Fisiopatología y relevancia clínica de los monocitos en la fibrosis pulmonar idiopática: revisión narrativa
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Las enfermedades pulmonares intersticiales son un grupo heterogéneo de desórdenes caracterizados por grado variable de inflamación y fibrosis. La fibrosis pulmonar idiopática (FPI) es una de las más frecuentes y se relaciona con pobre pronóstico, para lo cual se han desarrollado múltiples biomarcadores para predecir de forma temprana el curso clínico y respuesta al manejo. Los monocitos se han relacionado en la patogénesis de la enfermedad fibrótica aberrantemente. La proliferación de precursores de monocitos en la médula ósea y la posterior migración de monocitos a la sangre y los tejidos es un proceso estrechamente relacionado con los macrófagos alveolares. CCR2 es el receptor necesario para la migración clásica de monocitos a tejidos inflamados. Entre las múltiples quimiocinas asociadas, se destaca la proteína quimioatrayente de monocitos 1 (MCP-1, también conocida como CCL2) que tiene la mayor afinidad por CCR2. Se han encontrado niveles de monocitos activados en pacientes con FPI y los monocitos circulantes pueden producir proteínas de la matriz celular profibróticas. El conteo elevado de monocitos en sangre se ha relacionado con progresión y con incremento de la probabilidad de muerte en FPI.
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