoskeleton with jasplakinolide and calcium depletion
inhibited translocation of TLR4 to the cell surface by H2O2.
These and other studies suggest that the eff ect of oxidative
stress on exocytosis may involve alterations in intracellular
The precise intracellular source of TLR4 requires further
elucidation. Espevik et al. (38) recently showed that in an
epithelial cell line, entire lipid raft fractions containing
TLR4, CD14, and MD-2 continuously and rapidly recycle
between the Golgi complex and the plasma membrane. In
human monocytes, localization of TLR4 to perinuclear com-
partments was suggested to be evidence of its presence in
the Golgi, although no formal localization studies have been
performed (39). In RAW 264.7 cells as well as in rat AMs,
the intracellular localization of TLR4 appears more diff use,
consistent with its presence in preformed vesicles. Further
defi nition of the cytoplasmic localization of TLR4 in the
cells of monocyte/macrophage lineage should provide in-
sight into the preferred approaches to studying the mecha-
nisms whereby oxidative stress induces an increase in surface
Alterations in the redox status of cells have been shown to
aff ect a multitude of signaling pathways (40). With respect to
LPS signaling, these present experiments provide evidence
that oxidative stress generated during ischemia/reperfusion
may exert its eff ects by regulating the distribution of the most
proximal component of the signaling cascade, namely the
LPS receptor complex. Future studies defi ning the mecha-
nism of oxidant-induced TLR4 redistribution may provide
fundamental insights into the regulation of TLR4 in mono-
cytes/macrophages and suggest novel therapeutic approaches
in disease states wherein the process of ischemia/reperfusion
contributes to the pathogenesis of disease.
MATERIALS AND METHODS
Animal model. The animal protocol was approved by the Animal Care
Committee of St. Michael’s Hospital (protocol no. ACC756). S/R was per-
formed as described previously (14). In brief, male Sprague-Dawley rats
were anaesthetized, and the right carotid artery was cannulated for monitor-
ing of mean arterial pressure, blood sampling, and resuscitation. Mean arte-
rial pressure was reduced to 40 mmHg by blood withdrawal and maintained
between 35 and 45 mmHg by additional blood withdrawal or infusion of
Ringer’s lactate (Baxter Co.) if necessary. Shed blood was collected into
0.1 ml sodium citrate/ml blood. After 60 min, animals were resuscitated
with their shed blood and an equivalent amount of Ringer’s lactate with or
without 0.5 g/kg NAC (Mucomyst; Shire, Inc.) or 10 mg/kg Trolox over
a 2-h period. Animals were killed by a pentobarbital (MTC Pharmaceuticals)
overdose, and AMs were recovered by bronchoalveolar lavage with cold
PBS (Invitrogen), followed by centrifugation at 300 g (10 min).
Cell culture and activation. The murine macrophage cell line, RAW
264.7 (American Type Culture Collection), was cultured at 37°C in a hu-
midifi ed atmosphere of 5% CO2 in endotoxin-free DMEM (Invitrogen)
with 100 U/ml penicillin, 100 μg/ml streptomycin (Invitrogen), and 10%
FCS (Hyclone Lab, Inc.). Experiments were performed in HBSS (Invitro-
gen) supplemented with 2% FCS. The following treatments were applied:
100 μM (or the indicated concentration) H2O2, 0.1 μg/ml LPS (Escherichia
coli O111:B4; Sigma-Aldrich), 0.1 mM xanthine and 3 U/ml xanthine ox-
ide, and 50 μM menadione. In the functional studies, cells were exposed to
H2O2 for 1 h, followed by LPS for 15–60 min. Where indicated, cells were
treated with 10 μM BAPTA/AM (Calbiochem) for 10 min or 1 μM jas-
plakinolide (Invitrogen) for 30 min at 37°C before adding oxidants. Reac-
tions were stopped by placing cells on ice.
Immunofl uorescence microscopy. AMs or RAW264.7 cells on cover-
slips were fi xed with 4% paraformaldehyde (Canemco-MARivac) for 30
min, permeabilized with 0.2% Triton X-100 in PBS for 20 min, blocked
with 5% bovine serum albumin for 1 h, and incubated with the indicated
antibody. The following primary antibodies were used: anti-TLR4 antibody
(H-80; 1:200; for rat AMs), anti-MyD88 (F-19; 1:200), and anti-p65 (1:50)
from Santa Cruz Biotechnology, Inc.; and FITC-conjugated anti-TLR4/
MD2 (MTS510; for RAW 264.7 cells) from StressGen Biotechnologies.
The two anti-TLR4 antibodies diff er insofar as the H-80 antibody recog-
nizes TLR4, whereas the MTS510 recognizes the MD-2/TLR4 complex.
FITC- or Cy3-conjugated Fab fragment secondary antibodies were from
Jackson ImmunoResearch Laboratories, and Alexa 488–labeled anti–goat
antibody was from Invitrogen. GM-1 ganglioside, a component of lipid rafts,
was detected by incubating live cells with rhodamine (TRITC)-conjugated
CTxB (1:500; List Biological Laboratories) before fi xation. The coverslips
were mounted using DAKO medium (DakoCytomation) and visualized
with a Nikon TE200 fl uorescence microscope (100× objective) coupled to
an Orca 100 camera (Hamamatsu Photonics) driven by Simple PCI software
(Compix Inc.). Where indicated, a Zeiss LSM 510 confocal microscope with
a 100× objective was used to acquire 0.5-μm-thick serial optical slices.
Images of representative focal planes are shown. Image analysis was per-
formed using the Scionimage software. Peripheralization was defi ned as a
≥80% increase in the ratio of fl uorescence intensities at the cell periphery
and the cytosol (at 0.5 μm distance from the membrane). The percentage of
cells with peripheralized TLR4 under various conditions was calculated by
scoring 100 cells. NF-κB translocation was analyzed as described previously
(17). The percentage of cells with nuclear p65 staining was determined by
counting an average of 100 cells for each group. During quantitation, the
observer was blinded to the experimental group.
Flow cytometry. Cell surface expression of TLR4 and CD11b was detected
by fl ow cytometry of live cells stained with anti-TLR4 (H-80), anti-TLR4/
MD2 (MTS510), or anti-CD11b/CD18 (Mac-1; Cedarlane Laboratories)
and the corresponding FITC-labeled secondary antibody where required.
10,000 cells/condition were analyzed in a FACScan (Becton Dickinson) us-
ing FL1 525 mM Band Pass detector at an excitation wavelength of 488 nm.
Results were expressed as mean channel fl uorescence.
FRET. For FRET experiments, live RAW264.7 cells were stained at
4°C with anti-TLR4 antibody (H-80) followed by an FITC-conjugated
anti–rabbit Fab fragment and rhodamine-CTxB. The fl uorescence was de-
termined at 37°C using a DeltaRAM illumination system from Photon
Technologies, Inc. operated by FELIX software. The excitation wavelength
was 480 ± 5 nm and emission was detected at 510 ± 10 nm (green emission)
and at >590 nm (red emission) for at least six cells/coverslip. For each con-
dition, at least 20 cells from three to four coverslips were measured.
Manipulation and measurement of cellular cholesterol. Cholesterol
was depleted and repleted in RAW264.7 cells using a modifi ed procedure of
on July 24, 2014
Published July 17, 2006
1960 OXIDATIVE STRESS RECRUITS TLR4 TO THE MEMBRANE | Powers et al.
Furuchi et al. (41) and Roy et al. (42). In brief, cells were treated with
10 mM MβCD for 30 min at 37°C in HBSS. Cholesterol repletion was then
achieved by incubation with 80 μg/ml cholesterol and 0.2% MβCD for
30 min at 37°C. The total cholesterol content was determined using the
Amplex red cholesterol assay kit from Invitrogen.
Isolation and detection of lipid rafts. Lipid rafts were isolated as de-
scribed previously (24). RAW264.7 cells (2 × 107 cells/ml) were lysed in
0.25 ml TKM buff er (50 mM Tris, pH 7.4, 25 mM KCl, 5 mM MgCl2, and
1 mM EDTA) containing 0.5% wt/vol Brij58 (Sigma-Aldrich) and protease
inhibitors (Roche Diagnostics) on ice for 30 min. Lysates was mixed with an
equal volume cold 80% wt/vol sucrose in TKM and overlaid with 4.3 ml
cold 36% sucrose, followed by 0.2 ml 5% sucrose. The gradients were sub-
jected to ultracentrifugation at 200 000 g at 4°C for 18 h. Fractions were
collected from the top of the gradient. An equal volume of each fraction was
diluted in 10 μl TBS-T buff er (20 mM Tris, pH 7.4, 150 mM NaCl, and
0.05% Tween 20) containing 0.1% Triton X-100 and loaded onto Protran
Nitrocellulose Sheet (0.45-μm pore; S&S BioScience) using Dot Blot (Bio-
Rad Laboratories). The membrane was blocked in 5% milk in TBS-T,
followed by incubation with CTxB–horseradish peroxidase (1:500; List
Biological Laboratories), anti-TLR4 (H-80), or anti-MyD88 (F-19) for 1 h.
Where required, horseradish peroxidase–conjugated secondary antibody
(1:3,000 dilution for 1 h) was used. Labeling was visualized using enhanced
Western blotting. Proteins were detected using Western blotting as de-
scribed previously (43). Protein concentration was determined using the
Bradford protein assay (Bio-Rad Laboratories). Equal loading was verifi ed
using Ponceau S staining of the membranes. The phospho-p38 antibody was
from Cell Signaling.
Statistical analysis. Data are presented as mean ± standard error of n de-
terminations as indicated in the fi gure legends. Data were analyzed by one-
way analysis of variance, and post hoc testing was performed using the
Bonferroni modifi cation of the t test with signifi cance at P < 0.05. Blots and
images shown are representatives of at least three separate determinations.
The authors acknowledge the help of Dr. Michael Julius in lipid raft separation
This work was supported by the Canadian Institutes of Health Research. K.A.
Powers is a recipient of awards from the American College of Surgeons and the
Canadian Association For Clinical Microbiology and Infectious Diseases. R.G.
Khadaroo is supported by the Alberta Heritage Foundation. A. Kapus and K. Szászi
are recipients of support awards from the Canadian Institutes of Health Research.
The authors have no confl icting fi nancial interests.
Submitted: 2 May 2006
Accepted: 19 June 2006
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on July 24, 2014
Published July 17, 2006