Immunomodulation and inflammatory response syndrome

The human body has the ability to heal itself. We see it every day. From a skin cut to mended bones to liver regeneration, the body can resolve insults on its own in many situations. But for many acute and chronic conditions, the body needs help. Heart disease, acute respiratory disease and kidney disease are examples of chronic conditions that do not resolve on their own and can be long-lasting. In some cases, regenerative medicine can play an important role, going beyond disease management to support the body in repairing, regenerating and restoring itself to homeostasis.

Regenerative medicine was initially focused on tissue engineering to replace damaged tissues and organs with cell and biomaterials constructs. However, more research has expanded this area of translational medicine to explore immunomodulation, using the body’s own endogenous processes to prevent tissue damage in organs, and to repair and regenerate these damaged tissues.

This is particularly valuable for fighting the consequences of inflammation on organs. Inflammation is the body’s biological immune response to injury. It can be triggered by a variety of factors and can induce acute or chronic inflammatory responses in major organs including the kidney, lungs and heart. Sometimes the immune response can trigger an immune cell hyperactivation where too many pro-inflammatory cytokines are released into the blood too quickly. This inflammatory response can have devastating and even deadly consequences. 

Delivered via extracorporeal circuit, immunomodulation is shown to impact neutrophils and monocytes to alter the progression of inflammatory disease. This can alleviate tissue damage caused by diseases without treatment and help the reparative process, unlike the more commonly seen regenerative approach that uses tissue engineering to replace damaged tissues and organs with constructs derived from cells and biomaterials. Immunomodulation modulates the body’s own endogenous processes to prevent tissue damage in organs and to repair and regenerate these damaged tissues.

Studies have shown that the manipulation of the innate immunologic system may diminish acute kidney injury and enhance renal repair and recovery without the progression to chronic kidney disease or failure. Additional research shows these interventions may improve acute and chronic organ dysfunction in the heart, lung and brain. 

Increasingly, clinicians have recognized the critical role that the immune system plays in the response after organ injury, and the potential ramifications of excessive, dysregulated inflammation in both acute and chronic disease states, as well as the resulting impact on solid organ function. A growing body of clinical and preclinical supports immunomodulatory interventions.

More on these studies can be found at Kidney Int Rep (2018) 3, 771–783; https://doi.org/10.1016/j.ekir.2017.12.012