Metainflammation in Diabetic Coronary Artery Disease: Emerging Role of Innate and Adaptive Immune Responses

Figure 1

Role of innate immune response in triggering metainflammation associated with DM-CAD. Pattern recognition receptors (PRRs) are the well characterized innate immune receptors which trigger metainflammation following recognition of both pathogen associated molecular patterns (PAMPs) and damage associated molecular patterns (DAMPs). Viral nucleic acids, endotoxins, and peptidoglycans are some of the PAMPS which are released into the circulation following metabolic endotoxemia. Free fatty acids and self-nucleoproteins are some of the endogenous ligands which act as DAMPs. The end result is the activation of NF-κB and IRFs which in turn activate proinflammatory cytokines and type-1 interferons, respectively. These inflammatory mediators destroy pancreatic beta cells leading to insulin deficiency and induce inflammation at insulin target organs leading to insulin resistance (IR) eventually precipitating in Type-2 Diabetes. Long standing diabetes induces systemic inflammation leading to monocyte activation and endothelial dysfunction leading to the extravasation of monocytes and formation of atherosclerotic plaques.