Implications of macrophage polarization in autoimmunity

Summary Macrophages are extremely heterogeneous and plastic cells with an important role not only in physiological conditions, but also during inflammation (both for initiation and resolution). In the early 1990s, two different phenotypes of macrophages were described: one of them called classically activated (or inflammatory) macrophages (M1) and the other alternatively activated (or wound‐healing) macrophages (M2). Currently, it is known that functional polarization of macrophages into only two groups is an over‐simplified description of macrophage heterogeneity and plasticity; indeed, it is necessary to consider a continuum of functional states. Overall, the current available data indicate that macrophage polarization is a multifactorial process in which a huge number of factors can be involved producing different activation scenarios. Once a macrophage adopts a phenotype, it still retains the ability to continue changing in response to new environmental influences. The reversibility of polarization has a critical therapeutic value, especially in diseases in which an M1/M2 imbalance plays a pathogenic role. In this review, we assess the high plasticity of macrophages and their potential to be exploited to reduce chronic/detrimental inflammation. On the whole, the evidence detailed in this review underscores macrophage polarization as a target of interest for immunotherapy. “Classification in pro‐inflammatory (M1) and anti‐inflammatory (M2) macrophages is a simplified view of the heterogeneity and plasticity of these cells; it is necessary to consider a continuum of functional states. The reversibility of polarization has a critical therapeutic value, especially in diseases where M1/M2 imbalance has a pathogenic role. In this review, we assess the high plasticity of macrophages and highlight macrophage polarization as an interesting target for immunotherapy.”