中国神经再生研究(英文版) ›› 2026, Vol. 21 ›› Issue (9): 4195-4210.doi: 10.4103/NRR.NRR-D-24-01579

• 综述:脊髓损伤修复保护与再生 • 上一篇    下一篇

巨噬细胞M2极化:操纵脊髓损伤修复

  

  • 出版日期:2026-09-15 发布日期:2026-05-19

M2 polarization of macrophages: Manipulation of spinal cord injury repair

Yiran Lu1, #, Hantian Yin1, #, Lingwei Lou1, Zhonglin Liu1, Haiming Zhu1, Chunyi Gu1, Can Zhang2, *, Junjuan Wang1, *   

  1. 1Hangzhou Medical College, Hangzhou, Zhejiang Province, China; 
    2Hunan Research Center of the Basic Discipline for Cell Signaling, College of Biology, Hunan University, Changsha, Hunan Province, China
  • Online:2026-09-15 Published:2026-05-19
  • Contact: Junjuan Wang, MS, 2016000016@hmc.edu.cn; Can Zhang, PhD, zc420@hnu.edu.cn.
  • Supported by:
    This work was supported by Funds of Zhejiang Medical Science, No. 2023KY649 (to JW); National Innovation Training Program for College Students, No. 202513023016 (to YL); Scientific and Technological Innovation (Xinmiao Talents) Program of Zhejiang Province , No. 2024R424A001 (to CG and HY); and Hunan Science and Technology Innovation Plan, No. 2025ZYJ003 (to CZ).

摘要:

脊髓损伤由于再生能力有限,可诱导持续的感觉运动功能障碍。巨噬细胞可通过极化协调病理损伤和修复。脊髓损伤后,这些免疫细胞可通过多种调节通路介导吞噬清除、炎症调节和神经组织重塑。巨噬细胞持续的M1极化可通过细胞因子风暴、活性氧产生以及随之而来的神经元凋亡、轴突断裂和神经胶质瘢痕形成,加剧组织损伤。而其M2极化则可通过缓解炎症反应和促进轴突发芽来提供神经保护作用。因此,巨噬细胞可塑性的操纵已成为脊髓损伤修复的一种潜在的治疗策略。此次综述全面探索了脊髓损伤后巨噬细胞极化的调控机制、驻留小胶质细胞和外周巨噬细胞的功能差异以及不同损伤亚型的病理生理级联反应,继而分析了纳米疗法、工程外泌体、电活性生物材料和光生物调节等新兴干预措施在这一领域的成果。由于缺乏针对巨噬细胞重编程的人体试验且在没有非人灵长类动物验证的情况下过度依赖啮齿动物模型,因而尚缺乏以巨噬细胞为中心的临床疗法。鉴于免疫调节生物材料的加速发展和对巨噬细胞极化机制的深入了解,巨噬细胞的精确靶向治疗脊髓损伤未来有望成为一种变革性疗法。


https://orcid.org/0000-0002-6741-6604 (Junjuan Wang); 

https://orcid.org/0000-0002-7965-4562 (Can Zhang)

关键词: 激活, 生物材料, 临床试验, 炎症, 巨噬细胞, 神经元再生, 极化, 脊髓损伤, 治疗策略, 组织修复

Abstract: Spinal cord injury results in lasting sensory and motor dysfunction with limited regenerative capacity. Macrophages play a crucial role in orchestrating secondary pathogenesis and repair mechanisms through polarization dynamics. Following spinal cord injury, these immune cells deploy context-dependent responses via divergent regulatory pathways, mediating phagocytic clearance, inflammatory modulation, and neural tissue remodeling. M1 macrophage polarization exacerbates tissue damage through cytokine storms, reactive oxygen species generation, and subsequent neuronal apoptosis, axonal fragmentation, and glial scarring. Conversely, dominant M2 polarization provides neuroprotection by resolving inflammation and promoting axonal sprouting. Strategic manipulation of macrophage plasticity is a promising frontier in spinal cord injury recovery therapy. This review comprehensively examines the regulatory mechanisms that govern macrophage polarization after spinal cord injury, the functional distinctions between resident microglia and peripheral macrophages, the pathophysiological cascades that occur across injury subtypes, and the emerging interventions that span nanotherapeutics, engineered exosomes, electroactive biomaterials, and photobiomodulation. However, there is still a lack of clinical therapies centered around macrophages due to a lack of human trials targeting macrophage reprogramming and excessive reliance on rodent models without validation in non-human primates. However, given the accelerated development of immunomodulatory biomaterials and the expanding mechanistic insights into polarization pathways, the precision targeting of macrophages warrants prioritized investigation for transformative spinal cord injury therapeutics.

Key words: activation, biomaterial, clinical trial, inflammatory, macrophage, neuron regeneration, polarization, spinal cord injury, therapeutic strategy, tissue repair