REVIEW article
Front. Immunol.
Sec. Inflammation
From "Metabolic Storm" to "Immune Paralysis": The Dynamic Evolution of Macrophages and Metabolism Reprogramming in ARDS
Provisionally accepted
- Daping Hospital, Chongqing, China
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Sepsis is characterized by high mortality and a complicated pathological mechanism. Macrophages play a crucial role in the initiation and progression of sepsis-associated acute respiratory distress syndrome (ARDS). Macrophage functional states and polarization phenotype have been significantly influenced by metabolic programming. This review delineates the metabolic reprogramming of macrophages from the initial 'metabolic storm' to subsequent 'immune paralysis' in sepsis-associated ARDS. It focuses on the interplay between macrophage polarization (classical activated macrophages (M1) and alternative activated macrophages (M2) phenotypes) and key metabolic pathways, including glycolysis and oxidative phosphorylation (OXPHOS). Furthermore, it explains the molecular mechanism underlying the metabolic pattern's influence on macrophage and lung tissue damage. The final section of this review focuses on the therapeutic implications of bone marrow mesenchymal stem cells (BMMSCs) and myeloid-derived suppressor cells (MDSCs), which alter macrophage metabolic reprogramming. Based on the latest progress, this article aims to provide a comprehensive theoretical framework and cli Based on recent advances, nical guidance for immunometabolic therapy in sepsis-associated ARDS.
Keywords: sepsis-associated ARDS, Macrophage polarization, metabolic reprogramming, Metabolic storm, immune paralysis, Glycolysis, BMMSCs, Exosomes
Received: 03 Nov 2025; Accepted: 27 Nov 2025.
Copyright: © 2025 Tang, Yan, Li, Hu and Zhou. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Mengchun Li
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