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210   Principles and Methods

        represent another material type that has undergone some toxicity test-
        ing [11]. Water-soluble, monodisperse or colloidal fullerene aggregates
        induce O -anions, lipid peroxidation in cells and tissue as well as the
                 2
        ability to affect GSH depletion and cytotoxicity [23]. In vitro incubation
        of keratinocytes and bronchial epithelial cells with relatively high doses
        of single-wall carbon nanotubes (SWNT) results in ROS generation,
        lipid peroxidation, oxidative stress, mitochondrial dysfunction, and
        changes in cell morphology [24,25]. MWNT also elicits pro-inflammatory
        effects in keratinocytes [26].


        Oxidative stress elicits quantifiable
        cellular responses that can be used
        to study NM toxicity
        Cells respond to oxidative stress by mounting a number of protective and
        injurious responses that, depending on the stress level, can lead to a pro-
        tected or an injurious outcome [7, 11]. The protective responses are
        elicited by even minor changes in the cellular redox equilibrium. This
        sensitivity is rooted in the behavior of the cap ’n’ collar transcription
        factor, Nrf-2, that operates on the antioxidant response element (ARE)
        in the promoter of > 200 phase II enzymes [27]. These phase II enzymes
        exert antioxidant, detoxification and anti-inflammatory effects that are
        responsible for preventing or slowing the effects of oxidant injury [27].
        Examples of phase II enzymes include HO-1, glutathione-S-transferase,
        NADPH quinone oxidoreductase, catalase, superoxide dismutase, glu-
        tathione peroxidase, and UDP-glucoronosyltransferase [27, 28].  A
        reduced or compromised phase II response promotes susceptibility to oxi-
        dant injury. In studies conducted in epithelial cells and macrophages,
        phase II enzyme expression is the most sensitive oxidative response
        parameter and has also been referred to as Tier 1 of the hierarchical
        oxidative stress response [29–31]. A higher level of oxidative stress can
        lead to a Tier 2 response, which is characterized by pro-inflammatory
        effects that follow the activation of intracellular signaling cascades,
        including the MAP kinase and NF- B signaling cascades [30–32]. These
        signaling cascades are responsible for the activation of a number of
        cytokines, chemokines, and adhesion molecules that play a role in local
        and systemic inflammatory responses [32–34]. The dynamic equilib-
        rium between the protective (Tier 1) and pro-inflammatory responses
        (Tier 2) determines the outcome of the oxidative stress response and the
        likelihood that this will lead to injury.
                                                               2+
          Tier 3 responses involve mitochondrial perturbation, Ca  flux, and
        activation of apoptosis pathways [21, 30, 32, 35]. Although the in vivo
        significance of the mitochondrial pathway is still under investigation,
        it has been demonstrated in tissue culture cells that ambient PM inter-
        feres in mitochondrial electron transfer, thereby leading to dissipation
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