In contrast, the lncRNA growth arrest-specific 5 (GAS5) exerts inhibitory effects on ABCA1 function through its interaction with and stabilization of the enhancer of zeste homolog 2 (EZH2), a chromatin-repressive complex known to promote trimethylation of lysine 27 (H3K27) at the
Abca1 promoter
[30][38]. Notably, a significant elevation in GAS5 levels was detected in the serum of patients with coronary heart disease, exhibiting a correlation with heightened proinflammatory markers
[31][39].
2.3. LncRNAs That Regulate Macrophage Apoptosis, Pyroptosis, or Autophagy in Atherosclerosis
Cellular processes such as apoptosis, pyroptosis, and autophagy need to be balanced with macrophage proliferation. Disruption of the balance may destabilize atherosclerotic plaques. Apoptotic cell death, especially in overstimulated or exhausted foam cells, can enhance inflammation and trigger blood clot formation, which may lead to heart attack or stroke
[16][17][18,19].
LncRNAs that inhibit apoptosis tend to aggravate atherogenesis
[32][33][34][35][36][53,60,61,62,63]. By suppressing apoptosis, macrophages are allowed to proliferate and promote plaque formation. In addition to inhibiting apoptosis, lncRNAs such as taurine-upregulated gene 1 (TUG1) and X-inactive specific transcript (XIST) enhance inflammation via fibroblast growth factor 1 and Toll-like receptor 4 (TLR4), respectively
[33][34][60,61]. LncRNAs associated with the progression and intervention of atherosclerosis (RAPIA) and smooth-muscle-induced lncRNA (SMILR) also inhibit apoptosis and enhance atherosclerosis by regulating cellular receptor integrin beta 1 (ITGB1) and a transcription factor, Krueppel-like factor 5 (KLF5), respectively
[35][36][62,63].
The progression of atherosclerosis may also be aggravated by defects in a process known as efferocytosis, the clearance of apoptotic cells by macrophages. Simion et al., detected high-level expression of a macrophage-associated atherosclerotic lncRNA sequence (MAARS) in the aortic intima of atherogenic animal models, and it decreased with the regression of atherosclerosis. Knockdown experiments indicated that MAARS promotes macrophage apoptosis, thereby inhibiting efferocytosis, through its interaction with HuR (ELAVL1), an RNA-binding protein with an apoptosis regulator function
[37][57]. Another lncRNA, MI-associated transcript (MIAT), directly affects efferocytosis
[38][55]. Its expression has been detected in the serum of patients with advanced atherosclerosis and necrotic core macrophages.
2.4. LncRNAs Functioning via Exosomes in Atherogenesis
Many studies have indicated that exosomes can be used as carriers of lncRNA to regulate cellular activities of neighboring cells. The upregulation of lnc-MRGPRF-6:1 expression and as its correlation with levels of proinflammatory mediators have been detected in the plasma exosomes of patients with CAD
[39][67]. The expression level of lnc-MRGPRF-6:1 following M1 induction was higher than that following M2 induction in THP-1 cells. The knockout of
lnc-MRGPRF-6:1 reduced ROS generation, lipid accumulation, and subsequent foam cell formation. Furthermore,
lnc-MRGPRF-6:1 knockout in human monocyte-derived macrophages suppressed M1 marker and inflammatory cytokine expression and enhanced M2 marker expression by modulating the TLR4/myeloid differentiation primary response 88 (MyD88)/mitogen-activated protein kinase (MAPK) signaling pathway
[39][67].
2.5. Multiple Function of MALAT1 in Atherogenesis
The lncRNA metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) affects multiple atherosclerotic processes, such as foam cell formation and macrophage apoptosis, autophagy, and pyroptosis (
Figure 12). Treating THP-1 cells with oxLDL upregulated MALAT1 expression in a nuclear factor kappa-light-chain-enhancer of activated B cell (NF-κB)-dependent manner
[40][41][43,45]. MALAT1 enhanced lipid uptake by inducing CD36 expression by recruiting β-catenin to its binding sites on the CD36 promoter
[41][45]. MALAT1 also enhanced NF-κB activation and, subsequently, foam cell formation, apoptosis, and inflammation via sponging miR-330-5p
[40][43].
However, there are reports of an opposite role played by MALAT1 in atherosclerosis. For instance, in an apolipoprotein E (
apoE)-knockout mouse model,
MALAT1 deficiency accelerated inflammation and atherosclerosis. Treating
MALAT1-deficient BMDMs with LPS enhanced TNF-α and inducible nitric oxide synthase expression, suppressed matrix metalloproteinase-9 expression, and impaired phagocytic activity
[42][44].
3. Sepsis
Blood monocytes/macrophages and endothelial cells lining the blood vessels respond to gram-negative bacteria infiltration by releasing a flood of chemicals, including cytokines, into circulation to fight the infection. Macrophages can remove pathogens by phagocytosis and regulate the extent of sepsis by producing anti-inflammatory cytokines. However, the production of excess inflammatory cytokines, such as IL-6, IL-1β, and especially TNF-α, may damage the surrounding normal tissues and organs, which can be life-threatening
[43][44][70,71]. As observed in other diseases, the proinflammatory activity of M1 macrophages aggravates sepsis, whereas the anti-inflammatory activity of M2 macrophages mitigates it
[45][72].
3.1. NEAT1 Enhances Sepsis Progression through Promoting Inflammation
Previous studies have found a considerable increase in NEAT1 levels in serum of patients with sepsis and septic mouse models
[46][47][48][49][73,74,75,76]. These studies agree that NEAT1 is involved in the inflammatory activation of macrophages; however, the targets of its action differ. In THP-1 cells, LPS-induced NEAT1 expression enhances inflammatory responses by modulating the miR-17-5p/TLR4 axis
[49][76]. LPS-stimulated Kupffer or RAW264.7 cells exhibit the expression of NEAT1, which exerts its proinflammatory activities through the Let-7q/TLR4 axis
[46][73]. Other studies have reported that NEAT1 promotes inflammation in LPS-treated RAW264.7 cells by modulating the miR-495-3p/signal transducer and activator of transcription 3 (STAT3), miR-211/phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT), miR-370-3p/thrombospondin-1, or miR-31-5p/POU domain, class 2, transcription factor 1 (POU2F1) axes
[47][48][50][74,75,77].
3.2. MALAT1 Promotes M1 Polarization and Inflammation in Sepsis
An increase in lncRNA MALAT1 levels was detected in the serum of late-onset sepsis patients and in activated primary macrophages and macrophage cell lines
[51][79].
MALAT1-knockout mice exhibited reduced inflammation and death upon sepsis induction. Particularly, suppressing MALAT1 expression increased the antioxidant capacity of macrophages through the methyltransferase 16 (METTL16)/methionine adenosyltransferase 2 A (MAT2A) axis, wherein MALAT1 binds to METTL16, thereby stabilizing the METTL16 N6-methyladenosine (m6A) modification activity
[51][79]. MAT2A regulates cellular metabolism and catalyzes S-adenosylmethionine production
[52][80]. Intraperitoneal LPS injection in mice induces septic lung injury, substantially increasing MALAT1 expression in lung tissues. Additional intravenous MALAT1-specific small interfering RNA (siRNA) injection reduces the number of inflammatory cells and cytokine levels in the bronchoalveolar lavage fluid (BALF) of these animal models by inhibiting the p38 MAPK/p65 NF-κB signaling pathway
[53][81]
However, a few studies have reported different observations regarding the role of MALAT1. For instance, Yang et al., reported a significant decrease in MALAT1 serum levels and an increase in hsa-miR-346 levels in patients with sepsis. Activated RAW264.7 cells also exhibit reduced expression of MALAT1. Additional experiments demonstrated that MALAT1 regulates macrophage proliferation through the hsa-miR-346/small mothers against decapentaplegic homolog 3 (SMAD3) axis
[54][83]. SMAD3 is a receptor-regulated signaling adaptor activated by serine kinases.
3.3. Other lncRNAs Involved in Sepsis Development
LPS-induced NF-κB activation in THP-1 cells and the subsequent release of proinflammatory cytokines were shown to be regulated by lncRNA colorectal neoplasia differentially expressed (CRNDE) via the miR-181-5p/TLR4 axis. A considerable increase in CRNDE expression levels and decrease in miR-181-5p expression levels have been detected in the peripheral blood of patients with sepsis.