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Dynamic regulation and targeted intervention of neutrophils in hepatic ischemia‑reperfusion injury (Review)

  • Authors:
    • Sen Lu
    • Jiale Tong
    • Jing Jiang
    • Qin Zhang
    • Youjin Huang
  • View Affiliations / Copyright

    Affiliations: Department of Critical Care Medicine, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan 610072, P.R. China, Emergency Department of West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan 610041, P.R. China, Department of Critical Care Medicine, Chongqing General Hospital, Chongqing University, Chongqing, Sichuan 404100, P.R. China, Department of Health Management Center, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan 610072, P.R. China, Department of Vascular Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan 610072, P.R. China
    Copyright: © Lu et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 109
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    Published online on: March 3, 2026
       https://doi.org/10.3892/ijmm.2026.5780
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Abstract

Ischemia‑reperfusion injury (IRI) is a complex pathophysiological process characterized by oxidative stress, inflammatory response and cell death during tissue reperfusion, leading to organ dysfunction. In liver transplantation, hepatic ischemia‑reperfusion injury (HIRI) can result in irreversible liver failure and subsequently trigger rejection. Neutrophils, as the first recruited innate immune cells, play a central role in the initiation, progression and resolution stages of HIRI. However, current research predominantly focuses on their pro‑inflammatory and damaging mechanisms, lacking a theoretical framework that systematically integrates their dual functions. Based on a systematic review of key processes involving neutrophils in HIRI, including recruitment, adhesion, migration, neutrophil extracellular trap (NET) formation and phenotypic polarization, the present review proposed the ‘injury‑repair balance’ theory. It emphasized that neutrophils are dynamically regulated by the hepatic microenvironment and can undergo functional conversion between pro‑inflammatory N1 and anti‑inflammatory/repair N2 phenotypes. Their polarization state is a critical factor determining the progression and recovery of HIRI. The present review further explores multi‑dimensional intervention strategies targeting neutrophils, including inhibiting excessive recruitment and activation, regulating migration to reduce local accumulation, suppressing NET formation and promoting their clearance, as well as combining antioxidant and anti‑inflammatory therapies to reestablish immune homeostasis. Additionally, extracellular vesicles, due to their excellent targeting delivery and immunomodulatory capabilities, have emerged as potential tools for precise regulation of neutrophil function. Notably, current research on neutrophil polarization mechanisms remains incomplete. Future studies should delve into the temporal regulatory mechanisms of polarization and explore the possibility of driving neutrophils toward an N2‑like reparative phenotype through pharmacological or biological interventions. This strategy is expected to shift the treatment paradigm for HIRI from traditional ‘cell suppression’ to a more precise ‘functional reprogramming,’ transforming the approach from merely mitigating injury to actively promoting tissue regeneration.
View Figures

Figure 1

The pathological mechanism of HIRI
and the role of neutrophils in HIRI. HIRI, hepatic
ischemia-reperfusion injury; IRI, ischemia-reperfusion injury;
LSECs, liver sinusoidal endothelial cells; GAGs,
glycosaminoglycans; DAMP, damage associated molecular pattern;
NETs, neutrophil extracellular traps; ROS, reactive oxygen species;
NF-κB, nuclear factor-kappa B; TNF-α, tumor necrosis factor alpha;
LTB4, leukotriene B4; MPO, myeloperoxidase; NE, neutrophil
elastase; MMP8, matrix metallopeptidase 8; MMP9, matrix
metallopeptidase 9; NOS, nitric oxide synthase; Cyt C, Cytochrome
c.

Figure 2

Integrated signaling network in HIRI:
Inflammation amplification via cGAS-STING and cytokine crosstalk.
mtDNA release activates cGAS-STING, driving TBK1-IRF3/NF-κB to
enhance ROS and immune cell recruitment. Kupffer
cell/neutrophil-derived IL-1/TNF-α and IL-12/IL-23/IL-17 axes
promote inflammation, while IL-6, VEGF and HGF support regeneration
via STAT3/ERK1/2, antioxidant effects and reduced adhesion. HIRI,
hepatic ischemia-reperfusion injury; cGAS-STING, cyclic GMP-AMP
synthase-stimulator of interferon genes; mtDNA, mitochondrial DNA;
ROS, reactive oxygen species; NF-κB, nuclear factor-kappa B; IRF3,
interferon regulatory factor 3; JNK, c-Jun N-terminal kinase; MAPK,
mitogen-activated protein kinase; ICAM-1, intercellular adhesion
molecule-1; VCAM-1, vascular cell adhesion molecule-1; VEGF,
vascular endothelial growth factor; HGF, hepatocyte growth factor ;
STAT3, signal transducer and activator of transcription 3; GSH,
glutathione.

Figure 3

Neutrophil-targeted therapeutic
strategies for hepatic ischemia-reperfusion injury. Strategies
include targeting chemokine receptors and complement inhibitors to
regulate neutrophil recruitment, anti-adhesion and migration
therapies to prevent neutrophil accumulation, reducing NETs
formation and enhancing their degradation, antioxidant and
anti-inflammatory treatments to mitigate oxidative stress and the
application of extracellular vesicles as a novel approach for
targeted therapeutic delivery. LSECs, liver sinusoidal endothelial
cells; LXA4, lipoxin A4; ICAM-1, intercellular adhesion molecule-1;
NETs, neutrophil extracellular traps; PAD4, peptidylarginine
deiminase 4; MSCs-EVs, mesenchymal stem cells-extracellular
vesicles; TNF-α, tumor necrosis factor alpha; ROS, reactive oxygen
species; DNase I, Deoxyribonuclease I.
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Copy and paste a formatted citation
Spandidos Publications style
Lu S, Tong J, Jiang J, Zhang Q and Huang Y: Dynamic regulation and targeted intervention of neutrophils in hepatic ischemia‑reperfusion injury (Review). Int J Mol Med 57: 109, 2026.
APA
Lu, S., Tong, J., Jiang, J., Zhang, Q., & Huang, Y. (2026). Dynamic regulation and targeted intervention of neutrophils in hepatic ischemia‑reperfusion injury (Review). International Journal of Molecular Medicine, 57, 109. https://doi.org/10.3892/ijmm.2026.5780
MLA
Lu, S., Tong, J., Jiang, J., Zhang, Q., Huang, Y."Dynamic regulation and targeted intervention of neutrophils in hepatic ischemia‑reperfusion injury (Review)". International Journal of Molecular Medicine 57.5 (2026): 109.
Chicago
Lu, S., Tong, J., Jiang, J., Zhang, Q., Huang, Y."Dynamic regulation and targeted intervention of neutrophils in hepatic ischemia‑reperfusion injury (Review)". International Journal of Molecular Medicine 57, no. 5 (2026): 109. https://doi.org/10.3892/ijmm.2026.5780
Copy and paste a formatted citation
x
Spandidos Publications style
Lu S, Tong J, Jiang J, Zhang Q and Huang Y: Dynamic regulation and targeted intervention of neutrophils in hepatic ischemia‑reperfusion injury (Review). Int J Mol Med 57: 109, 2026.
APA
Lu, S., Tong, J., Jiang, J., Zhang, Q., & Huang, Y. (2026). Dynamic regulation and targeted intervention of neutrophils in hepatic ischemia‑reperfusion injury (Review). International Journal of Molecular Medicine, 57, 109. https://doi.org/10.3892/ijmm.2026.5780
MLA
Lu, S., Tong, J., Jiang, J., Zhang, Q., Huang, Y."Dynamic regulation and targeted intervention of neutrophils in hepatic ischemia‑reperfusion injury (Review)". International Journal of Molecular Medicine 57.5 (2026): 109.
Chicago
Lu, S., Tong, J., Jiang, J., Zhang, Q., Huang, Y."Dynamic regulation and targeted intervention of neutrophils in hepatic ischemia‑reperfusion injury (Review)". International Journal of Molecular Medicine 57, no. 5 (2026): 109. https://doi.org/10.3892/ijmm.2026.5780
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