炎症和氧化应激在肥胖、代谢综合征和糖尿病

我不认为任何人甚至远程连接领域的糖尿病患者,作为研究员或卫生保健提供者,将有严重的反对这个概念,某种程度的改变炎症活动或氧化应激在多个方面扮演一个严重的糖尿病。提到最有名的两个过程,一个暴力,急性炎症事件导致β细胞的破坏在1型糖尿病的发病和慢性亚临床炎症状态是底部缓慢发展的微型和macrovascular并发症占较大的部分所有形式的糖尿病发病率和死亡率相关。这个连接导致显著增加,近年来在这一领域的研究活动。运行一个搜索PubMed和“炎症和糖尿病”作为搜索条件,例如,返回14059篇文章;“氧化应激与糖尿病”8850篇文章;“炎症和动脉粥样硬化”11209篇文章;”和“炎症和心血管疾病49245篇文章。一个较小的程度上,这个特殊问题的内容是一个明显的例子的多样性和复杂性问题的预防、诊断、管理、和治疗糖尿病、一个或多个炎症或氧化应激组件也扮演着关键的角色。

炎症和氧化应激反应,然而,是两个非常广泛和全面的术语。这当然财富的研究和结果澄清了大量的途径,介质和监管机制、基因和转录后的监管机构的炎症和氧化应激相关基因表达。然而,考虑到非常大,不断增加,涉及的细胞和分子数量,它经常觉得新问题积累的速度远远超过之前的问题是明确回答。我们已经确定了数以百计的细胞因子和趋化因子,其完整的生理功能仍然在许多情况下,模糊的。术语如“pro”或“抗炎,“早些时候与个人密切相关炎症介质(如促炎白细胞介素- 6)定义的经典,现在更不情愿使用,同一分子经常显示不明确的活动,甚至从一个极端转到另一个,这取决于周围的代谢或信号环境。更重要的是,往往只有一些组件的复杂的炎症网络改变了在一个特定的病理状态。识别这些组件是什么,并使用它们作为生物标志物的出现,发展和对治疗的反应的一个给定的条件已经成为炎症的主要集中研究。然而,这些生物标记物的巨大的多样性呈现极其困难的任务。让我们假设,为了讨论,一群细胞因子,或某些白细胞表面活化的标志,是证实在人口显著增加糖尿病患者(比如说年轻白人成年男性2型糖尿病患者),和他们的增加成正比endothelia早期功能障碍的程度在这些科目。虽然这一块的知识可以导致治疗和预防工作在这个特定的人群,它马上引发了这些生物标志物是否有效的问题在其他人群,也就是说,在不同的年龄,性别,种族,不同程度的糖尿病控制,不同的疾病的持续时间,等等。 In short, each set of chosen inflammatory biomarkers should be closely tailored to as well defined a subpopulation of subjects as possible, which would obviously require an enormous amount of research work. This work is feasible and should indeed be planned and systematically performed. It is obvious, however, that to cover all aspects of the interaction between altered inflammation, oxidative stress, and diabetes (with associated prediabetic states such as obesity and metabolic syndrome), no single laboratory or group of laboratories can have the ability to perform all necessary studies. To really produce conclusive, reproducible, nonredundant results complementing each other and truly generating all interlocking pieces of an all-inclusive inflammatory jig-saw puzzle, a global scale, coordinated effort must be undertaken by a very large number of competent research groups, addressing in a synergistic, collaborative way the most pressing questions and then systematically chipping away at all collateral issues. Essential to this task is also the establishment of capillary informatics tools that would allow the immediate and complete exchange of data across groups, as soon as they are being gathered. While such an entity does not currently exist, at least not of the scale proposed here, many collaborations are indeed being formed across research groups, and the outlook for the future seems positive. In the meantime, I do not mean to discount the importance of many very good individual studies that are clarifying specific aspects of this broad issue. Given the immeasurable size of the task ahead, each new piece of information is precious, helpful, and welcome.

Pietro Galassetti

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