Hyperinsulinemia counteracts inflammation by suppressing IFNg and inducing senescence in CD4+ T cells of patients with rheumatoid arthritis

Malin C Erlandsson, Lauri Weman, Eric Malmhall-Bah, Venkataragavan Chandrasekaran, Mahomud Tuameh, Karin ME Andersson, Sofia T Silfversward, Lisa Nilsson, Tatiana Zverkova Sandstrom, Rille Pullerits, Mats Dehlin, Tuulikki Sokka-Isler, Maria I Bokarewa
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Abstract

Background. Clinical evidence connects hyperinsulinemia with obesity, and development of type 2 diabetes (T2D). However, its role in autoimmune conditions was questioned. We investigated consequences of hyperinsulinemia for development of T2D and CD4+T cell function in rheumatoid arthritis (RA). Methods. Incident T2D was prospectively studied in two independent RA cohorts and in gout patients matched to RA by age and gender, for 10 years. Effect of hyperinsulinemia and JAK-STAT signaling inhibition (JAKi) in CD4+T cells was studied by integrating transcriptional sequencing with direct effect of insulin, and JAKi on cell proliferation, DNA enrichment, and cytokine production. Results. T2D was 3.2-2.5 times less prevalent in RA compared to gout, particularly in females. Hyperinsulinemia predicted the development of T2D, regardless of metabolic parameters and insulin resistance. Additionally, hyperinsulinemia correlated with the senescence-associated high serum levels of IL6, IL8, and VEGF. Hyperinsulinemia, along with ex-vivo exposure of CD4+ cells to insulin, inhibited cell cycle progression and induced DNA enrichment through the suppression of the PI3K-Src kinases and cell cycle promoting genes. It also reduced IFNg production. JAKi-treated CD4+ cells regained insulin sensitivity, which activated glucose metabolism and facilitated senescence. This insulin-dependent mechanism promoted the accumulation of naive CD4+ cells in JAKi-treated patients. Conclusions. This study shows that insulin has important immunosuppressive ability controlling the adaptive immunity by suppressing IFNg production and inducing senescence in the effector CD4+ T cells. Inhibition of JAK-STAT signaling enhances insulin sensitivity and rejuvenates CD4+ cell population in RA patients.
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高胰岛素血症通过抑制 IFNg 和诱导类风湿性关节炎患者 CD4+ T 细胞衰老来抵消炎症反应
背景。临床证据表明,高胰岛素血症与肥胖和 2 型糖尿病(T2D)的发病有关。然而,高胰岛素血症在自身免疫性疾病中的作用却受到质疑。我们研究了高胰岛素血症对类风湿性关节炎(RA)T2D和CD4+T细胞功能的影响。我们对两个独立的 RA 群体以及与 RA 年龄和性别相匹配的痛风患者进行了为期 10 年的前瞻性 T2D 研究。通过整合转录测序以及胰岛素和 JAKi 对细胞增殖、DNA 富集和细胞因子产生的直接影响,研究了高胰岛素血症和 JAK-STAT 信号抑制(JAKi)对 CD4+T 细胞的影响。研究结果与痛风相比,T2D在RA中的发病率低3.2-2.5倍,尤其是在女性中。无论代谢参数和胰岛素抵抗如何,高胰岛素血症都预示着T2D的发生。此外,高胰岛素血症与衰老相关的高血清 IL6、IL8 和血管内皮生长因子水平相关。高胰岛素血症以及体内外将CD4+细胞暴露于胰岛素可抑制细胞周期的进展,并通过抑制PI3K-Src激酶和细胞周期促进基因诱导DNA富集。它还能减少 IFNg 的产生。经 JAKi 处理的 CD4+ 细胞恢复了对胰岛素的敏感性,从而激活了葡萄糖代谢并促进了衰老。这种胰岛素依赖机制促进了JAKi治疗患者体内幼稚CD4+细胞的积累。这项研究表明,胰岛素具有重要的免疫抑制能力,可通过抑制 IFNg 的产生和诱导效应 CD4+ T 细胞衰老来控制适应性免疫。抑制JAK-STAT信号传导可增强胰岛素敏感性,并使RA患者的CD4+细胞群恢复活力。
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