Westwell-Roper Clara, Nackiewicz Dominika, Dan Meixia, Ehses Jan A
Department of Pathology and Laboratory Medicine, Faculty of Medicine, The University of British Columbia, Child and Family Research Institute, Vancouver, British Columbia, Canada.
Department of Surgery, Faculty of Medicine, The University of British Columbia, Child and Family Research Institute, Vancouver, British Columbia, Canada.
Immunol Cell Biol. 2014 Apr;92(4):314-23. doi: 10.1038/icb.2014.4. Epub 2014 Feb 4.
The global health and economic burden of type 2 diabetes (T2D) has reached staggering proportions. Current projections estimate that 592 million people will have diabetes by 2035. T2D-which comprises 90% of cases-is a complex disease, in most cases resulting from a combination of predisposing genes and an unhealthy environment. Clinical onset of the disease occurs when pancreatic β cells fail in the face of insulin resistance. It has long been appreciated that chronic activation of the innate immune system is associated with T2D, and many organs critical to the regulation of glucose homeostasis show signs of a chronic inflammatory process, including the pancreatic islets of Langerhans. Recent clinical trials using IL-1-targeting agents have confirmed that inflammation contributes to β-cell failure in humans with T2D. However, little is known about the nature of the pro-inflammatory response within the islet, and there is considerable debate about the triggers for islet inflammation, which may be systemically derived and/or tissue-specific. In this review, we present evidence that Toll-like receptors 2 and 4 and the NLRP3 (Nucleotide-binding oligomerization domain, Leucine-rich Repeat and Pyrin domain containing 3) inflammasome are triggers for islet inflammation in T2D and propose that the activation of macrophages by these triggers mediates islet endocrine cell dysfunction. Therapeutically targeting these receptors may improve hyperglycemia and protect the β cell in T2D.
2型糖尿病(T2D)给全球健康和经济带来的负担已达到惊人的程度。目前的预测估计,到2035年将有5.92亿人患有糖尿病。T2D占糖尿病病例的90%,是一种复杂的疾病,在大多数情况下是由易感基因和不健康环境共同作用导致的。当胰腺β细胞在面对胰岛素抵抗时功能衰竭,疾病就会出现临床发作。长期以来,人们一直认识到先天免疫系统的慢性激活与T2D有关,许多对葡萄糖稳态调节至关重要的器官都显示出慢性炎症过程的迹象,包括胰岛。最近使用白细胞介素-1靶向药物的临床试验证实,炎症会导致T2D患者的β细胞功能衰竭。然而,关于胰岛内促炎反应的本质知之甚少,对于胰岛炎症的触发因素也存在相当大的争议,这些触发因素可能是全身性的和/或组织特异性的。在这篇综述中,我们提供证据表明,Toll样受体2和4以及NLRP3(含核苷酸结合寡聚化结构域、富含亮氨酸重复序列和吡啉结构域3)炎性小体是T2D中胰岛炎症的触发因素,并提出这些触发因素激活巨噬细胞会介导胰岛内分泌细胞功能障碍。针对这些受体进行治疗可能会改善T2D患者的高血糖状况并保护β细胞。