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Invited Commentary| Volume 221, ISSUE 2, P317-318, April 2012

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HMGB1 signals danger in acute coronary syndrome: Emergence of a new risk marker for cardiovascular death?

      High Mobility Group Box 1 protein (HMGB1), also known as amphoterin, is a 215 amino acid molecule that is highly conserved throughout evolution and ubiquitously expressed in most cell types. It is predominantly a nuclear protein that is involved in stabilizing nucleosome structure and regulating the binding of transcription factors via two positively charged DNA-binding domains, Box A and Box B. HMGB1 also has important extracellular functions including a role as a potential biomarker upon release from cells. Two distinct mechanisms have been described for its release [
      • Raucci A.
      • Palumbo R.
      • Bianchi M.E.
      HMGB1: a signal of necrosis.
      ]: (1) passive release from necrotic cells following disruption of nuclear and cell membranes. This mechanism of release is necrosis specific, as apoptotic cells retain HMGB1. (2) Active secretion by innate immune cells (e.g. monocytes and macrophages) in response to and as an amplifier of proinflammatory signals. HMGB1 released from cells is highly proinflammatory via interactions with several receptors including the receptor for advanced glycation end products (RAGE), toll-like receptor (TLR)-2, -4, and -9 [
      • Basta G.
      Receptor for advanced glycation endproducts and atherosclerosis: from basic mechanisms to clinical implications.
      ,
      • den Dekker W.K.
      • Cheng C.
      • Pasterkamp G.
      • Duckers H.J.
      Toll like receptor 4 in atherosclerosis and plaque destabilization.
      ]. The pivotal biological role of HMGB1 is underlined by it functioning as an alarmin; it has important roles in recruiting and activating antigen-presenting cells (e.g. dendritic cells), enhancing both innate and adaptive immune responses, and acting as an endogenous danger signal, reporting cell damage/necrosis and the necessity of repair and inducing a “sterile” immune response [
      • Klune J.R.
      • Dhpar R.
      • Cardinal J.
      • Billiar T.R.
      • Tsung A.
      HMGB1: endogenous danger signaling.
      ,
      • Yang D.
      • Tewary P.
      • de la Rosa G.
      • Wei F.
      • Oppenheim J.J.
      The alarmin functions of high-mobility group proteins.
      ]. These important functions of extracellular HMGB1 make it a highly attractive candidate as biomarker of cell ischemia and cell damage.

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