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Adeva-Andany MM, Carneiro-Freire N, Castro-Quintela E, Ameneiros-Rodriguez E, Adeva-Contreras L, Fernandez-Fernandez C. Interferon Upregulation Associates with Insulin Resistance in Humans. Curr Diabetes Rev 2025; 21:86-105. [PMID: 38500280 DOI: 10.2174/0115733998294022240309105112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 02/10/2024] [Accepted: 02/21/2024] [Indexed: 03/20/2024]
Abstract
In humans, insulin resistance is a physiological response to infections developed to supply sufficient energy to the activated immune system. This metabolic adaptation facilitates the immune response but usually persists after the recovery period of the infection and predisposes the hosts to type 2 diabetes and vascular injury. In patients with diabetes, superimposed insulin resistance worsens metabolic control and promotes diabetic ketoacidosis. Pathogenic mechanisms underlying insulin resistance during microbial invasions remain to be fully defined. However, interferons cause insulin resistance in healthy subjects and other population groups, and their production is increased during infections, suggesting that this group of molecules may contribute to reduced insulin sensitivity. In agreement with this notion, gene expression profiles (transcriptomes) from patients with insulin resistance show a robust overexpression of interferon- stimulated genes (interferon signature). In addition, serum levels of interferon and surrogates for interferon activity are elevated in patients with insulin resistance. Circulating levels of interferon- γ-inducible protein-10, neopterin, and apolipoprotein L1 correlate with insulin resistance manifestations, such as hypertriglyceridemia, reduced HDL-c, visceral fat, and homeostasis model assessment-insulin resistance. Furthermore, interferon downregulation improves insulin resistance. Antimalarials such as hydroxychloroquine reduce interferon production and improve insulin resistance, reducing the risk for type 2 diabetes and cardiovascular disease. In addition, diverse clinical conditions that feature interferon upregulation are associated with insulin resistance, suggesting that interferon may be a common factor promoting this adaptive response. Among these conditions are systemic lupus erythematosus, sarcoidosis, and infections with severe acute respiratory syndrome-coronavirus-2, human immunodeficiency virus, hepatitis C virus, and Mycobacterium tuberculosis.
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Affiliation(s)
- Maria M Adeva-Andany
- Internal Medicine Department, Hospital General Juan Cardona, c/ Pardo Bazán s/n, 15406 Ferrol, Spain
| | - Natalia Carneiro-Freire
- Internal Medicine Department, Hospital General Juan Cardona, c/ Pardo Bazán s/n, 15406 Ferrol, Spain
| | - Elvira Castro-Quintela
- Internal Medicine Department, Hospital General Juan Cardona, c/ Pardo Bazán s/n, 15406 Ferrol, Spain
| | - Eva Ameneiros-Rodriguez
- Internal Medicine Department, Hospital General Juan Cardona, c/ Pardo Bazán s/n, 15406 Ferrol, Spain
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Afarid M, Azimi A, Meshksar A, Sanie-Jahromi F. Interferons in vitreoretinal diseases; a review on their clinical application, and mechanism of action. Int Ophthalmol 2024; 44:223. [PMID: 38727788 DOI: 10.1007/s10792-024-03144-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/11/2024] [Indexed: 07/12/2024]
Abstract
PURPOSE This review investigates the therapeutic benefits of interferons (IFNs) in vitreoretinal diseases, focusing on their regulatory roles in innate immunological reactions and angiogenesis. The study aims to categorize the clinical outcomes of IFN applications and proposes a molecular mechanism underlying their action. METHODS A systematic review was conducted using MEDLINE/PubMed, Web of Science, EMBASE, and Google Scholar databases to identify randomized clinical trials, case series, and case-control studies related to IFNs' impact on vitreoretinal diseases (1990-2022). The data synthesis involved an in-depth analysis of the anti-inflammatory and anti-angiogenesis effects of IFNs across various studies. RESULTS Our findings indicate that IFNs exhibit efficacy in treating inflammation-associated vitreoretinal disorders. However, a lack of sufficient evidence exists regarding the suitability of IFNs in angiogenesis-associated vitreoretinal diseases like choroidal neovascularization and diabetic retinopathies. The synthesis of data suggests that IFNs may not be optimal for managing advanced stages of angiogenesis-associated disorders. CONCLUSION While IFNs emerge as promising therapeutic candidates for inflammation-related vitreoretinal diseases, caution is warranted in their application for angiogenesis-associated disorders, especially in advanced stages. Further research is needed to elucidate the nuanced molecular pathways of IFN action, guiding their targeted use in specific vitreoretinal conditions.
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Affiliation(s)
- Mehrdad Afarid
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Zand Boulevard, Poostchi Street, Shiraz, Iran
| | - Ali Azimi
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Zand Boulevard, Poostchi Street, Shiraz, Iran
| | - Aidin Meshksar
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Zand Boulevard, Poostchi Street, Shiraz, Iran
| | - Fatemeh Sanie-Jahromi
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Zand Boulevard, Poostchi Street, Shiraz, Iran.
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Martins LM, Fernandes VO, de Carvalho MMD, Gadelha DD, de Queiroz PC, Montenegro RM. Type B insulin resistance syndrome: a systematic review. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2020; 64:337-348. [PMID: 32813762 PMCID: PMC10522085 DOI: 10.20945/2359-3997000000257] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 03/02/2020] [Indexed: 01/27/2023]
Abstract
A literature review on the clinical, laboratory, and treatment features of type B insulin resistance syndrome (TBIRS). Data from PubMed, the Virtual Health Library and Cochrane database were selected and analyzed using the REDCap application and R statistical program. From 182 papers, 65 were selected, which assessed 119 clinical cases, 76.5% in females and 42.9% in African-Americans, with an average age of 44 years. A common feature of TBIRS is co-occurrence of autoimmune diseases, such as systemic lupus erythematosus (most frequently reported). Hyperglycemia of difficult control was the mostly reported condition. Tests for anti-insulin receptor antibodies were positive in 44.2% of the cases. Disease management comprised fractional diet, insulin therapy (maximum dose given was 57 600 IU/day), plasmapheresis and immunosuppression with several classes of drugs, mainly glucocorticoids. Remission occurred in 69.7% of cases, in 30.3% of these spontaneously. The mortality rate was 15.38%. There was an inverse relationship between anti-insulin antibodies and remission (p = 0.033); and a positive correlation between combined immunosuppressive therapy and remission (p = 0.002). Relapse occurred in 7.6% of the cases. This rare syndrome has difficult-to-control diabetes, even with high doses of insulin, and it is usually associated with autoimmune diseases. Therapeutic advances using immunomodulatory therapy have led to significant improvements in the rate of remission.
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Affiliation(s)
- Luizianne Mariano Martins
- Hospital Universitário Walter CantídioFaculdade de MedicinaUniversidade Federal do CearáFortalezaCEBrasilHospital Universitário Walter Cantídio, Faculdade de Medicina, Universidade Federal do Ceará (UFC), Fortaleza, CE, Brasil
| | - Virgínia Oliveira Fernandes
- Hospital Universitário Walter CantídioFaculdade de MedicinaUniversidade Federal do CearáFortalezaCEBrasilHospital Universitário Walter Cantídio, Faculdade de Medicina, Universidade Federal do Ceará (UFC), Fortaleza, CE, Brasil
| | - Manuela Montenegro Dias de Carvalho
- Hospital Universitário Walter CantídioFaculdade de MedicinaUniversidade Federal do CearáFortalezaCEBrasilHospital Universitário Walter Cantídio, Faculdade de Medicina, Universidade Federal do Ceará (UFC), Fortaleza, CE, Brasil
| | - Daniel Duarte Gadelha
- Hospital Universitário Walter CantídioFaculdade de MedicinaUniversidade Federal do CearáFortalezaCEBrasilHospital Universitário Walter Cantídio, Faculdade de Medicina, Universidade Federal do Ceará (UFC), Fortaleza, CE, Brasil
| | - Paulo Cruz de Queiroz
- Hospital Universitário Walter CantídioFaculdade de MedicinaUniversidade Federal do CearáFortalezaCEBrasilHospital Universitário Walter Cantídio, Faculdade de Medicina, Universidade Federal do Ceará (UFC), Fortaleza, CE, Brasil
| | - Renan Magalhães Montenegro
- Hospital Universitário Walter CantídioFaculdade de MedicinaUniversidade Federal do CearáFortalezaCEBrasilHospital Universitário Walter Cantídio, Faculdade de Medicina, Universidade Federal do Ceará (UFC), Fortaleza, CE, Brasil
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Censi S, Mian C, Betterle C. Insulin autoimmune syndrome: from diagnosis to clinical management. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:335. [PMID: 30306074 DOI: 10.21037/atm.2018.07.32] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Autoimmune forms of hypoglycemia are a rare cause of low blood sugar levels among Caucasians, and often go misdiagnosed, exposing patients to lengthy series of pointless, potentially harmful and expensive tests. There are two types of autoimmune hypoglycemia. One is insulin autoimmune syndrome (IAS), which is characterized by hyperinsulinemic hypoglycemia, elevated insulin autoantibody (IAA) titers, no prior exposure to exogenous insulin, and no of pathological abnormalities of the pancreatic islets. This condition is also known as "Hirata's disease". The other is type B insulin resistance syndrome (TBIRS), a rare autoimmune disorder resulting in a broad array of abnormalities in glucose homeostasis-from hypoglycemia to extremely insulin-resistant hyperglycemia-caused by the presence of insulin receptor autoantibodies (IRAbs). This review focuses on these two syndromes, describing their epidemiology, possible genetic background, clinical presentation, pathophysiology, diagnosis and treatment.
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Affiliation(s)
- Simona Censi
- Endocrinology Unit, Department of Medicine (DIMED), University of Padova, Padova, Italy
| | - Caterina Mian
- Endocrinology Unit, Department of Medicine (DIMED), University of Padova, Padova, Italy
| | - Corrado Betterle
- Endocrinology Unit, Department of Medicine (DIMED), University of Padova, Padova, Italy
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Huang Q, Yan Y, Zhao H, Zuo L. A systemic lupus erythematosus patient presenting as type B insulin resistance complicated with cryoglobulinemia. Lupus 2017; 26:95-97. [PMID: 27416845 DOI: 10.1177/0961203316655209] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 05/04/2016] [Indexed: 02/05/2023]
Abstract
Systemic lupus erythematosus (SLE) patients may present with various symptoms and multisystem damage. We reported a 63-year-old male patient with SLE presenting as type B insulin resistance (TBIR) complicated with cryoglobulinemia. TBIR is an extremely rare disease, which is a manifestation of anti-insulin receptor antibodies (AIRA). Clinical feature is a sudden onset of hyperglycemia with major weight loss; however, the ensuing refractory hypoglycemia is more fatal. The average dosage of exogenous insulin is 5100 U/d. SLE patients with AIRA had poor prognosis, most of whom died of SLE activity. Cryoglobulins are immunoglobulins that reversibly precipitate in the cold, which will induce clinical symptoms. Non-infectious mixed cryoglobulinemia is frequently secondary to autoimmune diseases, such as SLE. Our patient was prescribed methylprednisolone (MP) and cyclophosphamide (CTX). Finally he had remission during the short-term follow-up. To our knowledge, this is the first case report of an SLE patient presenting as TBIR complicated with cryoglobulinemia.
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Affiliation(s)
- Q Huang
- Department of Gastroenterology, Peking University People's Hospital, Beijing, China
| | - Y Yan
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - H Zhao
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - L Zuo
- Department of Nephrology, Peking University People's Hospital, Beijing, China
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Chien CH, Lin CL, Hu CC, Chang JJ, Chien RN. Clearance of Hepatitis C Virus Improves Insulin Resistance During and After Peginterferon and Ribavirin Therapy. J Interferon Cytokine Res 2015; 35:981-9. [PMID: 26308911 DOI: 10.1089/jir.2014.0200] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Patients with chronic hepatitis C virus (HCV) infection are at a greater risk of developing insulin resistance (IR). However, little is known about when insulin sensitivity may improve during or after treatment for hepatitis C. In this study, we examined the effect of combination therapy with pegylated interferon-α and ribavirin on IR in patients with chronic HCV infection. We also analyzed factors associated with changes in insulin sensitivity. IR was estimated by homeostasis model assessment (HOMA-IR). HOMA-IR was measured before therapy, during therapy (12 and 24 weeks), and at the end of therapy (EOT; 24 or 48 weeks). We analyzed 78 HCV patients receiving combination therapy. Twenty-two patients (28.2%) exhibited pretreatment IR (HOMA-IR >2.5). In all patients, HOMA-IR was not significantly different from baseline values at 12 weeks (P = 0.823), 24 weeks (P = 0.417), or at EOT (P = 0.158). In patients with pretreatment IR, a significant decrease in HOMA-IR was observed at 12 weeks (P = 0.023), 24 weeks (P = 0.008), and at EOT (P = 0.002). Multivariate analysis using a logistic regression model showed that baseline HOMA-IR is the only factor associated with the decline in HOMA-IR during and after therapy. The eradication of HCV infection was associated with improved insulin sensitivity among patients with pretreatment IR. This significant improvement in insulin sensitivity may occur as early as 12 weeks after the initiation of antiviral therapy.
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Affiliation(s)
- Cheng-Hung Chien
- Liver Research Unit, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University , Keelung, Taiwan
| | - Chih-Lang Lin
- Liver Research Unit, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University , Keelung, Taiwan
| | - Ching-Chih Hu
- Liver Research Unit, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University , Keelung, Taiwan
| | - Jia-Jang Chang
- Liver Research Unit, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University , Keelung, Taiwan
| | - Rong-Nan Chien
- Liver Research Unit, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University , Keelung, Taiwan
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Zhang S, Wang G, Wang J. Type B insulin resistance syndrome induced by systemic lupus erythematosus and successfully treated with intravenous immunoglobulin: case report and systematic review. Clin Rheumatol 2012; 32:181-8. [PMID: 23053690 DOI: 10.1007/s10067-012-2098-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 09/16/2012] [Accepted: 09/21/2012] [Indexed: 11/24/2022]
Abstract
Type B insulin resistance syndrome is characterized by the formation of autoantibodies against insulin receptors, which can cause severe hyperglycemia and insulin resistance. Systemic lupus erythematosus is the most common underlying diseases of the syndrome. This report details our study of a case involving a Chinese female with type B insulin resistance syndrome as well as systemic lupus erythematosus who completely recovered after undergoing immunosuppressive therapy, specifically pulse therapy utilizing intravenous immunoglobulin. We also conducted search in MEDLINE and Chinese BioMedicine database to identify relevant literatures published in the past 46 years. From our searches, six case reports in Chinese, 15 case reports, and a 28-year perspective article in English met our criteria; a total of 67 cases were included in our report. The mean age of subjects at presentation for groups A, B, and C were 42.95, 44.10, and 41.68 years, respectively, yielding no significant difference between these groups. African Americans were the most susceptible group to type B insulin resistance syndrome, followed by Asians representing 20.90 % of all cases. Comparisons between the three main racial groups surveyed indicated that the mean age of subjects at presentation were very contiguous for African Americans and Asians, and mean age of white people was remarkably higher than either of the first two groups. The syndrome appeared most common among Asian males, and white males were relatively less likely to suffer from type B insulin resistance syndrome. Hypoglycemia was most commonly observed in white people than in other racial groups. Hypoalbuminemia, elevated serum immunoglobulin G, and elevated sedimentation rates were more common in African Americans; Asian cases were more likely to show low serum C3 or C4 and nephritis. Two cases received intravenous immunoglobulin therapy, which has a remarkably rapid effect on insulin resistance.
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Affiliation(s)
- Sigong Zhang
- Department of Rheumatology, China-Japan Friendship Hospital, 2 Yinghua East Road, Chaoyang District, Beijing 100029, People's Republic of China
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Ponte CMM, Gurgel MHC, Ponte GA, Ramos AVA, Montenegro Júnior RM. [Metabolic disorders in emerging and neglected infectious diseases]. ACTA ACUST UNITED AC 2011; 54:785-92. [PMID: 21340170 DOI: 10.1590/s0004-27302010000900003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Accepted: 12/17/2010] [Indexed: 12/17/2022]
Abstract
The gradual and progressive replacement of infectious and parasitic by chronic diseases as causes of morbidity and mortality, characterizing the process of epidemiological transition hasn't been observed in various populations, especially in underdeveloped or developing countries characterizing a superposition of these profiles (incomplete transition). Besides the increased prevalence of metabolic disorders, various infectious diseases remain endemic in several regions, such as leprosy, tuberculosis, leishmaniasis, viral hepatitis, among others, as well as emerging diseases in recent decades, as HIV infection/Aids. In this context, more attention has been given to the occurrence of metabolic disturbances in the recent years, mainly from the observation of a high incidence of metabolic disorders associated with HIV infection/Aids, and its therapy with antiretroviral drugs. This review addresses clinical and epidemiological aspects of metabolic disturbances reported in some infectious and parasitic diseases with worldwide and local (Brazil) relevance, as well as possible mechanisms and factors involved in these associations.
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Chebane L, Tavassoli N, Bagheri H, Montastruc JL. [Drug-induced hyperglycemia: a study in the French pharmacovigilance database]. Therapie 2010; 65:447-58. [PMID: 21144480 DOI: 10.2515/therapie/2010051] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Accepted: 03/01/2010] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To analyse drugs inducing hyperglycemia by using data reported to the French spontaneous reporting system and recorded in the French PharmacoVigilance Database (FPVD). METHODS All cases with a report of hyperglycemia and/or diabetes in the French database between 1985 and 2008 were included in the study. We estimated the risk of hyperglycemia linked to drugs by the case/non-case method. Cases were reports including hyperglycemia and non cases all other reports. This risk was estimated through calculation of reporting odds ratios (ROR). RESULTS During this period, 1219 reports including the words "hyperglycemia and/or diabetes" were registered (0.34% of the database). This adverse drug reaction occurred 1 fold over 4 in diabetics or as a part of HIV infection. Effect was "serious" in approximatively 50% of cases. We found an increase of risk during exposition with methylprednisolone [ROR=43.5; 95% CI (37.3-50.8)], tacrolimus [ROR=25; 95% CI (17.9-34.8)], olanzapine [ROR=19.9; 95% CI (14.9-26.5)], prednisone [ROR=18.9; 95% CI (15.7-22.8)] or pentamidine [ROR=15.4; 95% CI (8.2-28.3)]. CONCLUSION Drug classes most frequently found in FPVD linked to hyperglycemia are antiretroviral, steroidal anti-inflammatory, second generation neuroleptic, immunosuppressive and diuretic drugs.
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Affiliation(s)
- Leila Chebane
- Laboratoire de Pharmacologie Médicale et Clinique, Unité de Pharmacoépidémiologie EA 3696, Université de Toulouse, Faculté de Médecine, Toulouse, France
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