October 18, 2019 | Deborah Kotz
Researchers outlined immune dysfunction in mice that leads to more severe respiratory infections in those with diabetes
Since the Middle East respiratory syndrome coronavirus (MERS-CoV) first emerged in Saudi Arabia in 2012, there have been more than 2,400 confirmed cases of the infection, resulting in greater than 800 deaths – an alarming fatality rate of 35 percent. For this reason, researchers have been eager to identify any risk factors that contribute to the development of severe or lethal disease. Current clinical evidence points to diabetes as a major risk factor in addition to other comorbidities including kidney disease, heart disease, and lung disease.
Researchers from the University of Maryland School of Medicine (UMSOM) and the Johns Hopkins University School of Medicine have demonstrated in a new study, published earlier this week in the Journal of Clinical Investigation Insights, how diabetes contributes to mortality from MERS-CoV infections, and the finding could shed light on why other respiratory illnesses like the flu or pneumonia might strike those with diabetes more severely.
They investigated the connection between diabetes and MERS-CoV in a mouse model and discovered that although the virus did not replicate more readily in the diabetic mice compared to the healthy controls, the diabetic mice exhibited a delayed and prolonged inflammatory response in the lung. Diabetic mice had lower levels of inflammatory cytokines and fewer inflammatory macrophages and T cells. This indicates that the increased severity of MERS-CoV infection in patients with diabetes was likely due to a malfunction in the body’s response to infection.
“Understanding how diabetes contributes to disease severity following MERS-CoV infection in this context is critical,” said Matthew Frieman, PhD, associate professor of microbiology and immunology who is the corresponding author of the study. “Our next step is to determine what drives the altered immune response in diabetics and how to reverse those effects with therapeutics for treatment of patients.”
Follow up research could also explore whether health care providers should double their efforts to manage and stabilize glucose levels in patients with diabetes experiencing a dangerous respiratory infection and whether better management would help mitigate the effects of these infections.
“This is an important finding for patients with diabetes and physicians who treat them,” said UMSOM Dean E. Albert Reece, MD, PhD, MBA, who is also the Executive Vice President for Medical Affairs, University of Maryland and the John Z. and Akiko K. Bowers Distinguished Professor. “We have long known that diabetic patients have worse outcomes when they get a serious infectious disease, but this new insight on immune function could pave the way for better treatments.”
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Now in its third century, the University of Maryland School of Medicine was chartered in 1807 as the first public medical school in the United States. It continues today as one of the fastest growing, top-tier biomedical research enterprises in the world -- with 43 academic departments, centers, institutes, and programs; and a faculty of more than 3,000 physicians, scientists, and allied health professionals, including members of the National Academy of Medicine and the National Academy of Sciences, and a distinguished recipient of the Albert E. Lasker Award in Medical Research. With an operating budget of more than $1 billion, the School of Medicine works closely in partnership with the University of Maryland Medical Center and Medical System to provide research-intensive, academic and clinically based care for more than 1.2 million patients each year. The School has over 2,500 students, residents, and fellows, and more than $540 million in extramural funding, with most of its academic departments highly ranked among all medical schools in the nation in research funding. As one of the seven professional schools that make up the University of Maryland, Baltimore campus, the School of Medicine has a total workforce of nearly 7,000 individuals. The combined School and Medical System (“University of Maryland Medicine”) has an annual budget of nearly $6 billion and an economic impact more than $15 billion on the state and local community. The School of Medicine faculty, which ranks as the 8th highest among public medical schools in research productivity, is an innovator in translational medicine, with 600 active patents and 24 start-up companies. The School works locally, nationally, and globally, with research and treatment facilities in 36 countries around the world. Visit medschool.umaryland.edu
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Deborah Kotz
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