A new ratio derived from inflammasome markers can serve as a marker of assessment of glycemic index in children with Type 1 diabetes

Zhian M I Dezayee; Marwan S M Al-Nimer

doi:10.4103/jrms.JRMS_773_18

Previous article Browse articles Next article

ORIGINAL ARTICLE

J Res Med Sci 2022, 27:14

A new ratio derived from inflammasome markers can serve as a marker of assessment of glycemic index in children with Type 1 diabetes

Zhian M I Dezayee¹, Marwan S M Al-Nimer²
¹ Department of Microbiology-Immunology, College of Health Sciences, Hawler Medical University, Erbil, Iraq
² College of Medicine, University of Diyala, Baqubah, Iraq

Date of Submission	05-Oct-2018
Date of Decision	15-Aug-2020
Date of Acceptance	05-Oct-2021
Date of Web Publication	18-Feb-2022

Correspondence Address:
Dr. Marwan S M Al-Nimer
College of Medicine, University of Diyala, Baqubah 32001
Iraq

Source of Support: None, Conflict of Interest: None

Check

DOI: 10.4103/jrms.JRMS_773_18

Abstract

Background: Mature inflammasome markers play a role in the development of Type 1 diabetes (T1D). This cross-sectional study aimed to derive ratios from the serum levels of interleukins (ILs): IL-1β and IL-18 and to relate their values with glycemic index and anti-inflammatory markers (IL-4 and IL-10) in children with T1D. Materials and Methods: This study was conducted at Hawler Medical University in Erbil-Iraq from April to July 2018. Healthy subjects (Group I, n = 40) and patients (Group II, n = 76) were recruited from primary schools and the Center of Diabetes in Erbil, respectively. Glycemic indices (including fasting serum glucose, insulin, glycosylated hemoglobin, and peptide C) and pro- and anti-inflammatory markers (including high-sensitivity C-reactive protein, IL-1β, IL-18, IL-4, and IL-10 and the ratio of neutrophil or platelet to lymphocyte) were determined. Results: Cutoff values of 105 pg/mL, 85 pg/mL, and 1.235 for serum IL-1β, IL-18, and IL-1β to IL-18 ratio, respectively, were found to be significant discriminators of glycemic index and anti-inflammatory markers with respect to the calculated area under the curve. Conclusion: A ratio of IL-1β to IL-18 adjusted to 1.235 can serve as a useful marker of assessment of glycemic index. This ratio does not discriminate the status of anti-inflammatory markers (IL-4 and IL-10) in children with T1D.

Keywords: Glycemic index, inflammasome, Type 1 diabetes

How to cite this article:
Dezayee ZM, Al-Nimer MS. A new ratio derived from inflammasome markers can serve as a marker of assessment of glycemic index in children with Type 1 diabetes. J Res Med Sci 2022;27:14

How to cite this URL:
Dezayee ZM, Al-Nimer MS. A new ratio derived from inflammasome markers can serve as a marker of assessment of glycemic index in children with Type 1 diabetes. J Res Med Sci [serial online] 2022 [cited 2023 Mar 24];27:14. Available from: https://www.jmsjournal.net/text.asp?2022/27/1/14/337901

Introduction

Type 1 diabetes (T1D) is an autoimmune disease characterized by the presence of autoantibodies in circulation which act against pancreatic β-islet cells. Evidence of existed inflammation in T1D had been documented by significantly high levels of cytokines and other pro- and inflammatory markers.^[1],[2],[3] Interleukin-1β (IL-1β) is a member of IL-1 family that is found in inflammasome as immature cytokines, and it is released into circulation after two steps of inflammasome activation.^[4] IL-1β can cause death of islet β-cell of pancreas in patients with insulin-dependent diabetes (T1D), and a high serum level of IL-1β had been observed significantly.^[5] On the other hand, serum IL-1β is significantly high in Type 2 diabetes and is inversely correlated with serum insulin level, indicating that IL-1β suppresses the secretion of insulin from β-cells.^[6] IL-18 is also a member of inflammasome, and it is secreted into the circulation after stimulation of inflammasome by certain triggers, for example, silicon particle and uric acid.^[7] One of the important functions of IL-18 is inhibiting the production of IL-1β.^[8] Active inflammasome plays a crucial role in complications due to diabetes in the form of both IL-1β- and IL-18-induced cell death by pyroptosis.^[9] Activated inflammasome by hyperglycemia plays an important role in inducing cell death by pyroptosis and enhancing fibrosis by activating fibroblasts.^[10] An imbalance between IL-1β and IL-18 secretions from the active inflammasome may interfere the production of anti-inflammatory cytokines, for example, IL-4 and IL-10, which may affect the glycemic status.^[11] Therefore, this cross-sectional study aimed to determine the cutoff levels of serum IL-1β, IL-18, and IL-1β to IL-18 ratio and to relate these values with glycemic index and anti-inflammatory markers in children with T1D.

Materials and Methods

This cross-sectional study was approved by the Ethical Scientific Committee of Hawler Medical University according to the guidelines established by the university. The authors ensured the parents or the proxy of the patients that any treatment or device used will not harm the patient, and the patient can withdraw from the study at any time.

The parents or the proxy of the patients signed a consent form before their child was included in the study. Eligible patients were children of both genders aged less than 13 years old. T1D patients without clinical evidence of complications, those with short duration of illnesses, and those with positive autoantibody test (islet cell and glutamic acid decarboxylase-67 antibodies) were included in the study. Patients with renal or liver or autoimmune disease, those with inflammatory disease, those with recent infectious or connective tissue diseases, or those using medicines related with steroids or nonsteroidal anti-inflammatory drugs were excluded from the study. This cross-sectional study was conducted in the Department of Microbiology/Immunology-College of Health Sciences at Hawler Medical University in cooperation with the Center of Diabetes in Erbil-Iraq from April to July 2018. Healthy subjects and patients were recruited from the primary schools (Group I, n = 40) and from the Center of Diabetes (Group II, n = 76), respectively. The sample size of Group II patients was calculated by using margin of errors (α =0.05, β =0.2), two tails, and 95% confidence interval.

Clinical data and measurements

The consultant endocrinologists and the authors examined each patient and measured the anthropometric variables, including the weight (kg) and height (m). Calculated body mass index (kg/m²) was determined by using the Quetlet's formula. A 12-h night fasting venous blood was drawn from each patient, which was divided into two portions: one portion was added into ethylenediaminetetraacetic acid (EDTA)-tubes for the determination of hematological indices by using automated coulter hematological analyzer, and glycosylated hemoglobin (HbA1c) was determined by using colorimetric methods after separating plasma by centrifugation, washing the cell pellet, and hemolyzing the red cells. The non-EDTA blood portion was centrifuged at 3000 rpm for 15 min, and the sera were separated for determining the following:

Determination of serum autoantibodies (islet cell and glutamic acid decarboxylase 67) using enzyme-linked immunosorbent antibodies (ELISA). Patients (Group II) with a negative test as well as healthy adolescents (Group I) with positive tests were excluded. Fasting serum glucose was determined by enzymatic method using a visible spectrophotometer
Determination of glycemic indices, included fasting serum insulin and C-peptide levels, was made by using ELISA
Measurement of inflammatory markers, including high-sensitivity C-reactive protein (hS-CRP), IL-1β, IL-4, IL-10, and IL-18 in the sera of the patients, was done by using ELISA technique.

The neutrophil-to-lymphocyte (NLR) ratio and platelet-to-lymphocyte ratio (PLR) were calculated, which served as inflammatory markers.

Statistical analysis

The results were expressed as number, percentage, and mean ± standard deviation. A two-tailed, independent two-sample t-test was performed to compare the laboratory measurements of the groups. Correlations between cytokine markers and glycemic parameters were assessed by bivariate linear correlation (Spearman's test). The sensitivity and the specificity of the IL-1β (cutoff = 105 pg/mL), IL-18 (cutoff = 85 pg/mL), the ratio of IL-1β to IL-18 (cutoff = 1.235), and the area under the curve (AUC) were calculated using the inflammasome markers as discriminators. All statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS) version 20 (IBM corporation product, Armonk, New York, USA).

Results

[Table 1] shows that Group I and Group II were of age and gender matched. The mean value of the body mass index of Group II patients was significantly higher than the corresponding value of Group I by 10.7% [Table 1]. Glycemic indices including fasting serum glucose and glycosylated hemoglobin were significantly high, whereas the fasting serum C-peptide and insulin were significantly low in Group II [Table 1]. The mean serum levels of inflammatory markers, including hS-CRP, IL-1β, and IL-18, significantly increased in Group II when compared with the corresponding values of Group I. The serum levels of anti-inflammatory markers, including IL-4 and IL-10, were significantly low in Group II when compared with the corresponding values of Group I [Table 1]. NLR was significantly higher in Group II patients compared to Group I patients, which increased by 18%, whereas the PLR declined by 24.5% [Table 1]. The ratio of IL-1β to IL-18 increased by 12.27% in T1D patients in reference to the healthy subjects. Bivariate Spearman's correlation between the ratio of Il-1β to IL-18 with body mass index, glycemic indices, and inflammatory or anti-inflammatory markers did not reach significant levels in both groups except with glycosylated hemoglobin which significantly and inversely correlated (r = −0.539, P < 0.001) [Table 2]. The AUC (using IL-1β as a discriminator with a cutoff value ≥105 pg/mL) was significantly high for glycosylated hemoglobin, fasting serum C-peptide, and serum IL-4, while it was significantly low for serum IL-10 and fasting serum insulin [Table 3] and [Figure 1]. The AUC (using IL-18 as a discriminator with a cutoff value ≥85 pg/mL) was significantly high for glycosylated hemoglobin [Table 3] and [Figure 1]. The AUC (using the ratio of IL-1β to IL-18 as a discriminator with a cutoff value ≥1.235) was significantly low for glycosylated hemoglobin [Table 3] and [Figure 1].

Figure 1: The area under the curve of the glycemic, inflammatory, and anti-inflammatory markers using the ratio of interleukin-1β/interleukin-18, interleukin-1β, and IL-18 as discriminators. The cutoff values are 105 pg/mL, 85 pg/mL, and 1.235 for serum IL-1β, IL-18, and IL-1β to IL-18 ratio, respectively

Click here to view

Table 1: Characteristics of the participants enrolled in the study

Click here to view

Table 2: Correlations between the ratio of interlekin-1β to interleukin-18 and the glycemic, inflammatory, and anti-inflammatory markers in healthy subjects (Group I) and type 1diabetic patients (Group II)

Click here to view

Table 3: The area under the curve of the glycemic, inflammatory, and anti-inflammatory markers using the ratio of interleukin-1β to interleukin-18, interleukin-1β and interleukin-18 as discriminators

Click here to view

Discussion

The results of this study show that the levels of IL-1β and IL-18 were reversed in T1D compared with those of healthy subjects. A significant inverse correlation between the ratio of IL-1β to IL-18 and glycosylated hemoglobin indicates that this ratio is a useful marker in assessing glycemic index. A cutoff value of ≥1.235 can discriminate patients with low glycosylated hemoglobin. The results of this study show that the serum levels of IL-1β and IL-18 did not correlate with the serum levels of hS-CRP, IL-4, and IL-10. Previous studies have showed a link between polymorphism of IL-4, IL-1β gene, and risk of T1D.^[12] Other studies have demonstrated a relationship between the ratio of IL-4 and IL-13 with the development of T1D, which claimed that the effects of Th-1 and Th-17 cytokines in animals deficient in IL-13 gene can induce T1D.^[13] In this study, a new ratio derived from the markers of inflammasomes can potentially serve as a marker of control of T1D. A cutoff value of 1.235 that represents the ratio of IL-1β to IL-18 indicates that a higher level of IL-1β is necessary to regulate the glycemic index. There is evidence that low serum IL-1β is associated with high titer of autoantibodies.^[14] Moreover, it has been shown that in children with early-onset T1D with positive CAD65 autoantibodies, the levels of plasma IL-1β are significantly higher (9.3 ± 7.3 pg/mL) than the corresponding values of healthy children (4.9 ± 3.8 pg/mL), which accounted 1.9 folds. However, IL-1β is necessary to overcome the effect of autoantibodies against the islet β-cells, but at the same time, IL-1β involves in inducing apoptosis of β-cells. Recent experimental animal models that mimic T1D demonstrate that as a result of inhibition of caspase-3, the levels of IL-1β get reduced accompanied by an improvement in the glycemic profile.^[15],[16] Therefore, it is necessary to obtain a balance between the release of IL-1β and IL-18. Pancreatic cells produce IL-18 which plays a role in inducing inflammation and thereby pancreatic cell injury.^[17],[18] Therefore, upregulation of IL-1β to counteract autoantibodies and downregulation of IL-18 to counteract the insulinitis can offer an improvement in glycemic index as the present study demonstrates a ratio of 1.235.

Conclusion

We conclude that the ratio of IL-1β to IL-18 adjusted to 1.235 can serve as a useful marker of assessment of glycemic index by the significant evidence of an inverse correlation between this ratio and glycosylated hemoglobin and a significant low AUC of glycosylated hemoglobin at a cutoff of 1.235 of this ratio as a discriminator. This ratio does not discriminate the status of anti-inflammatory markers (IL-4 and IL-10) in children with T1D.

Acknowledgments

It is a great pleasure to thank the endocrinologists and the laboratory workers at the Center of Diabetes who helped us in recruiting the patients and the Faculty of Health Sciences who gave us the opportunity to conduct this research. This study was registered and approved by the ethical board of the university (Registration No. 183 in February 11, 2018).

Financial support and sponsorship

This study was financially supported by the College of Health Sciences, Hawler Medical University.

Conflicts of interest

There are no conflicts of interest.

References

1.	Stechova K, Sklenarova-Labikova J, Kratzerova T, Pithova P, Filipp D. Not only glycaemic but also other metabolic factors affect T regulatory cell counts and proinflammatory cytokine levels in women with type 1 diabetes. J Diabetes Res 2017;2017:5463273.
2.	Brorsson CA, Nielsen LB, Andersen ML, Kaur S, Bergholdt R, Hansen L, et al. Genetic risk score modelling for disease progression in new-onset type 1 diabetes patients: Increased genetic load of islet-expressed and cytokine-regulated candidate genes predicts poorer glycemic control. J Diabetes Res 2016;2016:9570424.
3.	Dezayee ZM. The status of serum γ-interferonand antiviral antibodies in patients with type I and type 2 diabetes: A comparative study. J Res Med Sci 2012;17:855-8.
4.	Monteleone M, Stanley AC, Chen KW, Brown DL, Bezbradica JS, von Pein JB, et al. Interleukin-1β maturation triggers its relocation to the plasma membrane for gasdermin-D-dependent and -independent secretion. Cell Rep 2018;24:1425-33.
5.	Dogan Y, Akarsu S, Ustundag B, Yilmaz E, Gurgoze MK. Serum IL-1beta, IL-2, and IL-6 in insulin-dependent diabetic children. Mediators Inflamm 2006;2006:59206.
6.	Mojtaba E, Mahdi K, Mehdi K, Amir S. Serum interleukin-1 beta plays an important role in insulin secretion in type II diabetic. Int J Biosci 2011;1:93-9.
7.	Wang Y, Yang C, Mao K, Chen S, Meng G, Sun B. Cellular localization of NLRP3 inflammasome. Protein Cell 2013;4:425-31.
8.	Robuffo I, Toniato E, Tettamanti L, Mastrangelo F, Ronconi G, Frydas I, et al. Mast cell in innate immunity mediated by proinflammatory and antiinflammatory IL-1 family members. J Biol Regul Homeost Agents 2017;31:837-42.
9.	Volpe CM, Anjos PM, Nogueira-Machado JA. Inflammasome as a new therapeutic target for diabetic complications. Recent Pat Endocr Metab Immune Drug Discov 2016;10:56-62.
10.	Luo B, Huang F, Liu Y, Liang Y, Wei Z, Ke H, et al. NLRP3 inflammasome as a molecular marker in diabetic cardiomyopathy. Front Physiol 2017;8:519.
11.	Pérez F, Oyarzún A, Carrasco E, Angel B, Albala C, Santos JL. Plasma levels of interleukin-1beta, interleukin-2 and interleukin-4 in recently diagnosed type 1 diabetic children and their association with beta-pancreatic autoantibodies. Rev Med Chil 2004;132:413-20.
12.	Allam G, Nasr A, Talaat IM, Abuelsaad AS, Bakheit AM, Nemenqani D, et al. Association between cytokine genes polymorphisms and type 1 diabetes: A case-control study on Saudi population. Immunol Invest 2018;47:229-40.
13.	Ukah TK, Cattin-Roy AN, Chen W, Miller MM, Barik S, Zaghouani H. On the role IL-4/IL-13 heteroreceptor plays in regulation of type 1 diabetes. J Immunol 2017;199:894-902.
14.	Alkanani AK, Rewers M, Dong F, Waugh K, Gottlieb PA, Zipris D. Dysregulated Toll-like receptor-induced interleukin-1β and interleukin-6 responses in subjects at risk for the development of type 1 diabetes. Diabetes 2012;61:2525-33.
15.	Liu L, Du X, Zhang Z, Zhou J. Trigonelline inhibits caspase 3 to protect β cells apoptosis in streptozotocin-induced type 1 diabetic mice. Eur J Pharmacol 2018;836:115-21.
16.	Dos Santos RS, Marroqui L, Grieco FA, Marselli L, Suleiman M, Henz SR, et al. Protective role of complement C3 against cytokine-mediated β-cell apoptosis. Endocrinology 2017;158:2503-21.
17.	Lewis EC, Dinarello CA. Responses of IL-18- and IL-18 receptor-deficient pancreatic islets with convergence of positive and negative signals for the IL-18 receptor. Proc Natl Acad Sci U S A 2006;103:16852-7.
18.	Frigerio S, Holländer GA, Zumsteg U. Functional IL-18 Is produced by primary pancreatic mouse islets and NIT-1 beta cells and participates in the progression towards destructive insulitis. Horm Res 2002;57:94-104.