Mezouar Soraya, Mege Jean-Louis
Centre National de la Recherche Scientifique, Établissement Français du Sang, Anthropologie Bio-Culturelle, Droit, Éthique et Santé, Aix-Marseille University, Marseille, France.
Faculty of Medical and Paramedical Sciences, Aix-Marseille University, HIPE Human Lab, Marseille, France.
Rev Med Virol. 2025 May;35(3):e70034. doi: 10.1002/ird3.70006.
The concept of macrophage polarization has been largely used in human diseases to define a typology of activation of myeloid cells reminiscent of lymphocyte functional subsets. In COVID-19, several studies have investigated myeloid compartment dysregulation and macrophage polarization as an indicator of disease prognosis and monitoring. SARS-CoV-2 induces an in vitro activation state in monocytes and macrophages that does not match the polarization categories in most studies. In COVID-19 patients, monocytes and macrophages are activated but they do not show a polarization profile. Therefore, the investigation of polarization under basic conditions was not relevant to assess monocyte and macrophage activation. The analysis of monocytes and macrophages with high-throughput methods has allowed the identification of new functional subsets in the context of COVID-19. This approach proposes an innovative stratification of myeloid cell activation. These new functional subsets of myeloid cells would be better biomarkers to assess the risk of complications in COVID-19, reserving the concept of polarization for pharmacological programme evaluation. This review reappraises the polarization of monocytes and macrophages in viral infections, particularly in COVID-19.
巨噬细胞极化的概念在很大程度上已被用于人类疾病，以定义一种类似于淋巴细胞功能亚群的髓系细胞激活类型。在新冠肺炎中，多项研究调查了髓系细胞区室失调和巨噬细胞极化情况，以此作为疾病预后和监测的指标。严重急性呼吸综合征冠状病毒2（SARS-CoV-2）在单核细胞和巨噬细胞中诱导出一种体外激活状态，这在大多数研究中与极化类别不匹配。在新冠肺炎患者中，单核细胞和巨噬细胞被激活，但它们并未呈现极化特征。因此，在基础条件下对极化的研究与评估单核细胞和巨噬细胞激活无关。采用高通量方法对单核细胞和巨噬细胞进行分析，已能够在新冠肺炎背景下识别出新的功能亚群。这种方法提出了一种创新的髓系细胞激活分层方式。这些新的髓系细胞功能亚群将是评估新冠肺炎并发症风险的更好生物标志物，而将极化概念保留用于药理学方案评估。本综述重新评估了病毒感染，尤其是新冠肺炎中单核细胞和巨噬细胞的极化情况。
