A protein with two distinct roles: inside cells it helps regulate gene expression; released into the bloodstream, it acts as an alarm signal that activates inflammation and pain. Elevated extracellular HMGB1 levels are associated with sepsis, autoimmune disease, and chronic inflammation.
HMGB1 is a late-acting alarm protein. Unlike cytokines such as TNF-α that are released within minutes of an inflammatory trigger, HMGB1 release is typically delayed — appearing hours to days after the initial stimulus. This makes it a marker of sustained inflammation rather than the acute initial response. HMGB1 can also be released from nociceptors to mediate pain by sensitizing sensory neurons and enhancing inflammation.
Activation of the cholinergic anti-inflammatory pathway via vagus nerve stimulation suppresses HMGB1 release from both immune cells and nociceptors, offering a promising therapeutic strategy to reduce dysregulated inflammation and pain.