id: MODULE:efferocytosis_induced_anti_inflammatory_programme
title: Efferocytosis-induced anti-inflammatory programme
description: 'A macrophage that has engulfed apoptotic cells suppresses inflammation and makes
  pro-resolving signals such as IL-10, TGF-beta1 and prostaglandin E2. Several parallel routes
  read components of the digested cell: sterols activate the liver X receptors, lipids activate
  PPAR-delta, fatty acids fuel mitochondrial oxidation that raises NAD+ and activates SIRT1
  and PBX1, tryptophan feeds IDO1 and the aryl hydrocarbon receptor, DNA signals through TLR9
  to the same receptor, and methionine supplies the methyl groups DNMT3A uses to keep ERK
  signalling on. Chloride sensing through SLC12A2 decides whether the corpse is read as anti-inflammatory.
  Each route has cargo-specificity controls: engulfing beads, necrotic cells or cargo-free
  phosphatidylserine beads does not trigger it.'
status: DRAFT
scope: ABSTRACT
references:
- id: PMID:19646905
  title: Apoptotic cells promote their own clearance and immune tolerance through activation
    of the nuclear receptor LXR.
  reference_review:
    relevance: HIGH
    correctness: VERIFIED
    review_notes: PubMed-verified; full text cached and read in full.
- id: PMID:19838202
  title: PPAR-delta senses and orchestrates clearance of apoptotic cells to promote tolerance.
  reference_review:
    relevance: HIGH
    correctness: VERIFIED
    review_notes: PubMed-verified; full text cached and read in full.
- id: PMID:30595481
  title: Efferocytosis Fuels Requirements of Fatty Acid Oxidation and the Electron Transport
    Chain to Polarize Macrophages for Tissue Repair.
  reference_review:
    relevance: HIGH
    correctness: VERIFIED
    review_notes: PubMed-verified; full text cached and read in full.
- id: PMID:39242914
  title: Efferocytosis drives a tryptophan metabolism pathway in macrophages to promote tissue
    resolution.
  reference_review:
    relevance: HIGH
    correctness: VERIFIED
    review_notes: PubMed-verified; full text cached and read in full.
- id: PMID:29760532
  title: Apoptotic cell-induced AhR activity is required for immunological tolerance and suppression
    of systemic lupus erythematosus in mice and humans.
  reference_review:
    relevance: HIGH
    correctness: VERIFIED
    review_notes: PubMed-verified; full text cached and read in full.
- id: PMID:35361955
  title: Macrophages use apoptotic cell-derived methionine and DNMT3A during efferocytosis
    to promote tissue resolution.
  reference_review:
    relevance: HIGH
    correctness: VERIFIED
    review_notes: PubMed-verified; full text cached and read in full.
- id: PMID:31792382
  title: Interpreting an apoptotic corpse as anti-inflammatory involves a chloride sensing
    pathway.
  reference_review:
    relevance: HIGH
    correctness: VERIFIED
    review_notes: PubMed-verified; full text cached and read in full.
notes: 'Boundary: this module starts with the digested cargo of an engulfed apoptotic cell
  and ends with suppressed inflammatory output and production of IL-10, TGF-beta1 and PGE2.
  Engulfment and digestion belong to the phagocytosis modules. IL-10, TGF-beta1 and the opsonin
  C1q are outputs or readouts and are not modelled as participants.


  The routes come mostly from separate laboratories and model systems. Two disagree: PMID:39242914
  places IDO1 upstream of AhR, while PMID:29760532 found AhR activation intact without IDO1.
  They are modelled as independent routes rather than one chain. Some routes respond to engulfed
  cells in general, not only apoptotic ones (IgG-coated red cells also induce DNMT3A-dependent
  COX2 in PMID:35361955).


  Taxon scope: all shown in mouse, with some steps also in human macrophages. Whether any
  route operates outside mammals is not known.'
module:
  id: efferocytosis_induced_anti_inflammatory_programme
  label: Efferocytosis-induced anti-inflammatory programme
  module_type: SIGNALING_PATHWAY
  concepts:
  - preferred_term: negative regulation of inflammatory response
    term:
      id: GO:0050728
      label: negative regulation of inflammatory response
    notes: Shared output. GO has no term for this programme; "efferocytosis-induced interleukin-10
      production" (is_a GO:0032613) has been proposed to GO in go-ontology#32748.
  context:
    taxa:
    - preferred_term: Mammalia
      term:
        id: NCBITaxon:40674
        label: Mammalia
      notes: Mechanisms shown in mouse; SLC36A4, MAT2A, DNMT3A and PTGS2 steps also in human
        macrophages.
    cell_types:
    - preferred_term: macrophage
      term:
        id: CL:0000235
        label: macrophage
  parts:
  - order: 1
    role: cargo-derived signal routes
    node:
      id: cargo_signal_routes
      label: Cargo-derived signal routes
      module_type: SIGNALING_PATHWAY
      description: 'Each route reads a different component of the digested cell. The routes
        are additive alternatives: losing one blunts the response but does not abolish all
        of it, and several converge on IL-10 or TGF-beta1.'
      variant_sets:
      - id: cargo_component
        label: Cargo component sensed
        axis: component of the engulfed cell that supplies the signal
        selection: ONE_OR_MORE
        variants:
        - id: sterol_lxr_route
          label: 'Sterol route: LXR'
          module_type: SIGNALING_PATHWAY
          description: Sterols from the engulfed cell activate the liver X receptors. LXR
            induces the engulfment receptor MERTK, which speeds further clearance, and is
            needed for induction of IL-10 and TGF-beta and for repression of inflammatory
            genes. Depleting sterols from the corpses blunts LXR target induction.
          concepts:
          - preferred_term: oxysterol receptor signaling pathway
            term:
              id: GO:0141209
              label: oxysterol receptor signaling pathway
          annotons:
          - id: lxr_alpha
            label: LXR-alpha sterol-activated receptor
            participant:
              selector_type: FAMILY
              family:
                preferred_term: LXR-alpha
                term:
                  id: PANTHER:PTHR24082:SF259
                  label: OXYSTEROLS RECEPTOR LXR-ALPHA
                representative_members:
                - preferred_term: Nr1h3 (mouse)
                  term:
                    id: UniProtKB:Q9Z0Y9
                    label: Oxysterols receptor LXR-alpha
                - preferred_term: NR1H3 (human)
                  term:
                    id: UniProtKB:Q13133
                    label: Oxysterols receptor LXR-alpha
            function:
              preferred_term: nuclear receptor activity
              term:
                id: GO:0004879
                label: nuclear receptor activity
            processes:
            - preferred_term: oxysterol receptor signaling pathway
              term:
                id: GO:0141209
                label: oxysterol receptor signaling pathway
            locations: &id001
            - preferred_term: nucleus
              term:
                id: GO:0005634
                label: nucleus
            role_description: 'Sterol-activated transcription factor. Redundant with LXR-beta:
              only the double knockout loses Mertk induction by agonists and the response
              to apoptotic cells.'
            evidence:
            - source_id: PMID:19646905
              title: Apoptotic cells promote their own clearance and immune tolerance through
                activation of the nuclear receptor LXR.
              statement: LXR agonists induce Mertk unless both LXRs are absent.
              supporting_text: Expression of Mer was induced by LXR and RXR agonists in WT,
                Lxrα-/- and Lxrβ-/- but not in Lxrαβ-/- primary macrophages
            - source_id: PMID:19646905
              title: Apoptotic cells promote their own clearance and immune tolerance through
                activation of the nuclear receptor LXR.
              statement: 'The trigger is sterol cargo: sterol-depleted corpses induce LXR
                targets less.'
              supporting_text: depletion of sterols from AT by means of methyl beta-cyclodextran
                treatment reduced their ability to induce LXR target gene expression (Mer,
                Abca1) following ingestion by macrophages
          - id: lxr_beta
            label: LXR-beta sterol-activated receptor
            participant:
              selector_type: FAMILY
              family:
                preferred_term: LXR-beta
                term:
                  id: PANTHER:PTHR24082:SF316
                  label: OXYSTEROLS RECEPTOR LXR-BETA
                representative_members:
                - preferred_term: Nr1h2 (mouse)
                  term:
                    id: UniProtKB:Q60644
                    label: Oxysterols receptor LXR-beta
                - preferred_term: NR1H2 (human)
                  term:
                    id: UniProtKB:P55055
                    label: Oxysterols receptor LXR-beta
            function:
              preferred_term: nuclear receptor activity
              term:
                id: GO:0004879
                label: nuclear receptor activity
            processes:
            - preferred_term: oxysterol receptor signaling pathway
              term:
                id: GO:0141209
                label: oxysterol receptor signaling pathway
            locations: *id001
            role_description: Acts redundantly with LXR-alpha in this programme.
            evidence:
            - source_id: PMID:19646905
              title: Apoptotic cells promote their own clearance and immune tolerance through
                activation of the nuclear receptor LXR.
              statement: LXRs are needed for the IL-10 and TGF-beta response to apoptotic
                cells.
              supporting_text: AT promoted the expression of immunosuppressive mediators such
                as Tgf-β and Il-10 in WT macrophages (Fig. 4A,B). However, induction of these
                genes was impaired in macrophages lacking LXRs.
          - id: lxr_target_mertk
            label: MERTK induced by LXR
            participant:
              selector_type: FAMILY
              family:
                preferred_term: MERTK
                term:
                  id: PANTHER:PTHR24416:SF257
                  label: TYROSINE-PROTEIN KINASE MER
                representative_members:
                - preferred_term: Mertk (mouse)
                  term:
                    id: UniProtKB:Q60805
                    label: Tyrosine-protein kinase Mer
                - preferred_term: MERTK (human)
                  term:
                    id: UniProtKB:Q12866
                    label: Tyrosine-protein kinase Mer
            function:
              preferred_term: transmembrane receptor protein tyrosine kinase activity
              term:
                id: GO:0004714
                label: transmembrane receptor protein tyrosine kinase activity
            processes:
            - preferred_term: positive regulation of apoptotic cell clearance
              term:
                id: GO:2000427
                label: positive regulation of apoptotic cell clearance
            locations:
            - preferred_term: plasma membrane
              term:
                id: GO:0005886
                label: plasma membrane
            role_description: Direct LXR target. Its induction feeds back to raise clearance
              of further apoptotic cells.
        - id: lipid_ppard_route
          label: 'Lipid route: PPAR-delta'
          module_type: SIGNALING_PATHWAY
          description: Engulfment of apoptotic cells, but not of beads, necrotic cells or
            opsonised red cells, induces and activates PPAR-delta. PPAR-delta directly induces
            the opsonin C1qb and is needed for the switch to IL-10 production.
          concepts:
          - preferred_term: peroxisome proliferator activated receptor signaling pathway
            term:
              id: GO:0035357
              label: peroxisome proliferator activated receptor signaling pathway
          annotons:
          - id: ppard_receptor
            label: PPAR-delta lipid-sensing receptor
            participant:
              selector_type: FAMILY
              family:
                preferred_term: PPAR-delta
                term:
                  id: PANTHER:PTHR24082:SF15
                  label: PEROXISOME PROLIFERATOR-ACTIVATED RECEPTOR DELTA
                representative_members:
                - preferred_term: Ppard (mouse)
                  term:
                    id: UniProtKB:P35396
                    label: Peroxisome proliferator-activated receptor delta
                - preferred_term: PPARD (human)
                  term:
                    id: UniProtKB:Q03181
                    label: Peroxisome proliferator-activated receptor delta
            function:
              preferred_term: nuclear receptor activity
              term:
                id: GO:0004879
                label: nuclear receptor activity
            processes:
            - preferred_term: peroxisome proliferator activated receptor signaling pathway
              term:
                id: GO:0035357
                label: peroxisome proliferator activated receptor signaling pathway
            locations: *id001
            role_description: Transcriptional sensor of engulfed apoptotic cells. Global and
              macrophage-specific (LysM-Cre) knockouts lose opsonin expression and the anti-inflammatory
              cytokine switch and develop lupus-like disease.
            evidence:
            - source_id: PMID:19838202
              title: PPAR-delta senses and orchestrates clearance of apoptotic cells to promote
                tolerance.
              statement: PPAR-delta is activated by apoptotic cells but not by other engulfed
                particles.
              supporting_text: this transcriptional activation of PPAR-δ by apoptotic cells
                was specific, because necrotic cells and opsonized sRBCs failed to activate
                PPAR-δ
            - source_id: PMID:19838202
              title: PPAR-delta senses and orchestrates clearance of apoptotic cells to promote
                tolerance.
              statement: PPAR-delta/RXR directly controls C1qb.
              supporting_text: Deletion analysis of the mouse promoter affirmed that PPAR-δ/RXR
                heterodimers directly regulate C1qb gene expression
        - id: fatty_acid_oxidation_route
          label: 'Fatty acid oxidation route: NAD+, SIRT1 and PBX1'
          module_type: SIGNALING_PATHWAY
          description: Fatty acids from the engulfed cell are oxidised in the macrophage's
            mitochondria. Electron transport through complex III raises NAD+, which activates
            SIRT1, and SIRT1 is needed for the transcription factor PBX1 to occupy the IL-10
            promoter. Beads and live cells do not raise respiration.
          concepts:
          - preferred_term: positive regulation of interleukin-10 production
            term:
              id: GO:0032733
              label: positive regulation of interleukin-10 production
          annotons:
          - id: risp_complex_iii
            label: Complex III (Rieske subunit deleted)
            participant:
              selector_type: PROTEIN_COMPLEX
              protein_complex:
                preferred_term: respiratory chain complex III
                term:
                  id: GO:0045275
                  label: respiratory chain complex III
                active_units:
                - label: Rieske iron-sulfur subunit (RISP)
                  participant:
                    selector_type: FAMILY
                    family:
                      preferred_term: UQCRFS1 (RISP)
                      term:
                        id: PANTHER:PTHR10134
                        label: CYTOCHROME B-C1 COMPLEX SUBUNIT RIESKE, MITOCHONDRIAL
                      representative_members:
                      - preferred_term: Uqcrfs1 (mouse)
                        term:
                          id: UniProtKB:Q9CR68
                          label: Cytochrome b-c1 complex subunit Rieske, mitochondrial
                      - preferred_term: UQCRFS1 (human)
                        term:
                          id: UniProtKB:P47985
                          label: Cytochrome b-c1 complex subunit Rieske, mitochondrial
            function:
              preferred_term: quinol-cytochrome-c reductase activity
              term:
                id: GO:0008121
                label: quinol-cytochrome-c reductase activity
            locations:
            - preferred_term: mitochondrial inner membrane
              term:
                id: GO:0005743
                label: mitochondrial inner membrane
            role_description: Couples oxidation of cargo fatty acids to NAD+ regeneration.
              Myeloid Risp deletion abolishes IL-10 after efferocytosis, and an NAD+ precursor
              rescues it.
            evidence:
            - source_id: PMID:30595481
              title: Efferocytosis Fuels Requirements of Fatty Acid Oxidation and the Electron
                Transport Chain to Polarize Macrophages for Tissue Repair.
              statement: An NAD+ precursor rescues IL-10 in Risp-deficient macrophages, placing
                NAD+ downstream of complex III.
              supporting_text: we added NAD+ precursor NMN to Rispfl/fl LysMcre macrophages
                during efferocytosis and found that NMN was sufficient to rescue IL-10 production
          - id: sirt1_deacetylase
            label: SIRT1 NAD-dependent deacetylase
            participant:
              selector_type: FAMILY
              family:
                preferred_term: SIRT1
                term:
                  id: PANTHER:PTHR11085:SF9
                  label: NAD-DEPENDENT PROTEIN DEACETYLASE SIRTUIN-1
                representative_members:
                - preferred_term: Sirt1 (mouse)
                  term:
                    id: UniProtKB:Q923E4
                    label: NAD-dependent protein deacetylase sirtuin-1
                - preferred_term: SIRT1 (human)
                  term:
                    id: UniProtKB:Q96EB6
                    label: NAD-dependent protein deacetylase sirtuin-1
            function:
              preferred_term: NAD-dependent protein lysine deacetylase activity
              term:
                id: GO:0034979
                label: NAD-dependent protein lysine deacetylase activity
            processes:
            - preferred_term: positive regulation of interleukin-10 production
              term:
                id: GO:0032733
                label: positive regulation of interleukin-10 production
            locations: *id001
            role_description: Reads the NAD+ rise. siRNA only. Its substrate in this programme
              is not known; it is needed for PBX1 binding at the IL-10 promoter.
            evidence:
            - source_id: PMID:30595481
              title: Efferocytosis Fuels Requirements of Fatty Acid Oxidation and the Electron
                Transport Chain to Polarize Macrophages for Tissue Repair.
              statement: SIRT1 is needed for PBX1 occupancy of the IL-10 promoter.
              supporting_text: Sirt1 deficiency reduced PBX-1 binding to the apoptotic cell
                response element of the IL-10 promoter (Figure 6F)
          - id: pbx1_tf
            label: PBX1 at the IL-10 promoter
            participant:
              selector_type: FAMILY
              family:
                preferred_term: PBX1
                term:
                  id: PANTHER:PTHR11850:SF89
                  label: PRE-B-CELL LEUKEMIA TRANSCRIPTION FACTOR 1
                representative_members:
                - preferred_term: Pbx1 (mouse)
                  term:
                    id: UniProtKB:P41778
                    label: Pre-B-cell leukemia transcription factor 1
                - preferred_term: PBX1 (human)
                  term:
                    id: UniProtKB:P40424
                    label: Pre-B-cell leukemia transcription factor 1
            function:
              preferred_term: DNA-binding transcription activator activity, RNA polymerase
                II-specific
              term:
                id: GO:0001228
                label: DNA-binding transcription activator activity, RNA polymerase II-specific
            processes:
            - preferred_term: positive regulation of interleukin-10 production
              term:
                id: GO:0032733
                label: positive regulation of interleukin-10 production
            locations: *id001
            role_description: Transcription factor that drives Il10 after efferocytosis. siRNA
              only.
        - id: tryptophan_ahr_route
          label: 'Tryptophan route: SLC36A4, IDO1 and AhR'
          module_type: SIGNALING_PATHWAY
          description: Tryptophan released by digestion of the engulfed cell's proteins leaves
            the phagolysosome through SLC36A4. IDO1 converts it toward kynurenine, which activates
            AhR, and AhR induces IL-10 and TGF-beta1 and supports continued efferocytosis.
            Phosphatidylserine-coated beads, which engage the same receptors but carry no
            cargo, do not trigger it.
          concepts:
          - preferred_term: L-tryptophan catabolic process
            term:
              id: GO:0006569
              label: L-tryptophan catabolic process
          annotons:
          - id: slc36a4_trp_export
            label: SLC36A4 exports tryptophan from the phagolysosome
            participant:
              selector_type: FAMILY
              family:
                preferred_term: SLC36A4 (PAT4)
                term:
                  id: PANTHER:PTHR22950:SF190
                  label: NEUTRAL AMINO ACID UNIPORTER 4
                representative_members:
                - preferred_term: Slc36a4 (mouse)
                  term:
                    id: UniProtKB:Q8CH36
                    label: Neutral amino acid uniporter 4
                - preferred_term: SLC36A4 (human)
                  term:
                    id: UniProtKB:Q6YBV0
                    label: Neutral amino acid uniporter 4
            function:
              preferred_term: L-tryptophan transmembrane transporter activity
              term:
                id: GO:0015196
                label: L-tryptophan transmembrane transporter activity
            locations:
            - preferred_term: phagolysosome membrane
              term:
                id: GO:0061474
                label: phagolysosome membrane
            role_description: Rises on phagolysosomes containing apoptotic cells. Knockdown
              in mouse and human macrophages blocks the downstream response but not engulfment.
            evidence:
            - source_id: PMID:39242914
              title: Efferocytosis drives a tryptophan metabolism pathway in macrophages to
                promote tissue resolution.
              statement: Cargo-free beads do not induce SLC36A4.
              supporting_text: upregulation of SLC36A4 was not seen in macrophages incubated
                with phosphatidylserine (PS)-coated beads, which bind to and are internalized
                by efferocytosis receptors but have no cellular cargo
          - id: ido1_dioxygenase
            label: IDO1 converts cargo tryptophan
            participant:
              selector_type: FAMILY
              family:
                preferred_term: IDO1
                term:
                  id: PANTHER:PTHR28657:SF2
                  label: INDOLEAMINE 2,3-DIOXYGENASE 1
                representative_members:
                - preferred_term: Ido1 (mouse)
                  term:
                    id: UniProtKB:P28776
                    label: Indoleamine 2,3-dioxygenase 1
                - preferred_term: IDO1 (human)
                  term:
                    id: UniProtKB:P14902
                    label: Indoleamine 2,3-dioxygenase 1
            function:
              preferred_term: indoleamine 2,3-dioxygenase activity
              term:
                id: GO:0033754
                label: indoleamine 2,3-dioxygenase activity
            processes:
            - preferred_term: L-tryptophan catabolic process
              term:
                id: GO:0006569
                label: L-tryptophan catabolic process
            locations:
            - preferred_term: cytosol
              term:
                id: GO:0005829
                label: cytosol
            role_description: First step from tryptophan to kynurenine. Knockout, myeloid
              and inducible macrophage knockouts and an inhibitor added after the first engulfment
              all block the response; kynurenine partly rescues it.
            evidence:
            - source_id: PMID:39242914
              title: Efferocytosis drives a tryptophan metabolism pathway in macrophages to
                promote tissue resolution.
              statement: IDO1 is needed for IL-10 and TGF-beta1 induction in efferocytosing
                macrophages.
              supporting_text: We found that both siIdo1 and epacadostat markedly blocked
                the increases in levels of Tgfb1 and Il10 mRNAs in efferocytosing macrophages
          - id: ahr_trp_route
            label: AhR activated by kynurenine
            participant:
              selector_type: FAMILY
              family:
                preferred_term: AhR
                term:
                  id: PANTHER:PTHR10649:SF9
                  label: ARYL HYDROCARBON RECEPTOR
                representative_members:
                - preferred_term: Ahr (mouse)
                  term:
                    id: UniProtKB:P30561
                    label: Aryl hydrocarbon receptor
                - preferred_term: AHR (human)
                  term:
                    id: UniProtKB:P35869
                    label: Aryl hydrocarbon receptor
            function:
              preferred_term: ligand-modulated transcription factor activity
              term:
                id: GO:0098531
                label: ligand-modulated transcription factor activity
            processes:
            - preferred_term: positive regulation of interleukin-10 production
              term:
                id: GO:0032733
                label: positive regulation of interleukin-10 production
            locations: *id001
            role_description: Ligand-activated transcription factor that induces Il10 and
              Tgfb1. Knockout, myeloid knockout and an antagonist block the response.
            evidence:
            - source_id: PMID:39242914
              title: Efferocytosis drives a tryptophan metabolism pathway in macrophages to
                promote tissue resolution.
              statement: Kynurenine plus cargo-free engulfment reconstitutes AhR activation;
                neither alone does.
              supporting_text: neither Kyn alone nor PS beads alone could activate AhR or
                induce Ido1, Il10, or Tgfb1 mRNA expression, the combination of Kyn and PS
                beads was able to activate these downstream mediators
        - id: dna_tlr9_ahr_route
          label: 'DNA route: TLR9 and AhR'
          module_type: SIGNALING_PATHWAY
          description: DNA in the engulfed apoptotic cell signals through endolysosomal TLR9
            to activate AhR, which binds the Il10 promoter. Engulfment, not contact alone,
            is needed, and DNase-treated corpses fail to activate AhR. In this study AhR activation
            did not need IDO1, so this route is independent of the tryptophan route.
          concepts:
          - preferred_term: toll-like receptor 9 signaling pathway
            term:
              id: GO:0034162
              label: toll-like receptor 9 signaling pathway
          annotons:
          - id: tlr9_dna_sensor
            label: TLR9 senses apoptotic-cell DNA
            participant:
              selector_type: FAMILY
              family:
                preferred_term: TLR9
                term:
                  id: PANTHER:PTHR47410:SF3
                  label: TOLL-LIKE RECEPTOR 9
                representative_members:
                - preferred_term: Tlr9 (mouse)
                  term:
                    id: UniProtKB:Q9EQU3
                    label: Toll-like receptor 9
                - preferred_term: TLR9 (human)
                  term:
                    id: UniProtKB:Q9NR96
                    label: Toll-like receptor 9
            function:
              preferred_term: pattern recognition receptor activity
              term:
                id: GO:0038187
                label: pattern recognition receptor activity
            processes:
            - preferred_term: toll-like receptor 9 signaling pathway
              term:
                id: GO:0034162
                label: toll-like receptor 9 signaling pathway
            locations:
            - preferred_term: endolysosome membrane
              term:
                id: GO:0036020
                label: endolysosome membrane
            role_description: Needed for AhR activation after efferocytosis. An AhR agonist
              rescues Tlr9-/- cells, placing TLR9 upstream.
            evidence:
            - source_id: PMID:29760532
              title: Apoptotic cell-induced AhR activity is required for immunological tolerance
                and suppression of systemic lupus erythematosus in mice and humans.
              statement: AhR does not enter the nucleus after efferocytosis without TLR9.
              supporting_text: Tlr9−/− BMDMs did not show nuclear accumulation of AhR after
                efferocytosis (Fig. 3d)
          - id: ahr_dna_route
            label: AhR binds the Il10 promoter
            participant:
              selector_type: FAMILY
              family:
                preferred_term: AhR
                term:
                  id: PANTHER:PTHR10649:SF9
                  label: ARYL HYDROCARBON RECEPTOR
                representative_members:
                - preferred_term: Ahr (mouse)
                  term:
                    id: UniProtKB:P30561
                    label: Aryl hydrocarbon receptor
                - preferred_term: AHR (human)
                  term:
                    id: UniProtKB:P35869
                    label: Aryl hydrocarbon receptor
            function:
              preferred_term: ligand-modulated transcription factor activity
              term:
                id: GO:0098531
                label: ligand-modulated transcription factor activity
            processes:
            - preferred_term: positive regulation of interleukin-10 production
              term:
                id: GO:0032733
                label: positive regulation of interleukin-10 production
            locations: *id001
            role_description: Myeloid AhR deletion causes autoimmunity; AhR binds the Il10
              promoter after efferocytosis. The ligand in this route is not identified.
            evidence:
            - source_id: PMID:29760532
              title: Apoptotic cell-induced AhR activity is required for immunological tolerance
                and suppression of systemic lupus erythematosus in mice and humans.
              statement: AhR occupies the Il10 promoter after efferocytosis.
              supporting_text: AhR association with the AhRE was enriched 13-fold in the Cyp1a1
                promoter and 7 fold in the Il10 promoter in Ap-BMDMs compared to resting BMDMs
        - id: methionine_dnmt3a_route
          label: 'Methionine route: DNMT3A, ERK and prostaglandin E2'
          module_type: SIGNALING_PATHWAY
          description: Methionine from the digested cell is made into S-adenosylmethionine
            by MAT2A. DNMT3A uses it to methylate and silence Dusp4, so ERK1/2 stays active
            after the initial receptor signal. Sustained ERK induces PTGS2, and the PGE2 it
            makes induces TGF-beta1. Responses to LPS, IFN-gamma and IL-4 are normal without
            DNMT3A.
          concepts:
          - preferred_term: positive regulation of transforming growth factor beta1 production
            term:
              id: GO:0032914
              label: positive regulation of transforming growth factor beta1 production
          annotons:
          - id: mat2a_sam
            label: MAT2A makes SAM from cargo methionine
            participant:
              selector_type: FAMILY
              family:
                preferred_term: MAT2A
                term:
                  id: PANTHER:PTHR11964:SF73
                  label: S-ADENOSYLMETHIONINE SYNTHASE ISOFORM TYPE-2
                representative_members:
                - preferred_term: Mat2a (mouse)
                  term:
                    id: UniProtKB:Q3THS6
                    label: S-adenosylmethionine synthase isoform type-2
                - preferred_term: MAT2A (human)
                  term:
                    id: UniProtKB:P31153
                    label: S-adenosylmethionine synthase isoform type-2
            function:
              preferred_term: methionine adenosyltransferase activity
              term:
                id: GO:0004478
                label: methionine adenosyltransferase activity
            processes:
            - preferred_term: S-adenosylmethionine biosynthetic process
              term:
                id: GO:0006556
                label: S-adenosylmethionine biosynthetic process
            role_description: Inhibitor and siRNA block the response; added SAM bypasses it.
              Labelled methionine from corpses becomes SAM only in macrophages that engulfed
              them.
            evidence:
            - source_id: PMID:35361955
              title: Macrophages use apoptotic cell-derived methionine and DNMT3A during efferocytosis
                to promote tissue resolution.
              statement: SAM made from cargo methionine needs phagolysosomal digestion.
              supporting_text: 13C515N-SAM was found only in AC+ macrophages and, importantly,
                this was markedly inhibited when phagolysosomal hydrolysis was blocked by
                bafilomycin
          - id: dnmt3a_methyltransferase
            label: DNMT3A silences Dusp4
            participant:
              selector_type: FAMILY
              family:
                preferred_term: DNMT3A
                term:
                  id: PANTHER:PTHR23068:SF10
                  label: DNA (CYTOSINE-5)-METHYLTRANSFERASE 3A
                representative_members:
                - preferred_term: Dnmt3a (mouse)
                  term:
                    id: UniProtKB:O88508
                    label: DNA (cytosine-5)-methyltransferase 3A
                - preferred_term: DNMT3A (human)
                  term:
                    id: UniProtKB:Q9Y6K1
                    label: DNA (cytosine-5)-methyltransferase 3A
            function:
              preferred_term: DNA (cytosine-5-)-methyltransferase activity
              term:
                id: GO:0003886
                label: DNA (cytosine-5-)-methyltransferase activity
            processes:
            - preferred_term: negative regulation of gene expression via chromosomal CpG island
                methylation
              term:
                id: GO:0044027
                label: negative regulation of gene expression via chromosomal CpG island methylation
            locations: *id001
            role_description: Hematopoietic deletion blocks COX2, PGE2, TGF-beta1 and resolution
              in three in vivo models. Knockdown of Dusp4 rescues the DNMT3A defect.
            evidence:
            - source_id: PMID:35361955
              title: Macrophages use apoptotic cell-derived methionine and DNMT3A during efferocytosis
                to promote tissue resolution.
              statement: DNMT3A methylates the Dusp4 promoter after efferocytosis.
              supporting_text: the CpG-rich promoter region of the Dusp4 gene was methylated
                in response to ACs in wild-type but not DNMT3A-deficient macrophages
            - source_id: PMID:35361955
              title: Macrophages use apoptotic cell-derived methionine and DNMT3A during efferocytosis
                to promote tissue resolution.
              statement: DNMT3A loss does not affect other macrophage activation pathways.
              supporting_text: control and DNMT3A-KO macrophages, or macrophages treated with
                scrambled RNA or siDnmt3a, responded similarly to LPS
          - id: dusp4_phosphatase
            label: DUSP4 ERK phosphatase (silenced)
            participant:
              selector_type: FAMILY
              family:
                preferred_term: DUSP4
                term:
                  id: PANTHER:PTHR10159:SF111
                  label: DUAL SPECIFICITY PROTEIN PHOSPHATASE 4
                representative_members:
                - preferred_term: Dusp4 (mouse)
                  term:
                    id: UniProtKB:Q8BFV3
                    label: Dual specificity protein phosphatase 4
                - preferred_term: DUSP4 (human)
                  term:
                    id: UniProtKB:Q13115
                    label: Dual specificity protein phosphatase 4
            function:
              preferred_term: MAP kinase tyrosine/serine/threonine phosphatase activity
              term:
                id: GO:0017017
                label: MAP kinase tyrosine/serine/threonine phosphatase activity
            locations: *id001
            role_description: Limits ERK activity. Its silencing lets ERK stay active; its
              knockdown rescues DNMT3A loss.
          - id: ptgs2_cox2
            label: PTGS2 makes prostaglandin H2 for PGE2
            participant:
              selector_type: FAMILY
              family:
                preferred_term: PTGS2 (COX2)
                term:
                  id: PANTHER:PTHR11903:SF8
                  label: PROSTAGLANDIN G_H SYNTHASE 2
                representative_members:
                - preferred_term: Ptgs2 (mouse)
                  term:
                    id: UniProtKB:Q05769
                    label: Prostaglandin G/H synthase 2
                - preferred_term: PTGS2 (human)
                  term:
                    id: UniProtKB:P35354
                    label: Prostaglandin G/H synthase 2
            function:
              preferred_term: prostaglandin-endoperoxide synthase activity
              term:
                id: GO:0004666
                label: prostaglandin-endoperoxide synthase activity
            processes:
            - preferred_term: prostaglandin biosynthetic process
              term:
                id: GO:0001516
                label: prostaglandin biosynthetic process
            locations:
            - preferred_term: endoplasmic reticulum membrane
              term:
                id: GO:0005789
                label: endoplasmic reticulum membrane
            role_description: Induced by sustained ERK. Its knockdown or inhibition blocks
              TGF-beta1 induction; added PGE2 restores it.
  - order: 2
    role: interpretation gate
    optional: true
    node:
      id: chloride_sensing_gate
      label: Chloride sensing sets the anti-inflammatory reading
      module_type: REGULATORY_STEP
      description: Corpse uptake lowers cytosolic chloride. The WNK1-OSR1/SPAK kinases activate
        the chloride importer SLC12A2, and chloride influx limits further uptake and is needed
        for the corpse to be read as anti-inflammatory. Without SLC12A2, phagocytes switch
        to a pro-inflammatory programme even though they eat more; phagocytes made to eat
        more by TIM4 overexpression do not switch.
      annotons:
      - id: slc12a2_chloride_import
        label: SLC12A2 chloride importer
        participant:
          selector_type: FAMILY
          family:
            preferred_term: SLC12A2 (NKCC1)
            term:
              id: PANTHER:PTHR11827:SF58
              label: SOLUTE CARRIER FAMILY 12 MEMBER 2
            representative_members:
            - preferred_term: Slc12a2 (mouse)
              term:
                id: UniProtKB:P55012
                label: Solute carrier family 12 member 2
            - preferred_term: SLC12A2 (human)
              term:
                id: UniProtKB:P55011
                label: Solute carrier family 12 member 2
        function:
          preferred_term: sodium:potassium:chloride symporter activity
          term:
            id: GO:0008511
            label: sodium:potassium:chloride symporter activity
        locations:
        - preferred_term: plasma membrane
          term:
            id: GO:0005886
            label: plasma membrane
        role_description: Gate on the anti-inflammatory reading. Deletion or knockdown increases
          uptake and flips the response to pro-inflammatory; re-expression reverses this.
        evidence:
        - source_id: PMID:31792382
          title: Interpreting an apoptotic corpse as anti-inflammatory involves a chloride
            sensing pathway.
          statement: Loss of SLC12A2 increases corpse uptake.
          supporting_text: targeted deletion of Slc12a2 via CRISPR/Cas9 or siRNA-mediated
            knockdown in LR73 phagocytes resulted in significantly enhanced uptake of apoptotic
            corpses
        - source_id: PMID:31792382
          title: Interpreting an apoptotic corpse as anti-inflammatory involves a chloride
            sensing pathway.
          statement: The pro-inflammatory flip is not caused by eating more.
          supporting_text: Despite eating more corpses, the TIM4-overexpressing phagocytes
            did not show upregulation of pro-inflammatory signature genes, contrasting with
            Slc12a2-deficient phagocytes
        notes: Most mechanism is in hamster LR73 fibroblasts; macrophage evidence is mostly
          uptake phenotypes and inhibitors.
      - id: wnk1_chloride_sensor
        label: WNK1 chloride-sensing kinase
        participant:
          selector_type: FAMILY
          family:
            preferred_term: WNK1
            term:
              id: PANTHER:PTHR13902
              label: SERINE/THREONINE-PROTEIN KINASE WNK  WITH NO LYSINE -RELATED
            representative_members:
            - preferred_term: Wnk1 (mouse)
              term:
                id: UniProtKB:P83741
                label: Serine/threonine-protein kinase WNK1
            - preferred_term: WNK1 (human)
              term:
                id: UniProtKB:Q9H4A3
                label: Serine/threonine-protein kinase WNK1
        function:
          preferred_term: protein serine/threonine kinase activity
          term:
            id: GO:0004674
            label: protein serine/threonine kinase activity
        role_description: Upstream kinase of OSR1/SPAK and SLC12A2. Gene deletion only in
          LR73 cells; in macrophages only a pan-WNK inhibitor.
        notes: Treat as provisional in macrophages.
  connections:
  - source: lxr_alpha
    target: lxr_target_mertk
    connection_type: POSITIVELY_REGULATES
    description: LXR binds an LXR response element in the Mertk promoter.
  - source: lxr_beta
    target: lxr_target_mertk
    connection_type: POSITIVELY_REGULATES
  - source: risp_complex_iii
    target: sirt1_deacetylase
    connection_type: POSITIVELY_REGULATES
    description: Complex III activity raises NAD+, which SIRT1 uses.
  - source: sirt1_deacetylase
    target: pbx1_tf
    connection_type: POSITIVELY_REGULATES
    description: Needed for PBX1 occupancy of the IL-10 promoter; direct deacetylation of
      PBX1 is not shown.
  - source: slc36a4_trp_export
    target: ido1_dioxygenase
    connection_type: PROVIDES_INPUT_FOR
    description: Exported tryptophan is the IDO1 substrate.
  - source: ido1_dioxygenase
    target: ahr_trp_route
    connection_type: POSITIVELY_REGULATES
    description: Kynurenine activates AhR.
  - source: tlr9_dna_sensor
    target: ahr_dna_route
    connection_type: POSITIVELY_REGULATES
  - source: mat2a_sam
    target: dnmt3a_methyltransferase
    connection_type: PROVIDES_INPUT_FOR
    description: SAM is the methyl donor.
  - source: dnmt3a_methyltransferase
    target: dusp4_phosphatase
    connection_type: NEGATIVELY_REGULATES
    description: Promoter methylation silences Dusp4.
  - source: dusp4_phosphatase
    target: ptgs2_cox2
    connection_type: NEGATIVELY_REGULATES
    description: DUSP4 ends ERK signalling that induces Ptgs2.
  - source: wnk1_chloride_sensor
    target: slc12a2_chloride_import
    connection_type: POSITIVELY_REGULATES
    description: Through OSR1 and SPAK.
knowledge_gaps:
- gap_statement: The AhR ligand produced downstream of TLR9 after efferocytosis is unknown.
  boundary: TLR9 and corpse DNA are needed for AhR activation, but DNA is not an AhR ligand
    and the IDO1-kynurenine route was not needed in this system.
  gap_kind:
  - BIOLOGY
  dark_aspect: MF_DARK
  status: OPEN
  significance: The DNA route has no defined chemical link between TLR9 and AhR.
  resolution: Metabolite profiling of TLR9-dependent AhR ligands in efferocytosing Ido1-/-
    macrophages, with AhR binding assays.
  provenance:
  - reference_id: PMID:29760532
    supporting_text: we could observe Cyp1a1 mRNA induction by sqPCR analysis in Ap-BMDMs
      treated with the IDO inhibitor 1MT (Supplementary Fig. 3c) or in Ido1−/− Ap-BMDMs
