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Karen Bedard and Karl-Heinz Krause

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250 KAREN BEDARD AND KARL-HEINZ KRAUSE<br />

of other cytosolic factors, hence its designation as “organizer<br />

subunit.” The localization of p47 phox to the membrane<br />

brings the “activator subunit” p67 phox into contact<br />

with NOX2 (342) <strong>and</strong> also brings the small subunit p40 phox<br />

to the complex. Finally, the GTPase Rac interacts with<br />

NOX2 via a two-step mechanism involving an initial direct<br />

interaction with NOX2 (214), followed by a subsequent<br />

interaction with p67 phox (476, 508). Once assembled, the<br />

complex is active <strong>and</strong> generates superoxide by transferring<br />

an electron from NADPH in the cytosol to oxygen on<br />

the luminal or extracellular space.<br />

NOX2 can be regarded as a transmembrane redox<br />

chain that connects the electron donor (Fig. 1), NADPH<br />

on the cytosolic side of the membrane with the electron<br />

acceptor, oxygen on the outer side of the membrane. It<br />

transfers electrons through a series of steps involving a<br />

flavin adenine dinucleotide (FAD), binding to amino acids<br />

337HPFTLSA <strong>and</strong> 355IRIVGD (917) <strong>and</strong> two assymetrical<br />

hemes found in transmembrane domains III <strong>and</strong> V, with<br />

the inner heme binding to histidines H101 <strong>and</strong> H209 <strong>and</strong><br />

the outer heme binding to histidine H115 <strong>and</strong> H222 (262).<br />

In the first step, electrons are transferred from<br />

NADPH to FAD, a process that is regulated by the activation<br />

domain of p67 phox (658). NOX2 is selective for<br />

NADPH over NADH as a substrate, with K m values of<br />

40–45 �M versus 2.5 mM, respectively (160). In the second<br />

step, a single electron is transferred from the reduced<br />

flavin FADH 2 to the iron center of the inner heme. Since<br />

the iron of the heme can only accept one electron, the<br />

inner heme must donate its electron to the outer heme<br />

before the second electron can be accepted from the now<br />

partially reduced flavin, FADH. The force for the transfer<br />

of the second electron, while smaller (31 vs. 79 mV), is<br />

Physiol Rev VOL 87 JANUARY 2007 www.prv.org<br />

FIG. 3. Assembly of the phagocyte NADPH oxidase<br />

NOX2. The phagocyte NADPH oxidase was the first identified<br />

<strong>and</strong> is the best studied member of the NOX family. It<br />

is highly expressed in granulocytes <strong>and</strong> monocyte/macrophages<br />

<strong>and</strong> contributes to killing of microbes. In resting<br />

neutrophil granulocytes, NOX2 <strong>and</strong> p22 phox are found primarily<br />

in the membrane of intracellular vesicles. They<br />

exist in close association, costabilizing one another. Upon<br />

activation, there is an exchange of GDP for GTP on Rac<br />

leading to its activation. Phosphorylation of the cytosolic<br />

p47 phox subunit leads to conformational changes allowing<br />

interaction with p22 phox . The movement of p47 phox brings<br />

with it the other cytoplasmic subunits, p67 phox <strong>and</strong><br />

p40 phox , to form the active NOX2 enzyme complex. Once<br />

activated, there is a fusion of NOX2-containing vesicles<br />

with the plasma membrane or the phagosomal membrane.<br />

The active enzyme complex transports electrons from<br />

cytoplasmic NADPH to extracellular or phagosomal oxygen<br />

to generate superoxide (O 2 � ).<br />

still energetically favorable. However, the transfer of the<br />

electron from the inner heme to the outer heme is actually<br />

against the electromotive force between these two<br />

groups. To create an energetically favorable state, oxygen<br />

must be bound to the outer heme to accept the electron<br />

(175, 223, 917).<br />

NOX2 was first described in neutrophils <strong>and</strong> macrophages<br />

<strong>and</strong> is often referred to as the phagocyte NADPH<br />

oxidase. NOX2 is still widely considered to have a very<br />

limited, essentially phagocyte-specific tissue expression<br />

(e.g., Ref. 844), yet when tissue distribution of total mRNA<br />

from various organs is investigated, NOX2 appears to be<br />

among the most widely distributed among the NOX isoforms<br />

(Table 2). It is described in a large number of<br />

tissues, including thymus, small intestine, colon, spleen,<br />

pancreas, ovary, placenta, prostate, <strong>and</strong> testis (143).<br />

Mostly this wide tissue distribution is due to the presence<br />

of phagocytes <strong>and</strong>/or blood contamination in the tissues<br />

from which total mRNA has been extracted. However,<br />

there is now also increasing evidence at both the message<br />

<strong>and</strong> the protein level for expression of NOX2 in nonphagocytic<br />

cells, including neurons (806), cardiomyocytes<br />

(372), skeletal muscle myocytes (426), hepatocytes<br />

(739), endothelial cells (313, 434, 538), <strong>and</strong> hematopoietic<br />

stem cells (704).<br />

In phagocytes, NOX2 localizes to both intracellular<br />

<strong>and</strong> plasma membranes in close association with the<br />

membrane protein p22 phox (97, 394). In resting neutrophils,<br />

most of the NOX2 localizes to intracellular compartments,<br />

in particular secondary (i.e., specific) granules (26,<br />

97, 439) <strong>and</strong> tertiary (i.e., gelatinase-containing) granules<br />

(465). Upon phagocyte stimulation, there is a translocation<br />

of NOX2 to the surface as the granules fuse with the<br />

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