Department of Dermatology, University of Münster, Münster, Germany.
Institute of Immunology, University of Münster, Münster, Germany.
Front Immunol. 2019 Aug 27;10:2028. doi: 10.3389/fimmu.2019.02028. eCollection 2019.
Uncontrolled inflammation is a leading cause of many clinically relevant diseases. Current therapeutic strategies focus mainly on immunosuppression rather than on the mechanisms of inflammatory resolution. Glucocorticoids (GCs) are still the most widely used anti-inflammatory drugs. GCs affect most immune cells but there is growing evidence for cell type specific mechanisms. Different subtypes of monocytes and macrophages play a pivotal role both in generation as well as resolution of inflammation. Activation of these cells by microbial products or endogenous danger signals results in production of pro-inflammatory mediators and initiation of an inflammatory response. GCs efficiently inhibit these processes by down-regulating pro-inflammatory mediators from macrophages and monocytes. On the other hand, GCs act on "naïve" monocytes and macrophages and induce anti-inflammatory mediators and differentiation of anti-inflammatory phenotypes. GC-induced anti-inflammatory monocytes have an increased ability to migrate toward inflammatory stimuli. They remove endo- and exogenous danger signals by an increased phagocytic capacity, produce anti-inflammatory mediators and limit T-cell activation. Thus, GCs limit amplification of inflammation by repressing pro-inflammatory macrophage activation and additionally induce anti-inflammatory monocyte and macrophage populations actively promoting resolution of inflammation. Further investigation of these mechanisms should lead to the development of novel therapeutic strategies to modulate undesirable inflammation with fewer side effects via induction of inflammatory resolution rather than non-specific immunosuppression.
失控的炎症是许多临床相关疾病的主要原因。目前的治疗策略主要集中在免疫抑制上,而不是炎症消退的机制上。糖皮质激素(GCs)仍然是应用最广泛的抗炎药物。GCs 影响大多数免疫细胞,但越来越多的证据表明存在细胞类型特异性机制。不同亚型的单核细胞和巨噬细胞在炎症的发生和消退中都起着关键作用。这些细胞被微生物产物或内源性危险信号激活后,会产生促炎介质并引发炎症反应。GCs 通过下调巨噬细胞和单核细胞中的促炎介质来有效抑制这些过程。另一方面,GCs 作用于“幼稚”的单核细胞和巨噬细胞,诱导抗炎介质并促使其分化为抗炎表型。GC 诱导的抗炎性单核细胞向炎症刺激物迁移的能力增强。它们通过增强吞噬能力来清除内源性和外源性危险信号,产生抗炎介质并限制 T 细胞的激活。因此,GC 通过抑制促炎巨噬细胞的激活来限制炎症的放大,并且通过诱导炎症消退,主动促进炎症的解决,从而减少了不必要的炎症反应,副作用也更少。进一步研究这些机制,应该可以开发出通过诱导炎症消退而非非特异性免疫抑制来调节不良炎症的新的治疗策略。
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