The toxicology of chemokine inhibition

The dividing line between essential physiological inflammatory processes and excessive pathological inflammation is often very thin - in some circumstances, indeed, it may be non-existent. Devising anti-inflammatory medications that effectively target only the pathological component therefore remains a central challenge for the pharmaceutical industry. At present, the general rule is that the more powerful the anti-inflammatory effect of a drug, the greater the side-effects that accompany it. Steroids, for example, are potent anti-inflammatory medications, but they have a diverse array of side effects that substantially limit their use. Since chemokines play a central role in regulating the immune system, and in particular, the trafficking of leukocytes, inhibiting their action may represent a powerful new therapeutic strategy for treating diseases with an inflammatory component. However, this potential will only be realized if it is possible to interfere with chemokine signaling networks, without inducing unacceptable side effects. Although very little, direct human toxicology has been carried out using chemokine inhibitors, there is now a sufficient body of indirect and circumstantial evidence (for example, from genetically modified mice and from animal model studies using chemokine inhibitors) to allow a tentative assessment of the biological impact of chemokine inhibition. The purpose of this review is to outline the available data and to speculate on the likely toxicological profile resulting from chemokine inhibition. The tentative conclusion is that anti-inflammatory therapy achieved through chemokine inhibition may have fewer side effects than originally expected, even when the actions of multiple chemokines are inhibited simultaneously.