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Inflammatory Cytokine Concentrations Are Acutely Increased by Hyperglycemia in Humans: Role of Oxidative Stress
Abstract
Background— Circulating levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) are elevated in diabetic patients. We assessed the role of glucose in the regulation of circulating levels of IL-6, TNF-α, and interleukin-18 (IL-18) in subjects with normal or impaired glucose tolerance (IGT), as well as the effect of the antioxidant glutathione. Methods and Results— Plasma glucose levels were acutely raised in 20 control and 15 IGT subjects and maintained at 15 mmol/L for 5 hours while endogenous insulin secretion was blocked with octreotide. In control subjects, plasma IL-6, TNF-α, and IL-18 levels rose ( P <0.01) within 2 hours of the clamp and returned to basal values at 3 hours. In another study, the same subjects received 3 consecutive pulses of intravenous glucose (0.33 g/kg) separated by a 2-hour interval. Plasma cytokine levels obtained at 3, 4, and 5 hours were higher ( P <0.05) than the corresponding values obtained during the clamp. The IGT subjects had fasting plasma IL-6 and TNF-α levels higher ( P <0.05) than those of control subjects. The increase in plasma cytokine levels during the clamping lasted longer (4 hours versus 2 hours, P <0.01) in the IGT subjects than in the control subjects, and the cytokine peaks of IGT subjects after the first glucose pulse were higher ( P <0.05) than those of control subjects. On another occasion, 10 control and 8 IGT subjects received the same glucose pulses as above during an infusion of glutathione; plasma cytokine levels did not show any significant change from baseline after the 3 glucose pulses. Conclusions— Hyperglycemia acutely increases circulating cytokine concentrations by an oxidative mechanism, and this effect is more pronounced in subjects with IGT. This suggests a causal role for hyperglycemia in the immune activation of diabetes.
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“Similarly, a negative influence of postprandial hypertriglyceridemia on endothelial function has been reported in both normal and diabetic subjects.”
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“Other studies have demonstrated that fluctuations in blood glucose levels may contribute more to outcomes than constant high blood glucose concentrations.31–35”
From Increased Time in Range and Fewer Missed Bolus Injections After Introduction of a Smart Connected Insulin Pen (2020) · cites this paper as [32]
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“This has been corroborated by several observational studies of type 2 diabetic patients [14,35], but also in interventional studies in patients fitted with hyperglycaemic clamps and undergoing glucose challenge, in whom inflammatory cytokines increase after glucose input [36].”
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“Second, SSBs may cause symptoms of depression by increasing the circulating cytokine concentration through hyperglycemia [26].”
BackgroundEndotrophin as a Marker of Complications in a Type 2 Diabetes Cohort
Tougaard, N. H., Møller, A. L., Rønn, P. F., Hansen, T. W., Genovese, F., Karsdal, M. A., Rasmussen, D. G. K., & Rossing, P. R. (2022) · Diabetes Care · doi:10.2337/dc22-0852 · Cited by 20
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Beneficial Effect of Insulin Treatment on Islet Transplantation Outcomes in Akita Mice
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“Inflammatory cytokine concentrations increased as a result of hyperglycemia in humans [46].”
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“At the molecular level, hyperglycemia affects proinflammatory cytokine production [8] and the function of polymorphonuclear leukocytes [9] and T cells [10].”
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Glycemia and the cardioprotective effects of insulin pre-conditioning in the isolated rat heart
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“Perioperative hyperglycemia, a typical metabolic feature of the surgical stress response and established risk factor for adverse outcomes after cardiac surgery [4], has long been recognized to inhibit certain signal transduction pathways relevant for cardioprotection [5], to stimulate the production of pro-inflammator…”
BackgroundSoda Intake Is Directly Associated with Serum C-Reactive Protein Concentration in Mexican Women
Taméz, M., Monge, A., López‐Ridaura, R., Fagherazzi, G., Rinaldi, S., Ortiz‐Panozo, E., Yunes, E. M., Romieu, I., & Lajous, M. (2018) · Journal of Nutrition · doi:10.1093/jn/nxx021 · Cited by 20
Changing glucose control target and risk of surgical site infection in a Southeast Asian population
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Hyperglycemia in Nondiabetic Patients Presenting With Acute Myocardial Infarction
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Oral Glyburide, But Not Glimepiride, Blocks the Infarct-Size Limiting Effects of Pioglitazone
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“DM and hyperglycemia cause systemic inflammation [7, 8], endothelial dysfunction [9, 10], hypercoagulable state with impaired fibrinolysis [11, 12] and increased platelet degranulation [13, 14], reduces coronary collateral blood flow [15], and interfere with myocardial protection by preconditioning [16–18].”
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“independent of MVPA [8] and could by its effects on glycemia and through other mechanisms, contribute to CRP reduction [9].”
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“ment based on the level of pro-inflammatory cytokines may be an option for adequate glucose control [50, 51].”
BackgroundDiabetes Alone Does Not Impair Recovery From Uneventful Cataract Surgery
Danni, R., Taipale, C., Ilveskoski, L., & Tuuminen, R. (2018) · American Journal of Ophthalmology · doi:10.1016/j.ajo.2018.09.030 · Cited by 20
“Hyperglycemia increases the circulating cytokine levels associated with oxidative stress and immune activation.(22) Further, activation of proapoptotic pathways, angiopoietin-2 signaling, and consecutive vasoregression evidenced by pericyte loss have been identified as early pathologic features of diabetic posterior s…”
BackgroundPharmacotherapy for gestational diabetes
Patti, A. M., Giglio, R. V., Pafili, K., Rizzo, M., & Papanas, N. (2018) · Expert Opinion on Pharmacotherapy · doi:10.1080/14656566.2018.1509955 · Cited by 19
“Carotid intima-media thickness (CIMT) is a non-invasive marker of subclinical atherosclerosis [33] and is a surrogate marker of CVD in metabolic patients [33].”
BackgroundInfluentialInterleukin-18 and testosterone levels in men with metabolic syndrome
Angelova, P., Kamenov, Z. A., Tsakova, A. D., El‐Darawish, Y., & Okamura, H. (2017) · The Aging Male · doi:10.1080/13685538.2017.1401993 · Cited by 18
Zhu, W., Qiu, Q., Luo, H., Zhang, F., Wu, J., Zhu, X., & Liang, M. (2020) · Stem Cells International · doi:10.1155/2020/4910767 · Cited by 19
“Esposito and colleagues revealed that TNF-α concentration was acutely increased by hyperglycemia in human subjects through an oxidative mechanism [29], and the excessive TNF-α is closely related to diabetic complications by inducing endothelial cell apoptosis under high-glucose condition [30].”
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Kim, J.-H., Kim, B.-S., Han, K., & Kwon, H. (2023) · Diabetes & Metabolism Journal · doi:10.4093/dmj.2022.0275 · Cited by 19
“In addition, Esposito et al. [5] report-ed that hyperglycemia itself is a pro-inflammatory state.”
BackgroundPro-Inflammatory Food, Gut Microbiota, and Cardiovascular and Pancreatic Diseases
Chen, B., Patel, S., Bao, L., Nadeem, D., & Krittanawong, C. (2024) · Biomolecules · doi:10.3390/biom14020210 · Cited by 18
Cardiac energy metabolism in diabetes: emerging therapeutic targets and clinical implications
Panwar, A., Malik, S. O., Adib, M., & Lopaschuk, G. D. (2025) · American Journal of Physiology-Heart and Circulatory Physiology · doi:10.1152/ajpheart.00615.2024 · Cited by 19
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“An inflammatory response that follows prolonged food intake is not a novel concept [6,32-42].”
Background
Metadata
- Authors
- Esposito, K., Nappo, F., Marfella, R., Giugliano, G., Giugliano, F., Ciotola, M., Quagliaro, L., Ceriello, A., & Giugliano, D.
- Affiliations
- University of Udine (IT)
- Venue
- Circulation
- Published
- 2002-10-15
- Volume
- 106
- Issue
- 16
- Pages
- 2067-2072
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2123560318
- Cited by
- 1,961
- References
- 36
- Citations by year
- 2026: 57 · 2025: 69 · 2024: 88 · 2023: 95 · 2022: 106 · 2021: 91 · 2020: 102 · 2019: 83 · 2018: 86 · 2017: 70 · 2016: 87 · 2015: 112 · 2014: 99 · 2013: 102 · 2012: 101
- FWCI
- 38.18
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Institutional Research Information System (University of Udine) (submittedVersion)
- Archivio Istituzionale della Ricerca - Università degli Studi della Campania "Luigi Vanvitelli" (submittedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adipokines, Inflammation, and Metabolic Diseases
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Advanced Glycation End Products research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- hyperglycemia, inflammatory cytokines, interleukin-6, TNF-α, IL-18, impaired glucose tolerance, glutathione, oxidative stress, glucose clamp
- MeSH terms
- Adult, Antioxidants, Blood Glucose, Diabetes Mellitus, Type 2, Female, Glucose Tolerance Test, Glutathione, Humans, Inflammation, Kinetics, Male, Tumor Necrosis Factor-alpha, Interleukin-6, Cytokines, Glucose Intolerance, Oxidative Stress, Interleukin-18
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