Effect of obesity and insulin on immunity in non-insulin-dependent diabetes mellitus

Obesity and adiposity indicators in asthma and allergic rhinitis in children

PURPOSE OF REVIEW

The prevalence of obesity and allergic diseases, such as asthma and allergic rhinitis, is increasing worldwide not only in adults, but also in children. Experimental and clinical studies have demonstrated the effect of obesity not only on asthma, but also on other allergic diseases.

RECENT FINDINGS

Allergic diseases, such as asthma and allergic rhinitis, are common chronic inflammatory diseases of the airways. Obesity is an increasingly common pediatric disease and is a risk factor for the development of asthma in that obese patients with asthma tend to have more severe asthma that does not respond well to standard asthma therapy. On the contrary, children with asthma maybe at a high risk of obesity, suggesting that the relationship of asthma and obesity seems to be interrelated. The role of obesity on the development of allergic rhinitis is not well defined, whereas allergic rhinitis may have an impact on obesity.

SUMMARY

Childhood obesity is often considered to be less serious than obesity in adults because of the greater risk of complications in obese adults. In this review, we discuss the allergic confounders of obesity and the impact of allergic diseases on obesity. Proper control of the BMI within the normal range in children with allergic diseases is important.

Hyperglycemia Affects the Expression of Inflammatory Genes in Peripheral Blood Mononuclear Cells of Patients with Type 2 Diabetes

OBJECTIVE

Innate immune system dysregulation and chronic low-grade inflammation are associated with the pathogenesis of type 2 diabetes (T2D). The aim of this study was to investigate the effect of hyperglycemia on mRNA expression of four inflammatory genes in peripheral blood mononuclear cells (PBMCs) of pre-diabetic and diabetic individuals.

METHODS

In a case-control study, quantitative real-time PCR was used to analyze changes in IL-1β, IL1R1, IL-6, and IL6ST gene expression in PBMCs of 30 T2D patients with high blood glucose levels, 24 diabetic and nondiabetic individuals with moderately high blood glucose levels and 30 controls with normal blood glucose levels.

RESULTS

In T2D patients with high blood glucose, IL-1β expression showed a 2.69-fold increase (p = 0.0380), while IL-6 expression levels were 3.45 fold lower (p = 0.0045) versus control subjects. Moreover, compared with control group the expression of IL1R1 and IL-6 genes both were downregulated in individuals with moderately high blood glucose levels by 2.38 (p = 0.0365) and 4.34 fold (p = 0.0027), respectively. In addition, hemoglobin A1C (A1C) levels were positively correlated with IL-1β expression and fasting plasma glucose (FPG) levels showed a positive correlation with IL-1β and a negative correlation with IL-6 expression.

CONCLUSION

The observed changes in both IL-1β and IL-6 mRNA levels in PBMCs may contribute to the development of inflammatory processes involved in the pathogenesis of T2D. Downregulation of IL1R1 in individuals with mild hyperglycemia may indicate an attempt to reduce the pro-inflammatory effects of IL-1β via auto-stimulation.

Insulin-Treated Patients with Diabetes Mellitus Undergoing Emergency Abdominal Surgery Have Worse Outcomes than Patients Treated with Oral Agents

BACKGROUND

Diabetes mellitus (DM) is a known risk factor for worse outcomes after emergency abdominal surgery (EAS). However, it is unclear if the type of diabetes treatment (insulin or oral agents) has any effect on outcomes after EAS.

METHODS

Matched cohort study utilizing the ACS NSQIP database. Patients with DM undergoing EAS were divided into insulin and oral agent treatment groups. A 1:1 cohort matching of insulin-treated and oral agent-treated patients was performed (matched for sex, age, ASA score, BMI category, operative procedure, and preoperative acute renal failure, pneumonia, SIRS, sepsis, septic shock, and corticosteroid use). Outcomes of matched insulin- and oral agent-treated patients were compared with univariable and multivariable regression analysis.

RESULTS

A total of 7401 patients with DM underwent EAS, 3182 (43 %) of which were insulin treated and 4219 (57 %) were treated with oral agents. Matching resulted in 2280 matched cases, which formed the basis of this analysis. Insulin-treated patients were more likely to have postoperative complications (OR 1.279, CI 1.119-1.462), had a higher 30-day mortality rate in patients with sepsis at hospital admission (OR 3.421, CI 1.959-5.974), and a longer total hospital length of stay (RC 1.115, CI 1.065-1.168) and postoperative LOS (RC 1.082, CI 1.031-1.135).

CONCLUSIONS

In patients with DM undergoing emergency abdominal surgery, insulin-treated patients have worse outcomes than oral agent-treated patients. Insulin-treated patients with DM therefore should be monitored and treated more intensively in anticipation of potential complications after emergency abdominal surgery.

Systemic immune modulation induced by alcoholic beverage intake in obese-diabetes (db/db) mice

Alcohol over-consumption is generally immunosuppressive. In this study, the effects of single or repetitive alcohol administration on the systemic immunity of db/db mice were observed to clarify the possible mechanisms for the increased susceptibility of obese individuals to alcohol-related immunological health problems. Alcohol (as a form of commercially available 20% distilled-alcoholic beverage) was orally administered one-time or seven times over 2 weeks to db/db mice and normal C57BL/6J mice. Immunologic alterations were analyzed by observation of body weight and animal activity, along with proportional changes of splenocytes for natural killer cells, macrophages, and T and B lymphocytes. Modulation of plasma cytokine level and immune-related genes were also ascertained by micro-bead assay and a microarray method, respectively. The immune micro-environment of db/db mice was an inflammatory state and adaptive cellular immunity was significantly suppressed. Low-dose alcohol administration reversed the immune response, decreasing inflammatory responses and the increment of adaptive immunity mainly related to CD4(+) T cells, but not CD8(+) T cells, to normal background levels. Systemic immune modulation due to alcohol administration in the obese-diabetic mouse model may be useful in the understanding of the induction mechanism, which will aid the development of therapeutics for related secondary diseases.

Steam-dried ginseng berry fermented with Lactobacillus plantarum controls the increase of blood glucose and body weight in type 2 obese diabetic db/db mice

This study examined whether steam-dried ginseng berries fermented with Lactobacillus plantarum (FSGB) could improve the indices of type 2 diabetes mellitus (T2DM) in obese db/db mice. FSGB was shown to have an effect on body weight and blood glucose/serum parameters when administered at a dose of 0.5 g/kg. In the intraperitoneal glucose tolerance test (IPGTT) and insulin tolerance test (ITT), FSGB was clearly shown to improve insulin tolerance and glucose tolerance. Moreover, FSGB was shown to enhance immune activities by increasing the immune cell population, and glucose transpoter 1 (GLUT1) mRNA expression in L6 cells was up-regulated, suggesting that FSGB can increase glucose transport activity in target cells. These results indicate that steam- and dry-processed ginseng berries fermented with L. plantarum can be used to effectively control blood sugar metabolism via improving insulin and glucose tolerance and body weight gain in db/db mice.

A prospective evaluation of lower extremity ulcers in a Zimbabwean population

Aetiological factors and their frequencies, causes, level and impact of immunosuppression on outcome of lower extremity ulcers were prospectively recorded. A total of 100 patients were evaluated. Consent for HIV testing was given by 68 patients and 31 (46%) of these were HIV infected. Thirty patients were diabetic. CD 4+ T-lymphocyte count was assessed in 41 patients. Eleven were HIV infected with a mean CD 4+ count of 229 +/- 137 cells/microl. Six had non insulin-dependent diabetes mellitus (NIDDM) with a mean CD 4+ count 430 +/- 308 cells/microl. Five had both HIV infection and NIDDM with a mean CD 4+ count of 299 +/- 120 cells/microl. All three groups differed from the normal 707 +/- 285 cells/microl found in 17 non HIV-infected non diabetic patients (P < 0. 05). The main aetiologies were bacterial infection, arterial disease, trauma and neuropathy. Ulcer healing and limb salvage were noted in 71%. Mortality was 10%; seven in HIV-infected and three in non HIV-infected non diabetic patients (P = 0. 06). Amputation rate was 9%. Persisting ulcers were noted in 8% and 2% were lost to follow-up. Our evaluation shows that wound aetiologies in Zimbabwe differ from those in the West. Immunosuppression because of HIV infection and NIDDM was noted in more than half of the patients. HIV infection may increase mortality in this group of patients.

Long term effects of high fat and sucrose diets on obesity and lymphocyte proliferation in mice

OBJECTIVE

To clarify the effect of prolonged feeding of a high-fat and sucrose, and to clarify the effect of sucrose instead of other carbohydrate on obesity and immunity in C57BL/6J mice.

METHODS

We investigated the development of obesity and immune cell function in four groups of mice fed high-fat, high-fat plus high-sucrose, high-sucrose, and control diet for 7 months.

RESULTS

Mice fed high-fat and high-fat plus high-sucrose groups developed severe obesity. Body weight, adipose tissue weight, serum leptin, blood glucose, and insulin were significantly higher, while the level of serum soluble leptin receptor was significantly lower in mice fed high-fat and high-fat plus high-sucrose diets than in mice fed the control or high-sucrose diets. Splenocyte proliferation stimulated by T-cell mitogen (PHA, ConA, and anti-CD 3 antibody) and B-cell mitogen (LPS) was significantly lower in both obese, high-fat and high-fat plus high-sucrose groups than in control and high-sucrose groups. However, these parameters did not differ between high-fat and high-fat plus high-sucrose groups.

CONCLUSIONS

Long-term feeding of high-fat diet and high-fat plus high-sucrose diet similarly induced severe obesity in C57BL/6J mice. Not only T-cell, but also B-cell function may be impaired in mice made severely obese by the high-fat or high-fat plus high-sucrose diets.

Normative variation in self-reported sleep quality and sleep debt is associated with stimulated pro-inflammatory cytokine production

Activation of innate inflammatory pathways, marked by increased production of pro-inflammatory cytokines, has been proposed as a potential mechanism linking poor sleep and inflammatory disease risk. In the present study, we examined associations of self-reported sleep quality and duration, and a calculated measure of sleep debt with the production of pro-inflammatory cytokines, interleukin (IL)-6, IL-1beta, and tumor necrosis factor (TNF)-alpha among a community sample of 156 healthy adults. Bivariate correlations revealed an inverse association between sleep quality and production of all the three pro-inflammatory cytokines that was retained for IL-1beta after controlling for demographic and health characteristics. Hierarchical linear regressions also revealed that higher sleep debt scores predicted greater production of IL-1beta and IL-6 after adjusting for covariates. Secondary analyses showed an interaction between sleep debt and body mass index (BMI) in the prediction IL-1beta, suggesting that the impact of sleep debt on cytokine production is greater among participants with lower BMI scores. Further exploration of this potential psychophysiological pathway linking sleep difficulty and inflammatory disease susceptibility is warranted.

Effect of weight loss on cytokine messenger RNA expression in peripheral blood mononuclear cells of obese subjects with the metabolic syndrome

Inflammation is associated with obesity, the metabolic syndrome, and diabetes. No data are available on the effect of weight reduction on the gene expression of cytokines in immune cells in obesity and the metabolic syndrome. We assessed how long-term weight loss affects expression of cytokines in peripheral blood mononuclear cells (PBMCs) in individuals with impaired glucose metabolism and the metabolic syndrome. Data from 34 subjects randomized to either a weight reduction or a control group for a 33-week period were analyzed. The messenger RNA (mRNA) expression of interleukins (ILs) in PBMCs was measured using real-time polymerase chain reaction. Measures of insulin and glucose metabolism (intravenous and oral glucose tolerance tests), body composition, and circulating adipokines and inflammatory markers were also assessed. Weight reduction resulted in a decrease in the mRNA expression of IL-1beta (IL1B), IL-1 receptor antagonist, and tumor necrosis factor alpha (P < .001) and an increase in expression of IL-6 (IL6) and IL-8 (P < .01). The increase in IL6 expression was associated with a decrease in fasting glycemia (r = -0.53, P < .01). Interestingly, the decrease in IL1B expression was correlated with an increase in insulin sensitivity index (r = -0.68, P < .01). In general, a decrease in circulating levels of adipokines and inflammatory markers was also observed after weight loss. Weight loss altered gene expression of cytokines related to inflammation and the immune response in PBMCs. Changes in IL6 mRNA expression were associated with changes in fasting glycemia. The decrease in IL-1 receptor antagonist expression after weight loss and the strong correlation between the decrease in IL1B expression and the increase in insulin sensitivity suggest a contribution of these genes to insulin-resistant states found in obesity and the metabolic syndrome.

Decreased splenic mRNA expression levels of TNF-alpha and IL-6 in diet-induced obese animals

Obesity could be considered as a systemic low-grade inflammatory condition affecting inflammation markers. Adipose tissue synthesizes cytokines whose degree of elevation may depend on the obesity status. Recently, new information is collected on the cross-talking between immune system and adipose tissue in obesity. We report hereby that tumor necrosis factor alpha (TNF-alpha) and interleukin 6 (IL-6) gene expression in spleen of diet-induced obese animals were markedly decreased (more than 50%) as a consequence of the high fat feeding during five weeks. Interestingly, a very significant negative correlation was found between splenic TNF-alpha mRNA levels and total fat pads (r = -0.806, p = 0.000). These findings support the hypothesis that TNF-alpha gene expression may follow different trends in obese animals adipocytes and splenocytes.

Antiretroviral Drugs with Adverse Effects on Adipocyte Lipid Metabolism and Survival Alter the Expression and Secretion of Proinflammatory Cytokines and Adiponectin In Vitro

Objective

The lipodystrophy syndrome is a major adverse effect of highly active antiretroviral therapy (HAART), associated with altered circulating levels and adipose tissue mRNA expression of proinflammatory cytokines interleukin-6 (IL-6) and tumour necrosis factor (TNF)α, and adiponectin. Proinflammatory cytokines and adiponectin, which are secreted by adipose tissue, regulate fat metabolism, insulin sensitivity and adipose cell apoptosis. We examined the direct effects of individual antiretrovirals on lipid metabolism and cytokine and adiponectin production by cultured adipocytes.

Methods

Differentiating 3T3-F442A cells and differentiated 3T3-L1 adipocytes were treated for 12 or 4 days, respectively, with protease inhibitors (PIs) indinavir, nelfinavir, amprenavir, lopinavir and ritonavir, or nucleoside reverse transcriptase inhibitors (NRTIs) stavudine and zidovudine, at near-Cmax concentrations. Lipid metabolism was estimated by Oil Red O staining of intracellular lipids, mRNA expression of fatty acid synthase and adipocyte lipid binding protein 2, and insulin activation of lipogenesis. Apoptosis was estimated by flow cytometry. The expression and secretion of proinflammatory cytokines (IL-6, TNFα and IL-1β) and adiponectin were evaluated by real-time reverse transcription PCR and ELISA.

Results

Chronic treatment of 3T3-F442A differentiating adipocytes and differentiated 3T3-L1 adipocytes with PIs and NRTIs reduced lipid accumulation, mRNA expression of lipid markers and insulin-induced lipogenesis. IL-6, TNFα, IL-1β and adiponectin expression and secretion were markedly altered in differentiating 3T3-F442A adipocytes. PIs had either no effect on differentiated 3T3-L1 adipocytes (TNFα expression and secretion) or their effect was less marked than in 3T3-F442A cells. Indinavir and amprenavir did not alter cytokine secretion and expression by mature adipocytes. The effects of stavudine and zidovudine on differentiating and mature adipocytes were similar, despite the difference in treatment procedure. The drugs with the strongest effect on TNFα expression also increased adipocyte apoptosis, in contrast to the drugs that only moderately increased TNFα expression.

Conclusions

These results suggest that increased cytokine and decreased adiponectin secretion and expression induced by some PIs and NRTIs may contribute to the adipose tissue loss (via apoptosis and lipid leakage) and insulin resistance associated with the lipodystrophy syndrome.