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Targeting macrophage polarization: mechanisms and potential of mesenchymal stromal/stem cells therapy in acne treatment— a narrative review
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DOI：10.3389/fimmu.2026.1889795.png)
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Abstract
En 中文
Acne vulgaris(AV) is a clinically common skin disease. Globally; about one in ten individuals is affected by it. Current research on acne primarily focuses on the following four areas: first; the inflammatory response; second; sebum metabolism disorders; third; the colonization of Cutibacterium acnes (C. acnes); and fourth; abnormal keratinization of the pilosebaceous duct. Although the exact pathogenesis of this condition has not yet been fully elucidated; the dual polarization of macrophages play a crucial role in the onset; progression and outcome of acne. As key effector cells in the human immune system; macrophages can exhibit different phenotypes in the microenvironments of various diseases: the classical activated phenotype (M1); the alternative activated phenotype (M2); and a subset characterized by the expression of trigger receptor 2 (TREM2) in myeloid cells. Currently endorsed international acne therapy; encompassing topical agents; systemic drugs; and physical therapies; demonstrates efficacy but frequently elicits a range of adverse effects. Therefore; there is a pressing need for a new; ideal treatment approach. Extensive research on stem cells and their derivatives in recent years has shown that mesenchymal stromal/stem cells (MSCs) possess significant immunomodulatory and anti-inflammatory capabilities; particularly in terms of influencing macrophage polarization. They promote the transition of macrophages to the anti-inflammatory M2 phenotype; which may play a role in the recovery process of acne. The unique advantage of MSCs therapy is that it is not simply antibacterial or anti-inflammatory as traditional therapies; rather; it may alleviate inflammation and promote skin tissue repair by promoting polarization of M2 macrophages. At the same time; it is expected to avoid the common adverse reactions in current acne treatment methods. This paper aims to provide a narrative review on the function of macrophages in skin tissue; the core role of inflammatory responses in acne pathogenesis; the multifaceted functions of macrophages in acne; the mechanisms through which MSCs regulate macrophage polarization; the current guideline-recommended standard treatment protocols for acne; and the feasibility of MSCs and their derivative transplants as a therapeutic strategy for alleviating acne inflammation.
Keywords:
cell therapy
inflammatory response
macrophage polarization
acne vulgaris
C. acnes
mesenchymal stromal/stem cell
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