The complex role of estrogens in inflammation
Abstract
There is still an unresolved paradox with respect to the immunomodulating role of estrogens. On one side, we recognize inhibition of bone resorption and suppression of inflammation in several animal models of chronic inflammatory diseases. On the other hand, we realize the immunosupportive role of estrogens in trauma/sepsis and the proinflammatory effects in some chronic autoimmune diseases in humans. This review examines possible causes for this paradox. This review delineates how the effects of estrogens are dependent on criteria such as: 1) the immune stimulus (foreign antigens or autoantigens) and subsequent antigen-specific immune responses (e.g., T cell inhibited by estrogens vs. activation of B cell); 2) the cell types involved during different phases of the disease; 3) the target organ with its specific microenvironment; 4) timing of 17β-estradiol administration in relation to the disease course (and the reproductive status of a woman); 5) the concentration of estrogens; 6) the variability in expression of estrogen receptor α and β depending on the microenvironment and the cell type; and 7) intracellular metabolism of estrogens leading to important biologically active metabolites with quite different anti- and proinflammatory function. Also mentioned are systemic supersystems such as the hypothalamic-pituitary-adrenal axis, the sensory nervous system, and the sympathetic nervous system and how they are influenced by estrogens. This review reinforces the concept that estrogens have antiinflammatory but also proinflammatory roles depending on above-mentioned criteria. It also explains that a uniform concept as to the action of estrogens cannot be found for all inflammatory diseases due to the enormous variable responses of immune and repair systems.
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The male mice were used to preclude effects of sex hormone since liver metabolism and inflammatory responses are highly influenced by estrogen levels and activity of estrogen receptor.
“The male mice were used to preclude the effects of sex hormone since liver metabolism and inflammatory responses are highly influenced by estrogen levels and activity of estrogen receptor67,68.”
From Bioengineered liver crosslinked with nano-graphene oxide enables efficient liver regeneration via MMP suppression and immunomodulation (2023) · cites this paper as [68]
The discrepancy in E2 effects may be attributed to differences in estrogen metabolism, receptor expression, or interactions with other hormones such as androgens and insulin.
“This discrepancy may be attributed to differences in estrogen metabolism, receptor expression, or interactions with other hormones such as androgens and insulin which can be reviewed here (220).”
From Metabolic impact of endogenously produced estrogens by adipose tissue in females and males across the lifespan (2025) · cites this paper as [220]
Estrogen's modulation of inflammatory processes is complex, with effects depending on cell type, target organ, estrogen concentration, and expression of estrogen receptors.
“Prior work has shown estrogen to be both anti- and pro-inflammatory and its effects may depend on a variety of factors, such as cell type, target organ, estrogen concentration, and expression of estrogen receptors (Straub, 2007).”
From Developmental psychoneuroendocrine and psychoneuroimmune pathways from childhood adversity to disease (2017) · cites this paper as Straub, 2007
Estrogens stimulate B cell-dominated immune reactions supported by T helper type 2 responses, whereas they inhibit T helper type 1 and macrophage-dominated immune responses.
“Thus, B cell-dominated immune reactions that are supported by T helper type 2 immune responses are stimulated, whereas T helper type 1 and macrophage-dominated immune responses are inhibited.”
From Interaction of the endocrine system with inflammation: a function of energy and volume regulation (2014) · cites this paper as [27]
Estrogens have a bi-modal pro- and anti-inflammatory role.
“estrogens have a bi-modal pro- and anti-inflammatory role.”
From Interaction of the endocrine system with inflammation: a function of energy and volume regulation (2014) · cites this paper as [27]
Low-dose E2 exposure (doses consistent with oral contraceptive pills) is associated with increased pro-inflammatory cytokine expression, while high doses (pregnancy levels) tend to generate an anti-inflammatory response.
“Both in vitro and in vivo studies show that while low dose exposure to E2 (doses consistent with oral contraceptive pills) is associated with increased pro-inflammatory cytokine expression [74, 76, 77], high doses (pregnancy levels) tend to generate an anti-inflammatory response [74].”
From Estrogen and thrombosis: a bench to bedside review (2020) · cites this paper as [74]
Estrogens have a divergent effect on inflammation and immune modulation based on the dose and duration of treatment.
“Estrogens have a divergent effect on inflammation and immune modulation [74, 75] based on the dose and duration of treatment of the drug.”
From Estrogen and thrombosis: a bench to bedside review (2020) · cites this paper as [74]
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SYSTEMIC LUPUS ERYTHEMATOSUS FLARES DURING PREGNANCY
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HOPKINS LUPUS PREGNANCY CENTER: 1987 TO 1996
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Estrogen and Inflammation Increase the Excitability of Rat Temporomandibular Joint Afferent Neurons
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Sex‐hormone‐induced inflammation and fibromuscular proliferation in the rat lateral prostate
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Flagged first, then by citations
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“Estrogen effects depend on several recently summarized criteria [27]: (a) the immune stimulus (foreign antigens or autoantigens) and subsequent antigen-specific immune responses (for example, T cell inhibited by estrogens versus B cell activated by estrogens), (b) the cell types involved during different phases of the…”
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- Authors
- Straub, R. H.
- Affiliations
- University Hospital Regensburg (DE)
- Corresponding author
- Straub, Rainer H.
- ORCID
- Straub, Rainer H.
- Venue
- Endocrine Reviews
- Publisher
- The Endocrine Society
- Published
- 2007-08-01
- Volume
- 28
- Issue
- 5
- Pages
- 521-574
- ISSN
- 0163-769X (ISSN-L)
- 1945-7189
- OpenAlex
- W2159203244
- Cited by
- 1,950
- References
- 605
- Citations by year
- 2026: 118 · 2025: 157 · 2024: 129 · 2023: 136 · 2022: 137 · 2021: 196 · 2020: 123 · 2019: 100 · 2018: 100 · 2017: 98 · 2016: 77 · 2015: 104 · 2014: 81 · 2013: 71 · 2012: 83
- FWCI
- 5.84
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Endocrine Reviews (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Estrogen and related hormone effects
- Health Sciences › Medicine › Pharmacology › Inflammatory mediators and NSAID effects
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
- Keywords
- estrogen, inflammation, immunomodulation, estrogen receptor alpha, estrogen receptor beta, estradiol, estrogen metabolism, bone resorption, autoimmune disease, sepsis, trauma (physical injury), T cell activation, B cell activation, hypothalamic-pituitary-adrenal axis, sympathetic nervous system, sensory nervous system, reproductive status
- MeSH terms
- Animals, Autoimmune Diseases, Cell Movement, Estrogens, Female, Humans, Inflammation, Leukocytes, Neovascularization, Pathologic, Pregnancy, Receptors, Estrogen, Estrogen Replacement Therapy, Apoptosis, Mice
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