title: Interleukin-18 resistance in patients with obesity and type 2 diabetes mellitus.
abstract: OBJECTIVE
  Interleukin-18 (IL-18) has been recently demonstrated to improve experimental hyperphagia and insulin resistance. Paradoxically, concentrations of circulating IL-18 in obese subjects and in patients with type 2 diabetes are increased. The objective of this study is to provide an explanation for this paradox.
  
  
  METHODS
  We have hypothesized that cells from obese individuals or from patients with type 2 diabetes mellitus have a diminished response to stimulation with IL-18. IL-18 responsiveness was tested by stimulating blood monocytes of obese or diabetes patients with rIL-18 or microbial components.
  
  
  RESULTS
  Obese individuals and patients with type 2 diabetes mellitus exhibit increased circulating concentrations of IL-18. More importantly, leukocytes isolated from obese or type 2 diabetes patients respond poorly after stimulation with IL-18, as reflected by defective interferon-gamma (IFN gamma) production. The defective response to IL-18 stimulation was accompanied by a 50% reduction in the expression of IL-18R alpha and beta chains. In addition, cells of patients with obesity and diabetes displayed an impaired release of IFN gamma after challenge with bacterial or fungal pathogens, which was due to defective IL-18-mediated signaling.
  
  
  CONCLUSIONS
  Patients with obesity or type 2 diabetes mellitus are characterized by lower responses after stimulation with IL-18. This IL-18 resistance explains the association of obesity and diabetes with high IL-18 circulating concentrations, similar to hyperinsulinemia and hyperleptinemia. IL-18 resistance may represent an important mechanism of the increased susceptibility of these patients to a number of infections.
authors.affiliation: Department of General Internal Medicine, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
authors.forename: G R C
authors.initials: GR
authors.lastname: Zilverschoon
authors.forename: C J
authors.initials: CJ
authors.lastname: Tack
authors.forename: L A B
authors.initials: LA
authors.lastname: Joosten
authors.forename: B J
authors.initials: BJ
authors.lastname: Kullberg
authors.forename: J W M
authors.initials: JW
authors.lastname: van der Meer
authors.forename: M G
authors.initials: MG
authors.lastname: Netea
mesh_terms: D000328:Adult; D002176:Candida albicans / Q000276:immunology; D002478:Cells, Cultured; D003924:Diabetes Mellitus, Type 2 / Q000276:immunology*; D005260:Female; D006801:Humans; D007371:Interferon-gamma / Q000096:biosynthesis; D020382:Interleukin-18 / Q000097:blood / Q000276:immunology*; D008070:Lipopolysaccharides / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000276:immunology; D009765:Obesity / Q000276:immunology*; D011994:Recombinant Proteins / Q000276:immunology; D013211:Staphylococcus aureus / Q000276:immunology; D013851:Thinness / Q000276:immunology
chemical_list: D020382:Interleukin-18; D008070:Lipopolysaccharides; D011994:Recombinant Proteins; D007371:Interferon-gamma