From humoral fever to neuroimmunological control of fever

Abstract Fever is a part of the acute phase response to infection or systemic inflammation. It is thus a part of a complex physiological defence strategy against micro-organisms invading the body of the host, or against non-microbial agents recognized as foreign by mobile immune cells of the body. The fever is induced by inflammatory mediators (prostaglandins, cytokines) released by immune cells activated by contacts with foreign molecules (exogenous pyrogens). These fever-inducing mediators, produced by the host cells (endogenous pyrogens), were originally thought to be distributed by means of the bloodstream (similarly to hormones) to different tissues of the body. Although the details of their transport across the blood–brain-barrier have not been clarified, it has been assumed that they activate the local production of inflammatory mediators within the brain, inducing a change in the thermoregulatory set-range and resulting in fever (humoral theory of fever). This concept has apparently changed in the past few years. Evidence has recently been presented supporting the possibility of the transport of immune signals to the brain via vegetative and peripheral nerves. In this review an attempt is made to describe the events leading to a fever response accompanying the systemic inflammation against a background of microbiological, immunological and physiological data. The experimental evidence published during the last five years has been reviewed, and a new concept of neuroimmunological control of fever is presented. This concept suggests that the host immune defence is coordinated through an integration of the neural, immune, hemopoietic and endocrine systems. The brain seems to be informed of any damage or antigenic challenge in the periphery of the body by a sensory host-monitoring system, and this information is confirmed by immune signals delivered by the humoral transport. The combination of these signals would allow the brain to recognize the nature of the challenge, and to activate an appropriate defence strategy. Fever as a part of many successful defence strategies against infections may thus be beneficial.