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Diabetes mellitus und Immunantwort bei pyogenen Infektionen

Diabetes mellitus and the immune response to pyogenic infections

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Zusammenfassung

Hintergrund

Diabetes mellitus prädisponiert für eine Vielzahl von Infektionserkrankungen. Das Risiko für pyogene Infektionen ist etwa 2‑ bis 4‑fach erhöht, wobei Staphylococcus aureus einer der wichtigsten Erreger ist. Neben Komorbiditäten führen v. a. Dysfunktionen des Immunsystems zu einer erhöhten Infektanfälligkeit.

Ergebnisse

Trotz teils widersprüchlicher Ergebnisse ist insgesamt eine Reihe von Immundysfunktionen beschrieben. Beeinträchtigungen der Funktion der Granulozyten umfassen reduzierte Chemotaxis, Phagozytose und Bakterizidie mit verringertem oxidativem Burst. Eine erniedrigte pathogeninduzierte Apoptose bei Granulozyten geht mit einer längeren Entzündungsreaktion und Zytokinproduktion einher. Auf Seiten der humoralen Immunantwort sind erniedrigte IgG-Spiegel (Ig: Immunglobulin) sowie eine Inhibition der Komplementaktivierung und Opsonisation beschrieben. Eine gestörte Prostaglandin-E2-Produktion ist mit einer verminderten Reifung dendritischer Zellen und einer erniedrigten TH17-Antwort (TH17: Typ-17-T-Helferzelle) assoziiert. Zusätzlich gibt es Hinweise, dass auf Seiten der Pathogene erhöhte Glukosekonzentrationen zu Adaptationen mit veränderter Genexpression und teils erhöhter Virulenz führen.

Schlussfolgerung

Zusammenfassend ist von einer multifaktoriellen Genese des erhöhten Infektionsrisikos bei Diabetespatienten auszugehen. Neben prädisponierenden Begleiterkrankungen sind v. a. eine Beeinträchtigung der angeborenen Immunantwort in Kombination mit der Virulenz typischer Erreger Ursache der erhöhten Inzidenz pyogener Infektionen.

Abstract

Background

Diabetes mellitus predisposes to variety of infectious diseases. The risk for pyogenic infections is increased 2‑ to 4‑fold, with Staphylococcus aureus being among the most important pathogens. Apart from comorbidities, dysfunction of the immune system leads to an increased susceptibility to infections.

Results

Despite conflicting results, several disturbances of the immune system have been described. Impairments of granulocyte function comprise reduced chemotaxis, phagocytosis, and bacterial killing with reduced oxidative burst. Decreased pathogen-induced granulocyte apoptosis leads to prolonged inflammation and production of inflammatory cytokines. Lower IgG (Ig: immunoglobulin) levels and inhibition of complement activation and opsonization are found on the side of the humoral immune response. Disturbed prostaglandin E2 production leads to a reduced maturation of dendritic cells and a lower Th17 response (Th17: T helper 17 cell). Additionally, evidence suggests that pathogens adapt to increased glucose concentrations with altered gene expression and increased virulence.

Conclusions

A multifactorial genesis of the increased susceptibility to infections observed in patients with diabetes mellitus is assumed. Besides predisposing comorbidities mainly disturbances of the innate immune system in combination with the virulence of typical pathogens form the basis of the increased incidence of pyogenic infections.

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Authors and Affiliations

  1. Interdiziplinäre Notaufnahme und Stabsstelle Infektiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland

    F. Hanses

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Hanses, F. Diabetes mellitus und Immunantwort bei pyogenen Infektionen. Diabetologe 14, 138–144 (2018). https://doi.org/10.1007/s11428-018-0320-4

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