HMGB1

Definition

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.

A late-acting alarm signal in sustained 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.

Reviewed by

Ulf Andersson

Professor of Pediatric Rheumatology, Karolinska Institutet

Worked at Karolinska for five decades as a clinician and a basic scientist focusing on inflammation. Co-discoverer of HMGB1 as the prototype alarmin molecule. Honorary doctor at Hofstra University in New York. Highly Cited Clarivate Researcher Web of Science awards.

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