Understanding exocytosis in immune and inflammatory cells: the molecular basis of mediator secretion

Inflammatory cells secrete proteins from intracellular vesicles or granules by a process referred to either as exocytosis or as degranulation, which is common to all cell types. Exocytosis is a precise term that describes the process of granule or vesicular fusion with the plasma membrane and is accompanied by release of granule/vesicle contents to the cell exterior. This process is of particular significance with respect to tissue damage and remodeling in inflammatory diseases, inasmuch as these changes are the consequences of inflammatory cell activation and mediator elaboration. Despite its unifying importance to all inflammatory cell types, little is known about the precise molecular and intracellular mechanisms that regulate mobilization of secretory granules/vesicles and, ultimately, secretion of mediators from immune and inflammatory cells. This article reviews the mechanisms and molecules currently implicated at distal stages of exocytosis from eosinophils, neutrophils, mast cells, platelets, and macrophages. Conserved molecules identified among inflammatory cell types indicate a convergence of pathways leading to mediator secretion. The identification of essential molecules in the cascade of events leading to exocytosis is critical in the search for novel therapeutic targets aimed at modulating mediator secretion from these cell types.