Promoting tissue regeneration by modulating the immune system
Open accessAbstract
The immune system plays a central role in tissue repair and regeneration. Indeed, the immune response to tissue injury is crucial in determining the speed and the outcome of the healing process, including the extent of scarring and the restoration of organ function. Therefore, controlling immune components via biomaterials and drug delivery systems is becoming an attractive approach in regenerative medicine, since therapies based on stem cells and growth factors have not yet proven to be broadly effective in the clinic. To integrate the immune system into regenerative strategies, one of the first challenges is to understand the precise functions of the different immune components during the tissue healing process. While remarkable progress has been made, the immune mechanisms involved are still elusive, and there is indication for both negative and positive roles depending on the tissue type or organ and life stage. It is well recognized that the innate immune response comprising danger signals, neutrophils and macrophages modulates tissue healing. In addition, it is becoming evident that the adaptive immune response, in particular T cell subset activities, plays a critical role. In this review, we first present an overview of the basic immune mechanisms involved in tissue repair and regeneration. Then, we highlight various approaches based on biomaterials and drug delivery systems that aim at modulating these mechanisms to limit fibrosis and promote regeneration. We propose that the next generation of regenerative therapies may evolve from typical biomaterial-, stem cell-, or growth factor-centric approaches to an immune-centric approach. STATEMENT OF SIGNIFICANCE: Most regenerative strategies have not yet proven to be safe or reasonably efficient in the clinic. In addition to stem cells and growth factors, the immune system plays a crucial role in the tissue healing process. Here, we propose that controlling the immune-mediated mechanisms of tissue repair and regeneration may support existing regenerative strategies or could be an alternative to using stem cells and growth factors. The first part of this review we highlight key immune mechanisms involved in the tissue healing process and marks them as potential target for designing regenerative strategies. In the second part, we discuss various approaches using biomaterials and drug delivery systems that aim at modulating the components of the immune system to promote tissue regeneration.
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Several studies reported that MSC-derived exosomes efficiently suppressed detrimental immune response in inflamed tissues, and promoted the survival and regeneration of injured cells.
“Several studies reported that MSC-derived exosomes efficiently suppressed detrimental immune response in inflamed tissues, and promoted the survival and regeneration of injured cells [[73], [74], [75]].”
From Exosome-functionalized magnesium-organic framework-based scaffolds with osteogenic, angiogenic and anti-inflammatory properties for accelerated bone regeneration. (2022) · cites this paper as [75]
Section 3.5, “Extracellular vesicles” (page unavailable), reports that MSC-derived exosomes inhibit macrophage activation and suppress inflammation in a mouse model, supporting the immune-suppression part of the claim. It also reports reduced liver fibrosis, but does not establish that the exosomes promoted the survival and regeneration of injured cells. (LLM, conf=0.84)
Experimental — accuracy not yet measuredHIF-1α is a key factor in suppressing mitochondrial biogenesis and PGC-1α expression through negative regulation of MYC and MYC-dependent transcription factors (PPARs and ERRs) that activate the PGC-1α gene.
“HIF-1α is also a key factor in suppressing mitochondrial biogenesis and PGC-1α expression through mechanisms of negative regulation of the transcription factor MYC and the MYC-dependent transcription factors (PPARs and ERRs) that activate the PGC-1α gene [14,86,87].”
From Protective Effects of PGC-1α Activators on Ischemic Stroke in a Rat Model of Photochemically Induced Thrombosis (2021) · cites this paper as [87]
The passages from §§2.3 and 3.4.3 discuss immune-cell activity and inflammatory signaling, not the proposed mitochondrial mechanism. Searches of the full-text copy for HIF-1α, PGC-1α, mitochondrial biogenesis, and MYC found no passage addressing the claim. (LLM, conf=0.76)
Experimental — accuracy not yet measuredImprovement of microcirculation and penumbral tissue oxygenation mediated by Mexidol and Semax may be crucial to reverse the HIF-1α-dependent blockade of PGC-1α expression.
“Improvement of microcirculation and penumbral tissue oxygenation mediated by the drugs Mexidol and Semax may be crucial to reverse the HIF-1α-dependent blockade of PGC-1α expression [14,86,87].”
From Protective Effects of PGC-1α Activators on Ischemic Stroke in a Rat Model of Photochemically Induced Thrombosis (2021) · cites this paper as [87]
The supplied passages and further searches for Mexidol, Semax, penumbral oxygenation, HIF-1α, and PGC-1α found no discussion of the claimed drug effects or expression mechanism. The closest passages, in §§3.4 and 3.6 (page numbers unavailable), concern immune-mediated tissue repair rather than this claim. (LLM, conf=0.76)
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Self-citation
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“Improvement of microcirculation and penumbral tissue oxygenation mediated by the drugs Mexidol and Semax may be crucial to reverse the HIF-1α-dependent blockade of PGC-1α expression [14,86,87].”
Background
- Authors
- Julier, Z., Park, A. J., Briquez, P. S., & Martino, M. M.
- Affiliations
- Australian Regenerative Medicine Institute (AU)
- University of Chicago (US)
- Corresponding author
- Martino, Mikaël M.
- Venue
- Acta Biomaterialia
- Publisher
- Elsevier BV
- Published
- 2017-04
- Volume
- 53
- Pages
- 13-28
- ISSN
- 1742-7061 (ISSN-L)
- OpenAlex
- W2580555388
- Cited by
- 766
- References
- 217
- Citations by year
- 2026: 57 · 2025: 83 · 2024: 96 · 2023: 81 · 2022: 108 · 2021: 131 · 2020: 86 · 2019: 75 · 2018: 37 · 2017: 8 · 2016: 2
- FWCI
- 7.66
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Acta Biomaterialia (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Funders
- Astellas Foundation for Research on Metabolic Disorders
- Topics
- Health Sciences › Medicine › Rehabilitation › Wound Healing and Treatments
- Health Sciences › Medicine › Surgery › Tissue Engineering and Regenerative Medicine
- Health Sciences › Medicine › Urology › Periodontal Regeneration and Treatments
- Keywords
- tissue regeneration, tissue repair, immunomodulation, fibrosis, innate immune response, adaptive immune response, T cells, macrophages, neutrophils, damage-associated molecular patterns, biomaterials, drug delivery systems, regenerative medicine
- MeSH terms
- Alarmins, Animals, Biocompatible Materials, Dendritic Cells, Humans, Immunity, Innate, Leukocytes, Mast Cells, Regeneration, Wound Healing, Wounds and Injuries, Drug Delivery Systems, Inflammation Mediators, Pericytes, Myeloid Cells, Regenerative Medicine
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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