Active resolution of inflammation is a previously unrecognized process essential for tissue homeostasis. Monocytes play a pivotal role in the generation as well as resolution of inflammation. Glucocorticoids (GCs) are widely used antiinflammatory agents. We demonstrate that GCs exhibit antiapoptotic effects in monocytes resulting in differentiation to an anti-inflammatory phenotype. The molecular basis of this novel antiapoptotic effect is a prolonged activation of the extracellular signal regulated kinase/mitogenactivated protein kinase (ERK/MAPK) pathway resulting in inhibition of caspase activities and expression of antiapoptotic genes via activation of c-Myc. We identified up-regulation and activation of A3 adenosine receptor (A3AR) as the initial trigger of this antiapoptotic pathway. In summary, we deciphered a novel molecular pathway promoting survival of anti-inflammatory monocytes. Specific activation of A3AR or its downstream signaling pathways may thus be a novel strategy to modulate inflammation in autoimmune disorders with fewer side effects via induction of inflammatory resolution rather than immunosuppression.
IntroductionGlucocorticoids (GC) are very effective anti-inflammatory and immunosuppressive agents widely used in the treatment of many autoimmune and allergic diseases. 1 However, long-term therapy with GCs is associated with substantial side effects that limit their use in many clinical conditions. Thus, novel insights in the molecular mechanisms of GCs action on immune cells are a prerequisite for the development of more specific antiinflammatory therapies. 2 The anti-inflammatory effect of GCs on immune cells was believed to be primarily mediated by interaction with transcriptional factors essential for expression of proinflammatory genes (transrepression). GC-mediated gene expression (transactivation), on the other hand, has been supposed to be responsible for many GC side effects. 3 With respect to monocytes, however, we and other groups demonstrated that GC-mediated gene transcription is crucial for differentiation of an active anti-inflammatory monocytic phenotype. [4][5][6] Monocytes and macrophages are central components of the immune system. During infection and inflammation, they play a pivotal role in the generation of inflammatory mediators and regulation of innate and adaptive immune responses. They also contribute to resolution of inflammation, not only by producing anti-inflammatory cytokines but also by removal of proinflammatory pathogens, cellular debris and apoptotic cells present at later stages of inflammation. 7,8 Thus, monocytes and macrophages do not represent a homogenous cell population, but rather comprise specific subsets with proinflammatory or anti-inflammatory properties depending on their stage of differentiation as well as on distinct mechanisms of activation. [9][10][11] It was generally believed that anti-inflammatory actions of GCs on monocytes and macrophages are mainly due to down-regulation of proinflammatory functions. 12,13 However, analyzing the g...