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Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine
Open accessAbstract
The host response to biomaterials has been studied for decades. Largely, the interaction of host immune cells, macrophages in particular, with implanted materials has been considered to be a precursor to granulation tissue formation, the classic foreign body reaction, and eventual encapsulation with associated negative impacts upon device functionality. However, more recently, it has been shown that macrophages, depending upon context dependent polarization profiles, are capable of affecting both detrimental and beneficial outcomes in a number of disease processes and in tissue remodeling following injury. Herein, the diverse roles played by macrophages in these processes are discussed in addition to the potential manipulation of macrophage effector mechanisms as a strategy for promoting site-appropriate and constructive tissue remodeling as opposed to deleterious persistent inflammation and scar tissue formation.
Overview
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TL;DR
This review argues that macrophages are not simply drivers of the foreign body reaction; their context-dependent M1/M2 polarization can determine whether injury or implanted biomaterials lead to scarring or constructive tissue remodeling. It proposes that biomaterial properties and regenerative strategies could be designed to steer macrophage phenotype toward M2-like, pro-repair states.
Key findings
- Macrophages are plastic and exist along an M1/M2 continuum rather than as fixed subsets. M1, or classically activated, macrophages are induced by IFNγ alone or with LPS/TNFα and are pro-inflammatory; M2, or alternatively activated, macrophages are induced by IL-4, IL-13, IL-10, immune complexes, glucocorticoids, or vitamin D3 and are associated with Th2-like, pro-repair responses. A timely M1-to-M2 switch appears necessary for functional remodeling, while failure to resolve polarization is linked to cancer, atherosclerosis, obesity/insulin resistance, periodontal disease, and fibrosis.
- In tissue remodeling, the default mammalian response to injury often ends in scar tissue. Skin wound healing showed early upregulation of a mixed M1/M2 gene cluster (11 M1 genes and 7 M2 genes) and later upregulation of a predominantly M2 cluster (1 M1 gene and 9 M2 genes). Skeletal muscle repair requires an M1-to-M2 transition; blocking M2-associated gene expression in a mouse necrotic muscle injury model produced highly fibrotic tissue and decreased myofiber size, whereas wild-type mice recovered. In spinal cord injury, a predominantly M1 response persisted, and M2-conditioned media improved neuronal survival and neurite extension compared with M1-conditioned media.
- Following biomaterial implantation, macrophage phenotype is associated with outcome. Retrieved periprosthetic tissues from loose total joint replacements with osteolysis showed predominantly M1 macrophages, while synovium from osteoarthritic joints treated by primary joint replacement showed more M2 macrophages. Porous synthetic implants with 30–40 mm pores healed with less fibrosis, greater vascularity, and higher M2/M1 ratios than non-porous controls. Extracellular matrix scaffolds promoted a switch from predominantly M1 cells immediately after implantation to an M2-enriched population by 7–14 days; crosslinking that delayed degradation inhibited the M2 response and led to scar tissue.
- Adipose tissue macrophages illustrate disease-associated polarization shifts: they can make up as much as 10% of cells in lean tissue and as much as 40% in obese tissue, with M2-like cells in lean states and strongly M1-like cells in obesity.
Methods
- Narrative review, not a primary study; no new experiments, systematic search, or meta-analysis are described.
- The paper synthesizes literature on macrophage biology, disease pathogenesis, tissue remodeling after injury, and host responses to biomaterials, using selected examples from animal models, human tissue retrieval studies, and in vitro work.
- Main analysis is conceptual and thematic, organizing evidence around M1/M2 polarization, plasticity, and the potential for biomaterials to modulate macrophage phenotype.
Limitations
- Stated: the exact factors and mechanisms controlling macrophage differentiation and polarization switching are not fully identified; few studies have specifically evaluated macrophage polarization after biomaterial implantation; further studies are needed to define M1/M2 involvement in conditions such as periodontal disease and to develop strategies for controlling phenotype.
- Evident: as a narrative review, the selection of examples is not systematic and no quantitative synthesis is provided; many cited findings come from animal models or in vitro systems, which limits direct clinical generalizability.
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In the paper
“it has been shown that macrophages, depending upon context dependent polarization profiles, are capable of affecting both detrimental and beneficial outcomes in a number of disease processes and in tissue remodeling following injury.”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > Abstract
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Rests on an assumption: The ultimate functional success or failure of implantable materials is a function of the host tissue response and associated remodeling at each anatomical site.
In the paper
“Rather, macrophage phenotype has been described as occurring along a continuum between the M1 and M2 extremes [12].”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 2. Macrophages > 2.1. Macrophage polarization
What the sources say
- Not checked yetcites [12] Mosser, 2008, Exploring the full spectrum of macrophage activation, Nat Rev Immunol source
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In the paper
“Macrophages, like the monocytes from which they derive, are a heterogeneous cell population each with different markers and functions [1,8–12].”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 2. Macrophages > 2.1. Macrophage polarization
What the sources say
- Not checked yetcites [1] Gordon, 2005, Monocyte and macrophage heterogeneity, Nat Rev Immunol source
- Not checked yetcites [8] Mantovani, 2004, The chemokine system in diverse forms of macrophage activation and polarization, Trends Immunol source
- Not checked yetcites [9] Mantovani, 2002, Macrophage polarization: tumor-associated macrophages as a paradigm for polarized M2 mononuclear phagocytes, Trends Immunol source
- Not checked yetcites [10] Mills, 2000, M-1/M-2 macrophages and the Th1/Th2 paradigm, J Immunol source
- Not checked yetcites [11] Mosser, 2003, The many faces of macrophage activation, J Leukoc Biol source
- Not checked yetcites [12] Mosser, 2008, Exploring the full spectrum of macrophage activation, Nat Rev Immunol source
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In the paper
“Now commonly described as “smoldering inflammation”, these observations have led to a well-established link between inflammatory cells, macrophages in particular, and cancer [34–36].”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 3. The role of macrophage polarization in disease and tissue remodeling > 3.1. The role of macrophage polarization in the pathogenesis of disease
What the sources say
- Not checked yetcites [34] Balkwill, 2005, Smoldering and polarized inflammation in the initiation and promotion of malignant disease, Cancer Cell source
- Not checked yetcites [35] Mantovani, 2010, Macrophages, innate immunity and cancer: balance, tolerance, and diversity, Curr Opin Immunol source
- Not checked yetcites [36] Sica, 2008, Macrophage polarization in tumour progression, Semin Cancer Biol source
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In the paper
“This “extrinsic pathway” is initially characterized by a chronic pro-inflammatory environment resulting from a persistent microbial infection, autoimmune disease, or other etiology of unknown origin [37,38].”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 3. The role of macrophage polarization in disease and tissue remodeling > 3.1. The role of macrophage polarization in the pathogenesis of disease
What the sources say
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In the paper
“Thus, early tumor development is, in many cases, characterized by a polarized inflammatory, M1-like, environment.”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 3. The role of macrophage polarization in disease and tissue remodeling > 3.1. The role of macrophage polarization in the pathogenesis of disease
What the sources say
Strength:hedged· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesThe paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Similarly, cells exposed to M2 polarizing signals can be readily induced to express genes characteristic of an M1 phenotype by exposure to LPS or IFNγ.”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 2. Macrophages > 2.2. Macrophage plasticity
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In the paper
“Similar to cancer, atherosclerosis has an etiology that has, for many years, been recognized to include the involvement an inflammatory cell population, in particular macrophages [45–47].”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 3. The role of macrophage polarization in disease and tissue remodeling > 3.1. The role of macrophage polarization in the pathogenesis of disease
What the sources say
- Not checked yetcites [45] Johnson, 2009, Macrophage heterogeneity in atherosclerotic plaques, Curr Opin Lipidol source
- Not checked yetcites [46] Moore, 2011, Macrophages in the pathogenesis of atherosclerosis, Cell source
- Not checked yetcites [47] Mantovani, 2009, Macrophage diversity and polarization in atherosclerosis: a question of balance, Arterioscler Thromb Vasc Biol source
Strength:boosted· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIn the paper
“As will be discussed in the section which follows, dysregulation of macrophage phenotype and the inability to resolve polarized M1 or M2 states and return to tissue specific baselines is increasingly recognized to have an important role in chronic inflammatory and disease states, as well as adverse tissue remodeling following injury [31].”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 2. Macrophages > 2.2. Macrophage plasticity
What the sources say
- Not checked yetcites [31] Nathan, 2010, Nonresolving inflammation, Cell source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesThe paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“These changes are dependent upon the type, concentration and duration of the polarizing signals.”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 2. Macrophages > 2.2. Macrophage plasticity
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The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Macrophages assume diverse and context dependent phenotypes, which are defined by their functional properties and patterns of gene expression.”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 2. Macrophages > 2.1. Macrophage polarization
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
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In the paper
“These studies indicate that macrophages possess remarkable functional plasticity and, therefore, can play both positive and negative roles in the pathogenesis of disease and tissue remodeling.”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 1. Introduction
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Rests on an assumption: The ultimate functional success or failure of implantable materials is a function of the host tissue response and associated remodeling at each anatomical site.
In the paper
“Broadly, polarized macrophages are referred to as having either an M1 or an M2 phenotype, mimicking the Th1/Th2 nomenclature which has been described for T helper cells [10].”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 2. Macrophages > 2.1. Macrophage polarization
What the sources say
- Not checked yetcites [10] Mills, 2000, M-1/M-2 macrophages and the Th1/Th2 paradigm, J Immunol source
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In the paper
“In general, M1 activated macrophages express interleukin (IL)-12high, IL-23high, IL-10low; metabolize arginine, produce high levels of inducible nitric oxide synthase (iNOS); secrete toxic reactive oxygen and nitric oxygen intermediates and inflammatory cytokines such as IL-1β, IL-6, and TNFα; and are inducer and effector cells in Th1 type inflammatory responses.”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 2. Macrophages > 2.1. Macrophage polarization
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In the paper
“While the term ‘M2’ encompasses all non-classically activated macrophages, M2 macrophages have been shown to include three well recognized sub-populations (M2a, M2b, and M2c), each with its own distinct inducers, markers, and functions.”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 2. Macrophages > 2.1. Macrophage polarization
What the sources say
- Not checked yetcites [8] Mantovani, 2004, The chemokine system in diverse forms of macrophage activation and polarization, Trends Immunol source
- Not checked yetcites [12] Mosser, 2008, Exploring the full spectrum of macrophage activation, Nat Rev Immunol source
- Not checked yetcites [13] Gordon, 2003, Alternative activation of macrophages, Nat Rev Immunol source
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In the paper
“It has been shown that unlike lymphocytes, where cellular phenotype is relatively fixed upon differentiation, macrophages have dynamic and plastic phenotypes that change with local microenvironmental signals [5,14–16].”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 2. Macrophages > 2.2. Macrophage plasticity
What the sources say
- Not checked yetcites [5] Sunderkotter, 2004, Subpopulations of mouse blood monocytes differ in maturation stage and inflammatory response, J Immunol source
- Not checked yetcites [14] Stout, 2009, Functional plasticity of macrophages: in situ reprogramming of tumor-associated macrophages, J Leukoc Biol source
- Not checked yetcites [15] Porcheray, 2005, Macrophage activation switching: an asset for the resolution of inflammation, Clin Exp Immunol source
- Not checked yetcites [16] Stout, 2005, Macrophages sequentially change their functional phenotype in response to changes in microenvironmental influences, J Immunol source
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The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“M2 activated macrophages express IL-12low, IL-23low, and IL-10high; have high levels of scavenger, mannose, and galactose receptors; produce arginase in the place of arginine, subsequently producing ornithine and polyamines; and are involved in polarized Th2 reactions.”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 2. Macrophages > 2.1. Macrophage polarization
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In the paper
“M1, or “classically activated” pro-inflammatory macrophages are induced by interferon (IFN)γ alone or in combination with lipopolysaccharide (LPS, endotoxin) or tumor necrosis factor (TNF)α.”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 2. Macrophages > 2.1. Macrophage polarization
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This profile leads to an inability to mount a tumor-destructive Th1 type response while also driving the recruitment and development of T-regulatory cells (T-regs) and leading to a more tumor-permissive environment.”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 3. The role of macrophage polarization in disease and tissue remodeling > 3.1. The role of macrophage polarization in the pathogenesis of disease
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In the paper
“Interestingly, TAMs are found largely within hypoxic regions of tumors and have been shown drive the angiogenic response that is required for tumor survival and metastasis [40,41].”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 3. The role of macrophage polarization in disease and tissue remodeling > 3.1. The role of macrophage polarization in the pathogenesis of disease
What the sources say
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In the paper
“These cells, termed “tumor associated macrophages” (TAM), are characterized by production of large amounts of IL-10, low production of inflammatory cytokines and reactive oxygen intermediates, and poor antigen presenting capabilities.”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 3. The role of macrophage polarization in disease and tissue remodeling > 3.1. The role of macrophage polarization in the pathogenesis of disease
What the sources say
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In the paper
“The chronic production of large quantities of inflammatory mediators in these cases can lead, through a number of pathways, to tumor cell proliferation and survival or to the induction of genetic instabilities in normal cells, with resultant expression of oncogenes and production of immune suppressive cytokines [37,38].”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 3. The role of macrophage polarization in disease and tissue remodeling > 3.1. The role of macrophage polarization in the pathogenesis of disease
What the sources say
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In the paper
“A number of recent studies have begun to assess the polarization profile of plaque infiltrating macrophages, suggesting that the initial infiltrating population in early atherosclerosis is heterogeneous, but possesses a predominantly M2-like phenotype [28,45].”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 3. The role of macrophage polarization in disease and tissue remodeling > 3.1. The role of macrophage polarization in the pathogenesis of disease
What the sources say
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In the paper
“For example, in vitro experiments have shown that LPS stimulated, classically activated macrophages, become Toll-like receptor (TLR)-tolerant and unable to produce similarly elevated levels of pro-inflammatory cytokines upon second exposure to LPS [16–18].”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 2. Macrophages > 2.2. Macrophage plasticity
What the sources say
- Not checked yetcites [16] Stout, 2005, Macrophages sequentially change their functional phenotype in response to changes in microenvironmental influences, J Immunol source
- Not checked yetcites [17] Biswas, 2009, Endotoxin tolerance: new mechanisms, molecules and clinical significance, Trends Immunol source
- Not checked yetcites [18] Foster, 2007, Gene-specific control of inflammation by TLR-induced chromatin modifications, Nature source
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In the paper
“Specifically, STAT1 and IRF5 have been shown to be involved in polarization and maintenance of an M1 phenotype while STAT6, IRF4, CREB-C/EBPβ, and PPARγ are involved in polarization and maintenance of an M2 phenotype [23–30].”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 2. Macrophages > 2.2. Macrophage plasticity
What the sources say
- Not checked yetcites [23] Darnell, 1994, Jak-STAT pathways and transcriptional activation in response to IFNs and other extracellular signaling proteins, Science source
- Not checked yetcites [24] Ruffell, 2009, A CREB-C/EBPbeta cascade induces M2 macrophage-specific gene expression and promotes muscle injury repair, Proc Natl Acad Sci USA source
- Not checked yetcites [25] Satoh, 2010, The Jmjd3-Irf4 axis regulates M2 macrophage polarization and host responses against helminth infection, Nat Immunol source
- Not checked yetcites [26] Takeda, 1996, Essential role of Stat6 in IL-4 signalling, Nature source
- Not checked yetcites [27] Ohmori, 1997, IL-4-induced STAT6 suppresses IFN-gamma-stimulated STAT1-dependent transcription in mouse macrophages, J Immunol source
- Not checked yetcites [28] Bouhlel, 2007, PPARgamma activation primes human monocytes into alternative M2 macrophages with anti-inflammatory properties, Cell Metab source
- Not checked yetcites [29] Odegaard, 2007, Macrophage-specific PPARgamma controls alternative activation and improves insulin resistance, Nature source
- Not checked yetcites [30] Savitsky, 2010, Regulation of immunity and oncogenesis by the IRF transcription factor family, Cancer Immunol Immunother source
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In the paper
“That is, macrophages can play both beneficial and detrimental roles in the process of tissue remodeling and, in many cases, an efficient and timely phenotypic switch is essential for appropriate and functional remodeling as opposed to a deleterious or scar tissue outcome with a loss of function.”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 3. The role of macrophage polarization in disease and tissue remodeling > 3.2. The role of macrophage polarization in tissue remodeling
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“Overall, a complex multifactorial etiology of periodontal disease including the host immune response and environmental factors has been suggested likely involving multiple cell types [78].”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 3. The role of macrophage polarization in disease and tissue remodeling > 3.1. The role of macrophage polarization in the pathogenesis of disease
What the sources say
- Not checked yetcites [78] Cullinan, 2003, Acquisition and loss of Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans and Prevotella intermedia over a 5-year period: effect of a triclosan/copolymer dentifrice, J Clin Periodontol source
Strength:hedged· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“Foam cell macrophages exhibit a highly activated phenotype leading to production of pro-inflammatory mediators and MMPs that destabilize the plaques, potentially leading to thromboembolism [56].”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 3. The role of macrophage polarization in disease and tissue remodeling > 3.1. The role of macrophage polarization in the pathogenesis of disease
What the sources say
- Not checked yetcites [56] Newby, 2005, Dual role of matrix metalloproteinases (matrixins) in intimal thickening and atherosclerotic plaque rupture, Physiol Rev source
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In the paper
“Importantly, periodontal disease has been shown to have many mechanistic parallels and links to the pathogenic processes of atherosclerosis and obesity [69].”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 3. The role of macrophage polarization in disease and tissue remodeling > 3.1. The role of macrophage polarization in the pathogenesis of disease
What the sources say
- Not checked yetcites [69] Zelkha, 2010, Periodontal innate immune mechanisms relevant to atherosclerosis and obesity, Periodontol 2000 source
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In the paper
“The default response to tissue injury has been described as occurring in four stages: hemostasis, inflammation, proliferation, and remodeling [86].”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 3. The role of macrophage polarization in disease and tissue remodeling > 3.2. The role of macrophage polarization in tissue remodeling
What the sources say
- Not checked yetcites [86] Diegelmann, 2004, Wound healing: an overview of acute, fibrotic and delayed healing, Front Biosci source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“These cells are of a predominantly pro-inflammatory phenotype and secrete cytokines and chemokines that promote the further recruitment of leukocytes to the site of injury [89,91].”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 3. The role of macrophage polarization in disease and tissue remodeling > 3.2. The role of macrophage polarization in tissue remodeling
What the sources say
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In each case, the pathogenesis of disease results from inappropriate macrophage polarization, an inhibition of macrophage polarization, or an inability to resolve a chronic polarization towards the M1 or M2 extreme.”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 3. The role of macrophage polarization in disease and tissue remodeling > 3.2. The role of macrophage polarization in tissue remodeling
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
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In the paper
“A number of studies have shown that TLR-4 deficient mice are not protected from diet-induced obesity, but are protected from obesity-induced insulin resistance [74,76,77].”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 3. The role of macrophage polarization in disease and tissue remodeling > 3.1. The role of macrophage polarization in the pathogenesis of disease
What the sources say
- Not checked yetcites [74] Shi, 2006, TLR4 links innate immunity and fatty acid-induced insulin resistance, J Clin Invest source
- Not checked yetcites [76] Tsukumo, 2007, Loss-of-function mutation in Toll-like receptor 4 prevents diet-induced obesity and insulin resistance, Diabetes source
- Not checked yetcites [77] Saberi, 2009, Hematopoietic cell-specific deletion of toll-like receptor 4 ameliorates hepatic and adipose tissue insulin resistance in high-fat-fed mice, Cell Metab source
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In the paper
“In normal rodents and humans, ATMs make up as much as ten percent of the cellular constituents of the tissue [62]. In comparison, it has been shown that in obese subjects that number rises to as much as 40% [62].”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 3. The role of macrophage polarization in disease and tissue remodeling > 3.1. The role of macrophage polarization in the pathogenesis of disease
What the sources say
- Not checked yetcites [62] Weisberg, 2006, CCR2 modulates inflammatory and metabolic effects of high-fat feeding, J Clin Invest source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“Additionally, damage associated molecular pattern molecules, such as heat shock proteins, released from dead or dying adipocytes may signal through TLR pathways, producing activation of the NLRP3 inflammasome and promotion of a pro-inflammatory phenotype [75].”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 3. The role of macrophage polarization in disease and tissue remodeling > 3.1. The role of macrophage polarization in the pathogenesis of disease
What the sources say
- Not checked yetcites [75] Vandanmagsar, 2011, The NLRP3 inflammasome instigates obesity-induced inflammation and insulin resistance, Nat Med source
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“However, clodronate treatment was not shown to reduce the size of plaques that were already established prior to treatment, suggesting that such a treatment may be most effective in the early stages of disease progression [59].”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 3. The role of macrophage polarization in disease and tissue remodeling > 3.1. The role of macrophage polarization in the pathogenesis of disease
What the sources say
- Not checked yetcites [59] Stoneman, 2007, Monocyte/macrophage suppression in CD11b diphtheria toxin receptor transgenic mice differentially affects atherogenesis and established plaques, Circ Res source
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“These cells produce high levels of TNFα, IL-6, and IL-1β, all of which are also observed in increased levels of adipose tissue from insulin resistant individuals.”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 3. The role of macrophage polarization in disease and tissue remodeling > 3.1. The role of macrophage polarization in the pathogenesis of disease
What the sources say
- Not checked yetcites [63] Olefsky, 2010, Macrophages, inflammation, and insulin resistance, Annu Rev Physiol source
- Not checked yetcites [69] Zelkha, 2010, Periodontal innate immune mechanisms relevant to atherosclerosis and obesity, Periodontol 2000 source
- Not checked yetcites [70] Lumeng, 2007, Obesity induces a phenotypic switch in adipose tissue macrophage polarization, J Clin Invest source
- Not checked yetcites [71] Prieur, 2011, Differential lipid partitioning between adipocytes and tissue macrophages modulates macrophage lipotoxicity and M2/M1 polarization in obese mice, Diabetes source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Macrophages also remove apoptotic neutrophils, the phagocytosis of which may lead to a change toward a more reparative (M2) macrophage phenotype and the resolution of the inflammatory phase of wound healing [94–96].”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 3. The role of macrophage polarization in disease and tissue remodeling > 3.2. The role of macrophage polarization in tissue remodeling
What the sources say
- Not checked yetcites [94] Erwig, 2007, Immunological consequences of apoptotic cell phagocytosis, Am J Pathol source
- Not checked yetcites [95] Fadok, 1998, Regulation of macrophage cytokine production by phagocytosis of apoptotic and post-apoptotic cells, Biochem Soc Trans source
- Not checked yetcites [96] Sylvia, 2003, The role of neutrophil apoptosis in influencing tissue repair, J Wound Care source
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Studies in PPARγ deficient mice exhibit impaired M2 macrophage function and susceptibility to diet-induced inflammation and insulin resistance [29,65–67].”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 3. The role of macrophage polarization in disease and tissue remodeling > 3.1. The role of macrophage polarization in the pathogenesis of disease
What the sources say
- Not checked yetcites [29] Odegaard, 2007, Macrophage-specific PPARgamma controls alternative activation and improves insulin resistance, Nature source
- Not checked yetcites [65] Pascual, 2007, Macrophage peroxisome proliferator activated receptor gamma as a therapeutic target to combat Type 2 diabetes, Expert Opin Ther Targets source
- Not checked yetcites [66] Hevener, 2007, Macrophage PPAR gamma is required for normal skeletal muscle and hepatic insulin sensitivity and full antidiabetic effects of thiazolidinediones, J Clin Invest source
- Not checked yetcites [67] Norris, 2003, Muscle-specific PPARgamma-deficient mice develop increased adiposity and insulin resistance but respond to thiazolidinediones, J Clin Invest source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“These observations suggest that therapies which prevent the M2 to M1 switch or deplete M1 macrophages selectively may be of clinical utility for the stabilization of atherosclerotic plaques.”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 3. The role of macrophage polarization in disease and tissue remodeling > 3.1. The role of macrophage polarization in the pathogenesis of disease
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“These cells have been shown to possess a predominantly pro-inflammatory phenotype following injury, resulting in a microenvironment that is cytotoxic and propagates tissue damage and scar tissue deposition [128].”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 3. The role of macrophage polarization in disease and tissue remodeling > 3.2. The role of macrophage polarization in tissue remodeling
What the sources say
- Not checked yetcites [128] Kigerl, 2009, Identification of two distinct macrophage subsets with divergent effects causing either neurotoxicity or regeneration in the injured mouse spinal cord, J Neurosci source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“The results of the study showed that a predominantly M1 phenotype was induced immediately following injury and persisted within spinal cord lesions. A small number of M2 macrophages were also seen in the site of injury at early time points; however, these cells were not observed at later time points in the remodeling process, suggesting that the M1 to M2 phenotype shift does not occur in the same”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 3. The role of macrophage polarization in disease and tissue remodeling > 3.2. The role of macrophage polarization in tissue remodeling
What the sources say
- Not checked yetcites [128] Kigerl, 2009, Identification of two distinct macrophage subsets with divergent effects causing either neurotoxicity or regeneration in the injured mouse spinal cord, J Neurosci source
Load-bearingStrength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“It is interesting to note that diabetes and advanced age are also associated with delayed or impaired wound healing, and with a reduced ability to transition from an M1 to an M2 macrophage phenotype [63,108].”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 3. The role of macrophage polarization in disease and tissue remodeling > 3.2. The role of macrophage polarization in tissue remodeling
What the sources say
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Studies have also suggested that macrophage polarization may play an important role in the process of muscle wasting which occurs in models of muscular dystrophy [124,126,127].”
- Also stated in: § 3.2. The role of macrophage polarization in tissue remodeling · plain
“Unlike the normal process of muscle tissue remodeling, this environment is not characterized by a switch from M1 to M2. Rather, the mixed polarization state persists, constantly recruiting progenitor cells which then fail to differentiate along normal pathways resulting in ineffective remodeling and depletion of progenitor cell reserves within the tissue.”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 3. The role of macrophage polarization in disease and tissue remodeling > 3.2. The role of macrophage polarization in tissue remodeling
What the sources say
- Not checked yetcites [124] Villalta, 2011, Interleukin-10 reduces the pathology of mdx muscular dystrophy by deactivating M1 macrophages and modulating macrophage phenotype, Hum Mol Genet source
- Not checked yetcites [126] Villalta, 2009, Shifts in macrophage phenotypes and macrophage competition for arginine metabolism affect the severity of muscle pathology in muscular dystrophy, Hum Mol Genet source
- Not checked yetcites [127] Villalta, 2011, IFN-gamma promotes muscle damage in the mdx mouse model of Duchenne muscular dystrophy by suppressing M2 macrophage activation and inhibiting muscle cell proliferation, J Immunol source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- Also stated in: § 3.2. The role of macrophage polarization in tissue remodeling · plain
In the paper
“Of note, however, investigators identified two clusters of genes, associated with macrophage M1/ M2 polarization, which were upregulated transiently during the wound healing process.”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 3. The role of macrophage polarization in disease and tissue remodeling > 3.2. The role of macrophage polarization in tissue remodeling
What the sources say
- Not checked yetcites [105] Deonarine, 2007, Gene expression profiling of cutaneous wound healing, J Transl Med source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one. The quote only partly states this claim.
In the paper
“Briefly, the events that occur during skeletal muscle repair are thought to fall into three well defined stages including (1) proliferation, (2) early differentiation, and (3) terminal differentiation [110].”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 3. The role of macrophage polarization in disease and tissue remodeling > 3.2. The role of macrophage polarization in tissue remodeling
What the sources say
- Not checked yetcites [110] Le Grand, 2007, Skeletal muscle satellite cells and adult myogenesis, Curr Opin Cell Biol source
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“For example, IL-10 secreted by M2 macrophages is known both to drive a transition from an M1 to an M2 phenotype as well as to promote the fusion and maturation of myotubes [112,125].”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 3. The role of macrophage polarization in disease and tissue remodeling > 3.2. The role of macrophage polarization in tissue remodeling
What the sources say
- Not checked yetcites [112] Arnold, 2007, Inflammatory monocytes recruited after skeletal muscle injury switch into antiinflammatory macrophages to support myogenesis, J Exp Med source
- Not checked yetcites [125] Strle, 2007, Novel activity of an anti-inflammatory cytokine: IL-10 prevents TNFalpha-induced resistance to IGF-I in myoblasts, J Neuroimmunol source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“These cytokines include EGF, b-FGF, TGF-α, TGF-β, VEGF, and others depending on the nature of the injured tissue [86].”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 3. The role of macrophage polarization in disease and tissue remodeling > 3.2. The role of macrophage polarization in tissue remodeling
What the sources say
- Not checked yetcites [86] Diegelmann, 2004, Wound healing: an overview of acute, fibrotic and delayed healing, Front Biosci source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“The mechanisms of this switch from an M1 to an M2 phenotype during dermal remodeling are not well described, but are thought to include phenotypic changes caused by the phagocytosis of apoptotic cells and debris by M1 macrophages [94–96].”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 3. The role of macrophage polarization in disease and tissue remodeling > 3.2. The role of macrophage polarization in tissue remodeling
What the sources say
- Not checked yetcites [94] Erwig, 2007, Immunological consequences of apoptotic cell phagocytosis, Am J Pathol source
- Not checked yetcites [95] Fadok, 1998, Regulation of macrophage cytokine production by phagocytosis of apoptotic and post-apoptotic cells, Biochem Soc Trans source
- Not checked yetcites [96] Sylvia, 2003, The role of neutrophil apoptosis in influencing tissue repair, J Wound Care source
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“A number of studies have shown that reduction of the number of monocytes available to participate in the response following muscle injury via depletion of circulating cells results in slowed removal of cellular debris and delayed muscle tissue remodeling [112–114].”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 3. The role of macrophage polarization in disease and tissue remodeling > 3.2. The role of macrophage polarization in tissue remodeling
What the sources say
- Not checked yetcites [112] Arnold, 2007, Inflammatory monocytes recruited after skeletal muscle injury switch into antiinflammatory macrophages to support myogenesis, J Exp Med source
- Not checked yetcites [113] Summan, 2006, Macrophages and skeletal muscle regeneration: a clodronate-containing liposome depletion study, Am J Physiol Regul Integr Comp Physiol source
- Not checked yetcites [114] Tidball, 2007, Macrophages promote muscle membrane repair and muscle fibre growth and regeneration during modified muscle loading in mice in vivo, J Physiol source
Strength:boosted· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“Following the initial pro-inflammatory phase, a switch to an M2 macrophage phenotype and resolution of the inflammatory response has been shown to occur with the initial stages of differentiation of muscle satellite cells into differentiated skeletal muscle cells [123].”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 3. The role of macrophage polarization in disease and tissue remodeling > 3.2. The role of macrophage polarization in tissue remodeling
What the sources say
- Not checked yetcites [123] St Pierre, 1994, Differential response of macrophage subpopulations to soleus muscle reloading after rat hindlimb suspension, J Appl Physiol source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“That is, when placed into culture, muscle progenitor cells proliferate, express early markers of differentiation along a muscle phenotype (MyoD, Myf5), and then fuse and form mature myotubes with a contractile phenotype in the absence of immune cells or their secreted products [110].”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 3. The role of macrophage polarization in disease and tissue remodeling > 3.2. The role of macrophage polarization in tissue remodeling
What the sources say
- Not checked yetcites [110] Le Grand, 2007, Skeletal muscle satellite cells and adult myogenesis, Curr Opin Cell Biol source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“In vivo, however, the response following muscle tissue injury has been shown to include a significant number of infiltrating inflammatory cells which can exceed 100,000 cells/mm3 of tissue [111].”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 3. The role of macrophage polarization in disease and tissue remodeling > 3.2. The role of macrophage polarization in tissue remodeling
What the sources say
- Not checked yetcites [111] Wehling, 2001, A nitric oxide synthase transgene ameliorates muscular dystrophy in mdx mice, J Cell Biol source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“Following the deposition of significant amounts of ECM (predominantly collagens type I and III) during the proliferative phase, the remodeling phase of wound healing begins. This phase is characterized by MMP- and tissue inhibitor of metalloproteinase (TIMP)-mediated degradation and remodeling of the newly deposited collagen, generally resulting in scar tissue formation/maturation [86,100].”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 3. The role of macrophage polarization in disease and tissue remodeling > 3.2. The role of macrophage polarization in tissue remodeling
What the sources say
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“The transition to an M2 environment not only serves to attenuate the inflammatory response and potentially cytotoxic production of nitric oxide, but also to drive the differentiation and fusion of cells [114,124].”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 3. The role of macrophage polarization in disease and tissue remodeling > 3.2. The role of macrophage polarization in tissue remodeling
What the sources say
- Not checked yetcites [114] Tidball, 2007, Macrophages promote muscle membrane repair and muscle fibre growth and regeneration during modified muscle loading in mice in vivo, J Physiol source
- Not checked yetcites [124] Villalta, 2011, Interleukin-10 reduces the pathology of mdx muscular dystrophy by deactivating M1 macrophages and modulating macrophage phenotype, Hum Mol Genet source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“In this study it was shown that the deletion of two of the binding sites in the CREB-C/EBPβ pathway blocked the induction of M2 associated genes (Msr1, IL-10, IL-13ra, and Arg-1), while M1 gene (IL-1, IL-6, IL-12b, TNFα) expression was not affected.”
- Also stated in: § 3.2. The role of macrophage polarization in tissue remodeling · plain
“However, the tissue that formed within the site of remodeling was highly fibrotic and associated with a decrease in myofiber size. This result was in direct contrast to wild-type mice that exhibited full recovery of the injured muscle.”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 3. The role of macrophage polarization in disease and tissue remodeling > 3.2. The role of macrophage polarization in tissue remodeling
What the sources say
- Not checked yetcites [24] Ruffell, 2009, A CREB-C/EBPbeta cascade induces M2 macrophage-specific gene expression and promotes muscle injury repair, Proc Natl Acad Sci USA source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Also stated in: § 3.2. The role of macrophage polarization in tissue remodeling · plain
None of the sources cited for this claim have been checked yet.
In the paper
“However, it has also been shown that proinflammatory cytokines may inhibit muscle progenitor cell differentiation and that the reactive oxygen species that are produced by M1 cells (nitric oxide) can be cytotoxic if present in sufficient quantities, demonstrating the need for resolution of the proinflammatory response for muscle recovery to proceed beyond this initial stage [120–122].”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 3. The role of macrophage polarization in disease and tissue remodeling > 3.2. The role of macrophage polarization in tissue remodeling
What the sources say
- Not checked yetcites [120] Nguyen, 2003, Interactions between neutrophils and macrophages promote macrophage killing of rat muscle cells in vitro, J Physiol source
- Not checked yetcites [121] Szalay, 1997, TNF inhibits myogenesis and downregulates the expression of myogenic regulatory factors myoD and myogenin, Eur J Cell Biol
- Not checked yetcites [122] Tsujinaka, 1996, Interleukin 6 receptor antibody inhibits muscle atrophy and modulates proteolytic systems in interleukin 6 transgenic mice, J Clin Invest source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This phenotypic transition impairment suggests a potential, but as yet unexplored, link between defective macrophage polarization switching or disposition towards a pro-inflammatory phenotype and impaired tissue remodeling.”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 3. The role of macrophage polarization in disease and tissue remodeling > 3.2. The role of macrophage polarization in tissue remodeling
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This bimodal outcome scenario suggests that the default response following CNS injury is a chronic pro-inflammatory, M1 type response which leads to decreased viability of the neurons within the site of injury, and that induction of a more M2 type response may be capable of promoting a more constructive tissue remodeling type environment.”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 3. The role of macrophage polarization in disease and tissue remodeling > 3.2. The role of macrophage polarization in tissue remodeling
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“The byproducts of wear include particulate polymeric, ceramic and metallic debris (mostly in the nano, submicron, and micron size range) and in the case of metal-on-metal implants, metallic ions [143]. These byproducts are well known to cause pro-inflammatory responses which can persist for the life of the implant [144,145].”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 4. The role of macrophage polarization following biomaterial implantation > 4.1. The role of macrophage polarization following the implantation of long-term medical devices
What the sources say
- Not checked yetcites [143] Shanbhag, 1994, Composition and morphology of wear debris in failed uncemented total hip replacement, J Bone Jt Surg Br source
- Not checked yetcites [144] Goodman, 2007, Wear particles, periprosthetic osteolysis and the immune system, Biomaterials source
- Not checked yetcites [145] Ingham, 2005, The role of macrophages in osteolysis of total joint replacement, Biomaterials source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“Neurons which were exposed to media conditioned by M1 macrophages were shown to exhibit a decrease in viability as well as a decrease in neurite length, while those cells exposed to media conditioned by M2 macrophages showed improved survival and a greater degree of neurite extension.”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 3. The role of macrophage polarization in disease and tissue remodeling > 3.2. The role of macrophage polarization in tissue remodeling
What the sources say
- Not checked yetcites [128] Kigerl, 2009, Identification of two distinct macrophage subsets with divergent effects causing either neurotoxicity or regeneration in the injured mouse spinal cord, J Neurosci source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“Briefly, macrophages regulate the process of fibrosis through the production of cytokines which directly activate fibroblasts (TGF-β, PDGF, insulin like growth factor (IGF)-1), the production of MMPs and TIMPs which drive ECM remodeling, and M1 factors which drive a “feed-forward” state of inflammation and remodeling (IL-1b) [102].”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 3. The role of macrophage polarization in disease and tissue remodeling > 3.2. The role of macrophage polarization in tissue remodeling
What the sources say
- Not checked yetcites [102] Wynn, 2008, Cellular and molecular mechanisms of fibrosis, J Pathol source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“It was noted that those materials possessing pores of 30–40 mm healed with minimal fibrosis and the highest vascularity [149]. These pores were also found to be heavily infiltrated by macrophages, but not foreign body giant cells.”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 4. The role of macrophage polarization following biomaterial implantation > 4.2. The role of macrophage polarization following the implantation of materials in regenerative medicine
What the sources say
- Not checked yetcites [149] Fukano, 2010, Epidermal and dermal integration into sphere-templated porous poly(2-hydroxyethyl methacrylate) implants in mice, J Biomed Mater Res A source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“In the case of TJR, these processes result in periprosthetic bone resorption (osteolysis) which undermines the bony foundation of the implant and can lead to chronic synovitis, loosening and pathologic fracture [144].”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 4. The role of macrophage polarization following biomaterial implantation > 4.1. The role of macrophage polarization following the implantation of long-term medical devices
What the sources say
- Not checked yetcites [144] Goodman, 2007, Wear particles, periprosthetic osteolysis and the immune system, Biomaterials source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“It was also shown that the optimal time for injection of these cells was one week post-injury, suggesting that early M1 polarization may play a beneficial role in CNS remodeling following injury, similar to that observed in skeletal muscle [136].”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 3. The role of macrophage polarization in disease and tissue remodeling > 3.2. The role of macrophage polarization in tissue remodeling
What the sources say
- Not checked yetcites [136] Ziv, 2006, Synergy between immune cells and adult neural stem/progenitor cells promotes functional recovery from spinal cord injury, Proc Natl Acad Sci USA source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“While the specific mode of failure is highly context dependent, a major complication following the implantation of any material is the development of a foreign body reaction (FBR).”
- Also stated in: § 4.1. The role of macrophage polarization following the implantation of long-term medical devices · boosted
“The FBR consists of a set of well known and overlapping processes (reviewed in [141,142]) that result in the encapsulation of the material, thus isolating it from the surrounding tissues and, generally, negatively impacting the ability of the device to function as intended.”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 4. The role of macrophage polarization following biomaterial implantation > 4.1. The role of macrophage polarization following the implantation of long-term medical devices
What the sources say
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Also stated in: § 4.1. The role of macrophage polarization following the implantation of long-term medical devices · boosted
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“An increasing number of studies in the field of regenerative medicine have begun to apply these paradigms and concepts, and have shown that macrophage phenotype can be modulated by biomaterials with improved tissue remodeling and long-term functional outcomes as a result.”
§ Macrophage polarization: An opportunity for improved outcomes in biomaterials and regenerative medicine✰ > 5. Conclusions
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
The paper relies on this without support.
The ultimate functional success or failure of implantable materials is a function of the host tissue response and associated remodeling at each anatomical site.
“However, the ultimate functional success or failure of such materials is invariably a function of the host tissue response to the presence of the materials and the associated remodeling process at each anatomical site.”
The paper relies on this without support.
Surface structure, both topographical and chemical, are critically important determinants of downstream events at the material-tissue interface.
“Therefore, surface structure, both topographical and chemical, are critically important determinants of downstream events.”
The paper relies on this without support.
The specific factors and exact mechanisms controlling macrophage differentiation upon entering tissues have not been fully identified.
“However, the specific factors and exact mechanisms which control macrophage differentiation upon entering tissues have not yet been fully identified.”
The paper relies on this without support.
The M1/M2 paradigm provides a useful simplified framework for deciphering macrophage roles in disease and tissue remodeling.
“However, the M1/M2 paradigm provides a simplified framework from which to begin deciphering the complex and context dependent roles of macrophages in disease and tissue remodeling.”
The paper relies on this without support.
Manipulating macrophage effector mechanisms can promote site-appropriate constructive tissue remodeling rather than persistent inflammation and scar formation.
“Herein, the diverse roles played by macrophages in these processes are discussed in addition to the potential manipulation of macrophage effector mechanisms as a strategy for promoting site-appropriate and constructive tissue remodeling as opposed to deleterious persistent inflammation and scar tissue formation.”
The paper relies on this without support.
Few studies have assessed the role of specific macrophage sub-populations in dermal wound healing remodeling.
“However, despite the understanding that macrophages play an important and potentially determinant role in dermal wound healing, few studies to date have assessed the role of specific macrophage sub-populations in the remodeling process.”
The paper relies on this without support.
Every material used in implantable medical devices, tissue engineered constructs, or scaffold-based approaches will evoke a host response beginning immediately upon implantation.
“Every material used in implantable medical devices, tissue engineered constructs, or scaffold-based approaches to regenerative medicine will evoke a host response which begins immediately upon implantation.”
The paper relies on this without support.
Few studies have evaluated macrophage polarization specifically with respect to biomaterials implantation.
“However, few studies have evaluated macrophage polarization specifically with respect to biomaterials implantation.”
The paper relies on this without support.
In periprosthetic tissues from loose, revised implants with osteolysis, M1 macrophages predominate, whereas M2 macrophages are more prevalent in synovium from osteoarthritic joints treated by primary total joint replacement.
“In the former tissues, an M1 macrophage phenotype predominated, whereas M2 macrophages were more prevalent in the latter tissues, indicating that macrophage phenotype may play an important role in outcomes following TJR.”
The paper relies on this without support.
Exact strategies for eliciting an M2 response and the ability of such strategies to prevent osteolysis have yet to be explored.
“However, exact strategies for eliciting this type of response and the ability of such strategies to prevent osteolysis have yet to be explored.”
The paper relies on this without support.
Studies examining specific effects of macrophage polarization following implantation of synthetic or naturally derived biomaterials in regenerative medicine have been few.
“To date, studies examining the specific effects of macrophage polarization following implantation of synthetic or naturally derived biomaterials in regenerative medicine have been few.”
The paper relies on this without support.
Exact mechanisms underlying the observed responses of porous biomaterials remain largely unknown.
“Although the exact mechanisms which underlie the observed responses still remain largely unknown, such biomaterials mediated control of macrophage phenotype has significant implications for improving outcomes in regenerative medicine.”
The paper relies on this without support.
Mechanisms by which ECM-based scaffold materials promote M1 to M2 transition remain unknown.
“The mechanisms by which ECM based scaffold materials promote the M1 to M2 transition remain unknown.”
The paper relies on this without support.
Exact surface ligands responsible for macrophage-surface interactions have yet to be identified.
“While the exact surface ligands responsible have yet to be identified, a better understanding of macrophage-surface ligand interaction has significant potential to inform future biomaterial design and applications.”
The paper relies on this without support.
Exact contributions of specific M1 and M2 populations in fibrosis are not well defined.
“The exact contributions of specific M1 and M2 populations in fibrosis are not well defined.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Among several types of M2 macrophages, M2c macrophages are known to orchestrate matrix remodeling by releasing MMPs and TIMPs (tissue inhibitors of metalloproteinase)15,39.”
From Bioengineered liver crosslinked with nano-graphene oxide enables efficient liver regeneration via MMP suppression and immunomodulation (2023) · cites this paper as [15]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“circulating monocytes are also recruited into the tissues and differentiated into macrophages, which dictate both inflammatory responses and tissue remodeling in the implants12,15.”
From Bioengineered liver crosslinked with nano-graphene oxide enables efficient liver regeneration via MMP suppression and immunomodulation (2023) · cites this paper as [15]
In the citing paper
“In the context of biomaterial implantation, while the initial presence of M1 macrophages promotes a necessary inflammatory response, a prolonged M1 presence leads to a severe FBR, granuloma and fibrous encapsulation resulting in chronic inflammatory events and failure of biomaterial integration.”
From Biomaterial based modulation of macrophage polarization: a review and suggested design principles (2015) · cites this paper as [8]
In the citing paper
“Physical properties such as substrate stiffness, topography, pore size and size of wear debris; chemical properties such as surface chemistry, ligand presentation and release of growth factors; and temporal properties, such as degradation rates, all influence the behavior of cells [8,9].”
From Biomaterial based modulation of macrophage polarization: a review and suggested design principles (2015) · cites this paper as [8]
In the citing paper
“Therefore, a subsequent transition to the M2 phenotype -which promotes tissue remodeling and repair -is generally believed to be a favorable adaptation [8].”
From Biomaterial based modulation of macrophage polarization: a review and suggested design principles (2015) · cites this paper as [8]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
TLR-4 obesity claim conflicts with a cited reference
MinorThe text says TLR-4 deficiency does not protect against diet-induced obesity, but the title of cited reference 76 says a TLR-4 loss-of-function mutation prevents it.
“A number of studies have shown that TLR-4 deficient mice are not protected from diet-induced obesity, but are protected from obesity-induced insulin resistance [74,76,77].”
“76. Tsukumo DM Carvalho-Filho MA Carvalheira JB Prada PO Hirabara SM Schenka AA Loss-of-function mutation in Toll-like receptor 4 prevents diet-induced obesity and insulin resistance Diabetes 2007 56 1986 1998 17519423 10.2337/db06-1595”
Citations
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“However, the inducers and characteristics of M1 and M2 (including M2a, M2b, M2c) macrophages have been reviewed in depth elsewhere [8,12,13].”
BackgroundMizgerd, J. P., Kubo, H., Kutkoski, G. J., Bhagwan, S. D., Scharffetter-Kochanek, K., Beaudet, A. L., & Doerschuk, C. M. (1997) · The Journal of Experimental Medicine · doi:10.1084/jem.186.8.1357 · Cited by 7,332
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“However, the inducers and characteristics of M1 and M2 (including M2a, M2b, M2c) macrophages have been reviewed in depth elsewhere [8,12,13].”
BackgroundAlternative activation of macrophages
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“However, the inducers and characteristics of M1 and M2 (including M2a, M2b, M2c) macrophages have been reviewed in depth elsewhere [8,12,13].”
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Metadata
- Authors
- Brown, B. N., Ratner, B. D., Goodman, S. B., Amar, S., & Badylak, S. F.
- Affiliations
- University of Pittsburgh (US)
- University of Washington (US)
- Stanford Medicine (US)
- Boston University (US)
- Corresponding author
- Badylak, Stephen F.
- Venue
- Biomaterials
- Publisher
- Elsevier BV
- Published
- 2012-05
- Volume
- 33
- Issue
- 15
- Pages
- 3792-3802
- ISSN
- 0142-9612 (ISSN-L)
- PMC
- PMC3727238
- OpenAlex
- W2055901626
- Cited by
- 926
- References
- 166
- Citations by year
- 2026: 53 · 2025: 53 · 2024: 69 · 2023: 63 · 2022: 77 · 2021: 98 · 2020: 84 · 2019: 64 · 2018: 68 · 2017: 82 · 2016: 65 · 2015: 52 · 2014: 54 · 2013: 33 · 2012: 9
- FWCI
- 4.36
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Biomaterials (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Touro Scholar (Touro College) (submittedVersion)
- Funders
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01AR063717, R01AR055650)
- Topics
- Life Sciences › Immunology and Microbiology › Immunology › Immune cells in cancer
- Health Sciences › Medicine › Surgery › Tissue Engineering and Regenerative Medicine
- Health Sciences › Medicine › Surgery › Wound Healing and Treatments
- Keywords
- macrophage polarization, foreign body reaction, granulation tissue, tissue remodeling, scar formation, chronic inflammation, regenerative medicine, biomaterial implantation
- MeSH terms
- Animals, Biocompatible Materials, Humans, Macrophages, Cell Polarity, Treatment Outcome, Prostheses and Implants, 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.
A language model drew the claims from the paper on 2026-10-06, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-06 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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