Drugging the efferocytosis process: concepts and opportunities

Mehrotra, Parul; Ravichandran, Kodi S.

doi:10.1038/s41573-022-00470-y

Cited by 459Phagocytosis and Immune RegulationCell death mechanisms and regulationAutophagy in Disease and Therapy

Drugging the efferocytosis process: concepts and opportunities

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Mehrotra, Parul, Ravichandran, Kodi S.·2022·Nature Reviews Drug Discovery

DOI 10.1038/s41573-022-00470-yPMC PMC9157040

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Abstract

The daily removal of billions of apoptotic cells in the human body via the process of efferocytosis is essential for homeostasis. To allow for this continuous efferocytosis, rapid phenotypic changes occur in the phagocytes enabling them to engulf and digest the apoptotic cargo. In addition, efferocytosis is actively anti-inflammatory and promotes resolution. Owing to its ubiquitous nature and the sheer volume of cell turnover, efferocytosis is a point of vulnerability. Aberrations in efferocytosis are associated with numerous inflammatory pathologies, including atherosclerosis, cancer and infections. The recent exciting discoveries defining the molecular machinery involved in efferocytosis have opened many avenues for therapeutic intervention, with several agents now in clinical trials.

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Efferocytosis in other settings can promote fibrosis as part of tissue resolution, for example, by secreting TGF-β1.
“efferocytosis in other settings can promote fibrosis as part of the tissue resolution process, for example, by secreting TGF-β1 (12, 13).”
From Impaired TIM4-mediated efferocytosis by liver macrophages contributes to fibrosis in metabolic dysfunction–associated steatohepatitis (2025) · cites this paper as [13]
The Digestion phase says efferocytosis-associated signalling increases macrophage TGFβ expression, and the Cancer section describes possible TGFβ release by macrophages engulfing apoptotic cells. These passages support the secretion mechanism, but they do not say that efferocytosis promotes fibrosis during tissue resolution or identify the cytokine specifically as TGF-β1. Page numbers are unavailable in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measured
No approaches targeting efferocytosis have thus far been clinically approved.
“While some progress has been made with respect to the Fractalkine receptor (CX3C motif chemokine receptor 1), Axl, MerTK, CD47 and Tim4/3, no approaches have thus far been clinically approved (64).”
From Cholesterol efflux protein, ABCA1, supports anticancer functions of myeloid immune cells (2026) · cites this paper as [64]
Table 1 (Approaches to target the eating phase; page unavailable) lists therapeutics targeting Axl, MerTK, CD47 and TIM4/3 as being in clinical trials, supporting the distinction between progress in trials and clinical approval. The Introduction (page unavailable) also says an autologous apoptotic-cell approach is already in use. The review does not establish the broader claim that no approach targeting efferocytosis has been clinically approved. (LLM, conf=0.78)
Experimental — accuracy not yet measured
Accumulation of dead cells in disease indicates impaired clearance by macrophages.
“The accumulation of dead cells in disease settings indicates impaired clearance of dead cells by macrophages (“efferocytosis”) (12, 13).”
From Impaired TIM4-mediated efferocytosis by liver macrophages contributes to fibrosis in metabolic dysfunction–associated steatohepatitis (2025) · cites this paper as [13]
Efferocytosis prevents dead cell accumulation and reprograms macrophages for tissue resolution, and its impairment contributes to many chronic inflammatory diseases.
“Efferocytosis not only prevents dead cell accumulation but also reprograms macrophages to execute tissue resolution functions, and impaired efferocytosis contributes to many human chronic inflammatory diseases (12, 13).”
From Impaired TIM4-mediated efferocytosis by liver macrophages contributes to fibrosis in metabolic dysfunction–associated steatohepatitis (2025) · cites this paper as [13]
Efferocytosis is seen as a major hurdle to using antigen presenting cells in cell-based therapies.
“It is seen as a major hurdle to using antigen presenting cells in cell-based therapies (61–64).”
From Cholesterol efflux protein, ABCA1, supports anticancer functions of myeloid immune cells (2026) · cites this paper as [64]
The Cancer section describes efferocytosis as a challenge for antitumour drug development, and the Infectious diseases section reports reduced antigen presentation by dendritic cells in a specific infection. Neither passage addresses whether efferocytosis is a major hurdle to using antigen-presenting cells in cell-based therapies. Searches for antigen-presenting cells and cell-based therapies found no passage making that connection. (LLM, conf=0.72)
Experimental — accuracy not yet measured

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Authors: Mehrotra, P., & Ravichandran, K. S.
Affiliations: VIB-UGent Center for Inflammation Research (BE)
Washington University in St. Louis (US)
Corresponding author: Ravichandran, Kodi S.
ORCID: Mehrotra, Parul
Ravichandran, Kodi S.
Venue: Nature Reviews Drug Discovery
Publisher: Springer Science and Business Media LLC
Published: 2022-06-01
Volume: 21
Issue: 8
Pages: 601-620
ISSN: 1474-1776 (ISSN-L)
1474-1784
DOI: 10.1038/s41573-022-00470-y
PMC: PMC9157040
OpenAlex: W4281737563
Cited by: 459
References: 231
Citations by year: 2026: 130 · 2025: 153 · 2024: 104 · 2023: 66 · 2022: 6
FWCI: 8.88
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.springernature.com/gp/researchers/text-and-data-mining (tdm)
www.springernature.com/gp/researchers/text-and-data-mining (vor)
Locations: Nature Reviews Drug Discovery (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Ghent University Academic Bibliography (Ghent University) (submittedVersion)
Funders: National Heart, Lung, and Blood Institute (P01HL120840)
National Institute of General Medical Sciences (R35GM122542)
National Institute of Allergy and Infectious Diseases (R01AI159551)
Topics: Life Sciences › Immunology and Microbiology › Immunology › Phagocytosis and Immune Regulation
Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Cell death mechanisms and regulation
Health Sciences › Medicine › Epidemiology › Autophagy in Disease and Therapy
Keywords: efferocytosis, phagocytes, anti-inflammatory mechanism, inflammation resolution, therapeutic target, atherosclerosis, cancer, infection
MeSH terms: Homeostasis, Humans, Phagocytes, Phagocytosis, Apoptosis, Atherosclerosis

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Drugging the efferocytosis process: concepts and opportunities

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