Cited by 3,051Immune Response and InflammationInflammasome and immune disordersInflammation biomarkers and pathways

The DOI matches its Crossref record; 127 of the 128 references it cites were found in a registry or an index; none of the 207 sources its claims cite is checked for support yet.

Sterile inflammation: sensing and reacting to damage

Open access
Chen, Grace Y., Nuñez, Gabriel·2010·Nature Reviews Immunology

Abstract

Over the past several decades, much has been revealed about the nature of the host innate immune response to microorganisms, with the identification of pattern recognition receptors (PRRs) and pathogen-associated molecular patterns, which are the conserved microbial motifs sensed by these receptors. It is now apparent that these same PRRs can also be activated by non-microbial signals, many of which are considered as damage-associated molecular patterns. The sterile inflammation that ensues either resolves the initial insult or leads to disease. Here, we review the triggers and receptor pathways that result in sterile inflammation and its impact on human health.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

Sterile inflammation is triggered when endogenous damage-associated molecular patterns (DAMPs) released by injured or necrotic cells activate the same pattern recognition receptors (PRRs) that sense microbial pathogens, notably TLRs, the NLRP3 and AIM2 inflammasomes, and C-type lectins. The review argues that IL-1 (particularly IL-1α and IL-1β) is a central mediator of these responses and a promising therapeutic target across gout, atherosclerosis, type 2 diabetes and cancer.

Key findings

  • DAMPs are endogenous molecules normally sequestered intracellularly (HMGB1, HSPs, ATP, uric acid) or generated by extracellular matrix degradation (hyaluronan, heparan sulphate, biglycan) that become immunostimulatory when released by necrosis; their relative importance and redundancy remain unresolved — uric acid depletion reduced neutrophil recruitment after acetaminophen-induced liver injury in two mouse models but had no effect in particulate-induced inflammation.
  • NLRP3 is activated by structurally diverse sterile stimuli (asbestos, silica, MSU and CPPD crystals, cholesterol crystals, β-amyloid fibrils); NLRP3-deficient mice showed decreased inflammation in gout, asbestosis and silicosis models, and LDL-receptor-deficient mice infused with NLRP3-deficient bone marrow had lower IL-1β, smaller atherosclerotic lesions and less neutrophilic infiltration.
  • Three proposed mechanisms of NLRP3 activation — ATP/P2RX7, lysosomal damage with cathepsin B, and ROS — are each supported only partially, with contradictory data (e.g., TXNIP-deficient macrophages showed impaired IL-1β in one study but no difference in another; p22phox- or Gp91phox-deficient macrophages had normal caspase 1 activation).
  • Therapeutic blockade of IL-1R with anakinra produced significant symptom relief in all ten evaluated gout patients who could not tolerate or respond to prior therapy, and improved glucose and reduced IL-6 and C-reactive protein in a randomized trial of 70 patients with type 2 diabetes; results in osteoarthritis and rheumatoid arthritis were not promising.

Methods

  • Narrative review (not a primary study) synthesizing the literature on sterile inflammation, its triggers, receptor pathways and disease implications.
  • Evidence drawn from in vitro and in vivo mouse models (including knockout and bone marrow chimera studies) and human clinical trials, organized around three proposed mechanisms: PRR activation by DAMPs, release of intracellular cytokines such as IL-1α, and direct activation via non-PRR receptors such as RAGE.
  • No new data, systematic search strategy or meta-analysis is reported.

Limitations

  • Stated by the paper: it is unclear whether DAMPs identified by in vitro cytokine induction (HSPs, S100 proteins, ATP) actually drive sterile inflammation in vivo; stimulatory activity of some purified DAMPs may reflect bacterial product contamination (HSPs and HMGB1 bind LPS); many DAMPs interact with several receptors, so the significance of individual interactions is unresolved; the relative importance and possible redundancy of individual DAMPs is unknown; the relevance of ROS and TXNIP in NLRP3 activation in vivo remains unclear and contested; whether RAGE and other non-PRRs have a primary or secondary role in human disease is unknown; and the clinical studies cited (10 gout patients; 70 type 2 diabetes patients) were small and not designed to determine optimal dosing, duration or long-term outcomes.
  • Evident from the text: the review is largely built on mouse models, and the authors repeatedly note that human relevance for NLRP3 in type 2 diabetes, RAGE in atherosclerosis and Alzheimer's disease, and CLEC4E/CLEC9A in sterile inflammation remains to be determined.

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Integrity signals

Registry

Crossref · 10.1038/nri2873

Cites

127 of 127 references verified0 citation errors · 0 not checkable

Statistics

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Verification

Claims the paper makes

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Show all 119 claims

  • Probably not a substantial claim. 10
  • It may state two separate claims as one. 55
61 of 61
  • The paper relies on this without support.

    Sterile inflammation is marked by the recruitment of neutrophils and macrophages and the production of pro-inflammatory cytokines and chemokines, notably tumour necrosis factor (TNF) and interleukin-1 (IL-1).

    “Similar to microbially induced inflammation, sterile inflammation is marked by the recruitment of neutrophils and macrophages and the production of pro-inflammatory cytokines and chemokines, notably tumour necrosis factor (TNF) and interleukin-1 (IL-1).”
  • The paper relies on this without support.

    DAMPs are endogenous factors that are normally sequestered intracellularly and are therefore hidden from recognition by the immune system under normal physiological conditions.

    “A common feature of DAMPs is that they are endogenous factors that are normally sequestered intracellularly and are therefore hidden from recognition by the immune system under normal physiological conditions.”
  • The paper relies on this without support.

    Under conditions of cellular stress or injury, DAMPs can be released into the extracellular environment by dying cells and trigger inflammation under sterile conditions.

    “However, under conditions of cellular stress or injury, these molecules can then be released into the extracellular environment by dying cells and trigger inflammation under sterile conditions.”
  • The paper relies on this without support.

    The type of cell death affects its immunogenicity and its ability to release immunostimulatory DAMPs.

    “The type of cell death notably affects its immunogenicity and ability to release immunostimulatory DAMPs.”
  • The paper relies on this without support.

    Secretion of IL-1β by inflammatory cells is largely dependent on a multiprotein complex termed the inflammasome, of which the hallmark activity is the activation of caspase 1.

    “The secretion of IL-1β by inflammatory cells is largely dependent on a multiprotein complex termed the inflammasome, of which the hallmark activity is the activation of caspase 1.”
  • The authors state this as an assumption.

    The three proposed mechanisms by which sterile endogenous stimuli trigger inflammation are not necessarily mutually exclusive.

    “based on our current understanding, we propose three, not necessarily mutually exclusive, mechanisms by which sterile endogenous stimuli trigger inflammation:”
6 of 6

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Metadata

Authors
Chen, G. Y., & Nuñez, G.
Affiliations
University of Michigan (US)
Venue
Nature Reviews Immunology
Published
2010-11-19
Volume
10
Issue
12
Pages
826-837
ISSN
  • 1474-1733 (ISSN-L)
  • 1474-1741
OpenAlex
W2042851093
Cited by
3,051
References
128
Citations by year
2026: 150 · 2025: 141 · 2024: 186 · 2023: 199 · 2022: 224 · 2021: 245 · 2020: 248 · 2019: 190 · 2018: 231 · 2017: 209 · 2016: 198 · 2015: 193 · 2014: 207 · 2013: 164 · 2012: 148
FWCI
10.93
Type
journal article
Language
en
Open access
Locations
  • Nature reviews. Immunology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Amgen
  • National Cancer Institute (CA133185, K08CA133185)
  • National Institute of Allergy and Infectious Diseases (R01AI063331, AI06331)
  • National Institute of Diabetes and Digestive and Kidney Diseases (DK 61707, DK091191, R01DK061707, R01DK091191)
  • National Institute of Arthritis and Musculoskeletal and Skin Diseases (AR 051790, R01AR059688, AR059688)
Topics
  • Life Sciences › Immunology and Microbiology › Immunology › Immune Response and Inflammation
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Inflammasome and immune disorders
  • Life Sciences › Immunology and Microbiology › Immunology › Inflammation biomarkers and pathways
Keywords
sterile inflammation, damage-associated molecular patterns, pattern recognition receptors, pathogen-associated molecular patterns, innate immune response, inflammation resolution, inflammatory diseases
MeSH terms
Animals, Diabetes Mellitus, Type 2, Humans, Immunity, Innate, Inflammation, Signal Transduction, Reperfusion Injury, Cytokines, Reactive Oxygen Species, Inflammation Mediators, Receptors, Pattern Recognition, Mice

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