IL-1 family member interleukin 37 (IL-37) has broad antiinflammatory properties and functions as a natural suppressor of innate inflammation. In this study, we demonstrate that treatment with recombinant human IL-37 reverses the decrease in exercise performance observed during systemic inflammation. This effect was associated with a decrease in the levels of plasma and muscle cytokines, comparable in extent to that obtained upon IL-1 receptor blockade. Exogenous administration of IL-37 to healthy mice, not subjected to an inflammatory challenge, also improved exercise performance by 82% compared with vehicle-treated mice (P = 0.01). Treatment with eight daily doses of IL-37 resulted in a further 326% increase in endurance running time compared with the performance level of mice receiving vehicle (P = 0.001). These properties required the engagement of the IL-1 decoy receptor 8 (IL-1R8) and the activation of AMP-activated protein kinase (AMPK), because both inhibition of AMPK and IL-1R8 deficiency abrogated the positive effects of IL-37 on exercise performance. Mechanistically, treatment with IL-37 induced marked metabolic changes with higher levels of muscle AMPK, greater rates of oxygen consumption, and increased oxidative phosphorylation. Metabolomic analyses of plasma and muscles of mice treated with IL-37 revealed an increase in AMP/ATP ratio, reduced levels of proinflammatory mediator succinate and oxidative stress-related metabolites, as well as changes in amino acid and purine metabolism. These effects of IL-37 to limit the metabolic costs of chronic inflammation and to foster exercise tolerance provide a rationale for therapeutic use of IL-37 in the treatment of inflammation-mediated fatigue.inflammation | interleukin 37 | metabolism | AMPK | fatigue T he IL-1 family cytokine interleukin 37 (IL-37) functions as a natural suppressor of innate inflammation and acquired immunity (1). Reduction in endogenous IL-37 levels results in increased cytokine production induced by toll-like receptors (TLR) in human monocytes. In mice, IL-37 is truncated and not functional, but the human IL37 transgenic mouse exhibits reduced severity of systemic and local inflammation, as well as dampening of acquired immune responses (2-5). Moreover, administration of recombinant human IL-37 to wild-type mice also suppresses proinflammatory cytokines and curbs excessive inflammation, for example, in inflammatory arthritis (5). Recombinant IL-37 suppresses NLRP3 and IL-1β gene expression following acute lung injury (6). Recombinant IL-37 also increases insulin sensitivity in diet-induced obesity (7).The mechanism of action for IL-37 is unique in the IL-1 family. IL-37 binds to the IL-18 receptor alpha chain (IL-18Rα), but then recruits IL-1R8. IL-1R8 functions to suppress local and systemic inflammation, as well as acquired immunity (8). Indeed, recombinant IL-37 administered to mice deficient for IL-1R8 does not suppress inflammation (5, 9). The complex of IL-18Rα with IL-37 plus IL-1R8 as the coreceptor signals the cell to reduce p...