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Inflammation, stress, and diabetes
Kathryn E. Wellen, Gökhan S. Hotamisligil
Kathryn E. Wellen, Gökhan S. Hotamisligil
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Inflammation, stress, and diabetes

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Abstract

Over the last decade, an abundance of evidence has emerged demonstrating a close link between metabolism and immunity. It is now clear that obesity is associated with a state of chronic low-level inflammation. In this article, we discuss the molecular and cellular underpinnings of obesity-induced inflammation and the signaling pathways at the intersection of metabolism and inflammation that contribute to diabetes. We also consider mechanisms through which the inflammatory response may be initiated and discuss the reasons for the inflammatory response in obesity. We put forth for consideration some hypotheses regarding important unanswered questions in the field and suggest a model for the integration of inflammatory and metabolic pathways in metabolic disease.

Authors

Kathryn E. Wellen, Gökhan S. Hotamisligil

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Figure 2

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Lipids and inflammatory mediators: integration of metabolic and immune r...
Lipids and inflammatory mediators: integration of metabolic and immune responses in adipocytes and macrophages through shared mechanisms. Under normal conditions, adipocytes store lipids and regulate metabolic homeostasis, and macrophages function in the inflammatory response, although each cell type has the capacity to perform both functions. In obesity, adipose tissue becomes inflamed, both via infiltration of adipose tissue by macrophages and as a result of adipocytes themselves becoming producers of inflammatory cytokines. Inflammation of adipose tissue is a crucial step in the development of peripheral insulin resistance. In addition, in proatherosclerotic conditions such as obesity and dyslipidemia, macrophages accumulate lipid to become foam cells. Adipocytes and macrophages share common features such as expression of cytokines, FABPs, nuclear hormone receptors, and many other factors. As evidenced by genetic loss-of-function models, adipocyte/macrophage FABPs modulate both lipid accumulation in adipocytes and cholesterol accumulation in macrophages, as well as the development of insulin resistance and atherosclerosis. PPARγ and LXR pathways oppose inflammation and promote cholesterol efflux from macrophages and lipid storage in adipocytes.

Copyright © 2026 American Society for Clinical Investigation
ISSN: 0021-9738 (print), 1558-8238 (online)

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