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Development of a novel Ag-specific immunotherapy using CpG oligodeoxynucleotides in a new, unique mouse cutaneous eosinophilic inflammation model.

The number of patients with severe atopic dermatitis (AD) has been on the rise recently. We are therefore urgently in need of a treatment that can suppress Th2 cell-mediated responses in an Ag-specific fashion. Oligodeoxynucleotides (ODN)containing CpG motifs (CpG ODN) have been highlighted as immunomodulators that reduce Th2-mediated responses. To determine the effect of CpG ODN on Th2-mediated skin inflammation, we first developed a reproducible murine model of protein Ag-induced eosinophilic inflammation that is accompanied by epidermal acanthosis and increased serum IgE levels as seen in AD. In this model we found that treatment with CpG ODN during epicutaneous sensitization in previously i.p.-primed mice prevented the development of Th2-mediated responses. Furthermore, to evaluate the therapeutic effect of CpG ODN on established eosinophilic inflammation, mice were treated with a course of the immunotherapy at a skin site remote from the area of Ag application prior to the second 1-wk epicutaneous exposure to Ag. Therapeutic treatment with CpG ODN plus Ag, but not that with CpG ODN alone, could reverse the established eosinophilic inflammation. The presented results provide strong evidence for the feasibility of a novel Ag-specific immunomodulator to treat cutaneous eosinophilic inflammation such as that characteristically found in patients with severe AD.

Animals↗

Relating nickel-induced tissue inflammation to nickel release in vivo.

Nickel has a number of adverse biological effects that have made the use of nickel in biomedical implants controversial. Yet information about the distribution of nickel in tissues around nickel-containing implants is scarce. The purpose of the current study was to use a laser ablation technique, combined with inductively coupled mass spectroscopy, to assess the spatial distribution of nickel around nickel-containing implants in vivo. Polyethylene, pure nickel wire, or a nickel-containing alloy (Ni-Cr) were implanted subcutaneously into rats for 7 days. The tissues were analyzed for Ni content and inflammation at 1-mm intervals up to 5 mm away from the implants. The sham surgery sites and the polyethylene caused mild to moderate inflammation 1-2 mm from the implant site with no detectable nickel in the tissue. The nickel wire caused severe inflammation up to 5 mm away from the implant site with necrosis for 1 mm around the implant. Nickel concentrations reached 48 microg/g near the implants, falling exponentially to undetectable levels at 3-4 mm from the implants. The Ni-Cr wire caused inflammation equivalent to polyethylene, with less than 4 microg/g of nickel present in the tissue for 1-2 mm around the implants. The current study showed that the laser-ablation technique was well suited for the analysis of soft tissues for metal-ion content, and that the nickel distribution in tissues correlated well with overt tissue inflammation.

Alloys↗

The relationship between infection and inflammation in the early stages of lung disease from cystic fibrosis.

We examined the relationship of pulmonary infection and inflammation in cystic fibrosis (CF) by performing 31 bronchoalveolar lavages (BAL) in 14 young children with minimal lung disease from CF. While 10 of the 14 patients had elevated polymorphonuclear leukocyte (PMN) counts initially, only 4 had bacteria generally regarded as pathogenic in the recovered BAL fluid. Three of these 4 and 6 of the others had follow-up bronchoscopies at 6 months intervals. PMN counts remained normal for only one patient. However, pathogenic bacteria were recovered during the repeat BALs only in those patients who were colonized initially. Proinflammatory cytokines and proteinases were generally elevated, and interleukin-8 (IL-8) concentration correlated inversely with oxygen saturation (SaO2). No complications of the procedure occurred. We conclude that BAL identifies inflammation and the presence of bacteria in the lower airway at an early stage of the disease. This information may be used to guide therapy in patients too young or otherwise unable to produce sputum. These data also suggest that inflammation is present early in the course of CF lung disease before colonization and infection of the lungs with potentially pathogenic bacteria occurs. Since inflammation appears to be the earliest detectable evidence of lung disease in CF, monitoring of inflammation with BAL may serve as a useful marker of clinical benefits from new treatments in patients with minimal lung disease.

Bacteria↗

Intracerebroventricular transplantation of embryonic neuronal tissue from inflammatory resistant into inflammatory susceptible rats suppresses specific components of inflammation.

To more directly define the role of central nervous system factors in susceptibility to peripheral inflammatory disease, we examined the effect of intracerebroventricular transplantation of neuronal tissue from inflammatory resistant into inflammatory susceptible rats on subcutaneous carrageenan-induced inflammation (a measure of innate immunity), and on the relative percentage of naive and memory T helper cells in peripheral blood (a measure of the anamnestic immune response). Female inflammatory disease susceptible Lewis (LEW/N) rats transplanted with hypothalamic tissue from inflammatory resistant Fischer (F344/N) rats exhibited > 85% decrease in carrageenan inflammation compared to naive LEW/N rats, LEW/N rats transplanted with F344/N spinal cord, or sham-operated animals. LEW/N rats transplanted with LEW/N hypothalamic tissue exhibited > 50% decrease in carrageenan inflammation. In contrast, intracerebroventricular transplantation of neuronal tissue did not affect the characteristically twofold higher percentage of naive versus memory T helper cells in LEW/N rats, suggesting that the central nervous system (CNS) and hypothalamus play a greater role in the innate inflammatory response than in the acquired immune processes. Grafted tissue survived well and did not show extensive gliosis or inflammation. Compared to naive LEW/N rats, LEW/N rats transplanted with F344/N or LEW/N hypothalamic tissue expressed significantly greater hypothalamic corticotropin releasing hormone mRNA. LEW/N rats transplanted with F344/N hypothalamic tissue also showed significant increases in plasma corticosterone responses to lipopolysaccharide. These data indicate that intracerebroventricular transplantation of fetal hypothalamic tissue from inflammatory resistant into inflammatory susceptible rats suppresses peripheral inflammation partially through hypothalamic factors. These findings have implications for understanding the contribution of specific neuronal tissue in regulation of components of the immune/inflammatory response and in susceptibility to inflammatory disease. Furthermore, this model could be used in the development of potential new treatments for inflammatory/autoimmune diseases aimed specifically at sites within the CNS.

Animals↗

Vanadium-induced chemokine mRNA expression and pulmonary inflammation.

Occupational exposure to vanadium is common in petrochemical, mining, steel, and utilities industries and results in toxic effects largely confined to the respiratory system. Vanadium exposure has been associated with inflammatory changes in the upper and lower respiratory tracts in addition to changes in pulmonary function. We investigated the abilities of several vanadium compounds to increase mRNA levels for selected cytokines in bronchoalveolar lavage (BAL) cells and also to induce pulmonary inflammation. Rats (200-250 g) were intratracheally instilled with either sodium metavanadate (NaVO3), vanadyl sulfate (VOSO4), vanadium pentoxide (V2O5) at several concentrations, or vehicle alone. Pulmonary inflammation was assessed by cytologic analysis of cells recovered from the respiratory tract (1 hr to 10 days postexposure). All three vanadium compounds were capable of inducing pulmonary inflammation in a dose-dependent manner. Neutrophil influx was greatest following exposure to VOSO4 (peaked at approximately 40% of cell population) and lowest following exposure to V2O5 (peaked at approximately 20 %). Significant neutrophil influx was detected as early as 4 hr following the instillation of NaVO3 and VOSO4 but not until 24 hr upon exposure to V2O5. The VOSO4-induced inflammatory response persisted longer (5 days) than that induced by NaVO3 and V2O5. Analysis of inflammatory cytokine mRNA expression closely followed these cytologic observations. Levels of mRNA for macrophage inflammatory protein-2 (MIP-2) and KC, considered the principal neutrophil chemotactic factors expressed in the rat, were rapidly induced as early as 1 hr following exposure, continued to be expressed throughout 48 hr, and were low but detectable at 5 and 10 days. NaVO3 and VOSO4, both very soluble forms of vanadium, tended to induce pulmonary inflammation and inflammatory cytokine mRNA expression more rapidly and more intensely than the less soluble form, V2O5. Analysis of KC mRNA expression in BAL cells 24 hr after instillation of NaVO3 by PCR in situ hybridization confirmed the increase in KC mRNA levels and indicated that alveolar macrophages have the highest expression level observed. Vanadium content of lavage fluid, BAL cells, and lung indicated rapid clearance of the metal from the lung surface and substantial accumulation by BAL cells and lung tissue. The rapid expression of MIP-2 and KC mRNA in BAL cells prior to the observed neutrophilia implicate them as important in the initiation of inflammation.

Animals↗

Glucocorticoids suppress the inflammation-mediated tolerance to acute toxicity of cadmium in mice.

Several compounds have been shown to cause acute toxicity to cadmium (Cd). The mechanism of tolerance to Cd toxicity induced by glucocorticoids or by inflammation involves induction of metallothionein (MT) synthesis via glucocorticoid response elements or by inflammatory cytokines. We have demonstrated previously that the synthetic glucocorticoid dexamethasone suppresses inflammation-mediated induction of hepatic MT synthesis. Here we investigated the effect of glucocorticoid on tolerance to Cd induced by inflammation in mice. The LD50 of Cd for mice with induced inflammation by injection with turpentine oil (Tur-mice) was higher than the LD50 in control mice. Pretreatment of Tur-mice with dexamethasone to the Tur-mice (Dex+Tur-mice) resulted in a decrease in LD50 after Cd treatment. A significant increase in plasma alanine aminotransferase and aspartate aminotransferase levels in the Dex+Tur-mice was observed at lower doses of Cd than in the Tur-mice and at higher doses of Cd than in control mice. Dexamethasone did not suppress tolerance to cadmium toxicity in the testes of the Tur-mice. Pretreatment of Tur-mice with dexamethasone resulted in suppression of both plasma interleukin (IL)-6 elevation and in suppression of hepatic MT levels when induced by inflammation but not when induced by Cd. These data suggest that suppression of tolerance to Cd toxicity induced by glucocorticoid may involve hepatic MT synthesis mediated by inflammatory cytokines, such as IL-6. We suggest that the inflammatory response can modulate Cd toxicity by induction of MT by inflammatory cytokines.

Animals↗

Effects of inflammation on copper antioxidant enzyme levels.

Inflammation increases plasma levels of ceruloplasmin, a copper protein with possible antioxidant function. This paper describes modulation of these increases by copper intake, and describes combined effects of inflammation and copper intake on Cu-Zn and extracellular (EC) superoxide dismutase (SOD) activities. Turpentine injections in rats fed 1 of 4 copper levels increased ceruloplasmin activities, but values were sensitively limited by copper intake. Cu-Zn SOD activities in the liver, but not in erythrocytes or lungs, were reduced by inflammation in each dietary copper group. Inflammation in rats fed a standard mixed feed diet reduced plasma EC superoxide dismutase activities measured by inhibition of pyrogallol autoxidation. Different results were obtained with 3 xanthine oxidase based SOD assays which were each subject to assay interference. Studies in humans found a group of rheumatoid arthritis patients to possess relatively low erythrocyte SOD and relatively high ceruloplasmin activities. Activity levels of SOD, but not of ceruloplasmin, increased after 4 weeks of copper supplementation (2 mg/day). The fate of cellular Cu-Zn SOD activity contents in inflamed tissues is largely uninvestigated. However, interleukin-1, a hormone released at inflammation sites, elevated Cu-Zn SOD activities in cultured fibroblasts.

Animals↗

Stress proteins in inflammation.

Inflammation provides those searching in the field with a number of "models" allowing them to study, in vivo, in humans and in animals, the regulation and the functions of HSP, which are being considered as a new and promising marker for the severity and the prognosis of inflammatory diseases. HSP are differentially regulated according to the type of inflammation, whether acute or chronic, whether self-limiting (inflammatory cell elimination by apoptosis) or self-perpetuating (inflammatory cell death by necrosis). We propose that mitochondria are a key organelle in determining the outcome of inflammation, because they are both the cellular "switchboard" for apoptosis and a selective target for the protective effects of HSP against the cytotoxic effects of TNF alpha and ROS. On the other hand, HSP exert multiple protective effects in inflammation, including self/non-self discrimination, enhancement of immune responses, immune protection, thermotolerance and protection against the cytotoxicity of inflammatory mediators. The latter protective effects against the deleterious effects of the mediators of inflammation, including ROS and cytokines, open new avenues for the development of original anti-inflammatory therapies, such as non-toxic inducers of a complete HS response. It may well be that the "beneficial effects of fever" already described by Hippocrates actually relate to increased HSP expression during fever, and to their protective effects....

Animals↗

Prognostic significance of peritumoural inflammation in invasive urothelial bladder carcinoma.

Peritumoural inflammation consisting of lymphocytes, plasma cells and lymph follicles is present in two thirds of invasive urothelial bladder carcinomas. This type of inflammation is significantly rarer in advanced tumour stages (P3, P/) and its presence is a favourable prognostic factor. The mean survival time in patients with this type of inflammation is 26.1 months compared to only 14.8 months in patients without. All other forms of inflammation e. g. eosinophilic or polymorphonuclear leukocytes have no relation with prognosis. The significant prognostic value of lympho-plasmocytic inflammation may be considered as local expression of immunological host resistance.

Aged↗

Major acute-phase reactant synthesis during chronic inflammation in amyloid-susceptible and -resistant mouse strains.

Hepatic levels of mRNA specific for total serum amyloid A (SAA), the SAA1 and SAA2 isotypes, serum amyloid P (SAP), C-reactive protein (CRP), and fibronectin, as well as the plasma concentrations of SAA and SAP were examined in amyloid-resistant (A/J) and amyloid-susceptible (CBA/J) mice during azocasein-induced chronic inflammation. In both strains hepatic SAA and SAP mRNA levels and plasma SAA and SAP protein concentrations increased dramatically during the early stages of inflammation; this was followed by a decrease to concentrations that were maintained at levels considerably higher than background. The ratios of SAA1 and SAA2 mRNA and plasma protein were 1:1 throughout. This indicated that there was no preferential accumulation of mRNA specifying a particular isotype and no preferential synthesis or clearance of a particular isotype during chronic inflammation and the early stages of amyloidogenesis in either strain. Similarly, hepatic SAP mRNA levels in both strains increased dramatically during the early stages of inflammation and were subsequently maintained at elevated levels. Plasma SAP concentrations increased rapidly during the first three days of the study in both A/J and CBA/J mice; however, during the later stages of inflammation, A/J plasma SAP levels decreased to a steady-state concentration that was approximately half that observed in CBA/J mice. Our results identify differences in the hepatic mRNA and plasma protein levels of the major mouse acute-phase reactants (APR) in the amyloid-resistant A/J and amyloid-susceptible CBA/J mouse strains. These findings are consistent with circulating inflammatory APR concentrations contributing, together with other factors, to the onset and pathogenesis of secondary amyloidosis.

Acute-Phase Proteins↗

Neurogenic inflammation in the rat trachea. I. Changes in venules, leucocytes and epithelial cells.

This study was done to characterize the morphological changes in the respiratory mucosa that occur in neurogenic inflammation, which is a type of inflammation mediated by substances released from sensory nerves. Neurogenic inflammation was produced in the trachea and bronchi of atropine-treated Long-Evans rats by electrically stimulating the left or right superior laryngeal and vagus nerves. This procedure is known to increase vascular permeability in the airways, presumably as a consequence of antidromic activation of sensory vagal axons (Lundberg & Saria, 1982). By using a particulate tracer (Monastral blue, 30 mg kg-1 i.v.) that does not cross the walls of normal tracheal blood vessels but does cross the endothelium of abnormally permeable vessels, it was possible to identify which blood vessels were affected in neurogenic inflammation. Light and electron microscopic examination of tracheas prepared after 2 or 5 min of vagal stimulation revealed that postcapillary venules and collecting venules 7-80 micron in diameter were labelled by extravasated Monastral blue but capillaries, arterioles, and larger venules were not. Venules from which the extravasation occurred had gaps as wide as 1.5 micron between endothelial cells. Most of the abnormally permeable venules were located just beneath the airway epithelium in regions between the cartilaginous rings. Extravasation also occurred from venules in the mucosa overlying the posterior membrane of the extrathoracic trachea, but little occurred in the posterior membrane of the intrathoracic trachea. After unilateral vagal stimulation, vascular permeability was increased on both sides of the trachea; it was also increased in first through fourth order bronchi but only on the side of stimulation. Leucocytes (principally monocytes and neutrophils) were adherent to the endothelium of some of the abnormally permeable venules. Erythrocytes and platelets also were adherent to the walls of some venules. These changes in venules were accompanied by a degranulation of epithelial secretory cells, widening of the spaces between tracheal epithelial cells, and probably an increase in epithelial permeability. Neurogenic inflammation in the trachea and bronchi of rats is thus characterized by increased permeability of postcapillary venules and collecting venules in specific regions of the respiratory mucosa as well as adherence of leucocytes, erythrocytes and platelets to the endothelium of these venules and prominent changes in the respiratory epithelium.

Animals↗

Acute sterile inflammation--correlation between cellular changes and extramedullary-produced regulators in vivo.

Rats with polyvinylpyrrolidone (PVP)-induced sterile inflammation were used as a model in vivo for investigation of granulopoiesis and extramedullary-produced regulators. The data obtained demonstrated the invasion of massive numbers of granulocytes at the site of inflammation (peritoneal cavity) during the first 24 h of the acute phase of inflammation. To meet the organism's needs for granulocytes the activation of granulopoiesis in bone marrow occurred simultaneously. Accelerated production of granulocytic cells is manifested by involvement of granulocytic proliferative compartment in various stages of differentiation (CFU-GM and morphologically recognizable proliferative granulocytes--PG). Together with cellular changes within the granulocytic cells line, the changes in the content of investigated regulators influencing granulopoiesis were observed. At different time intervals the levels of interleukin-6 (IL-6), colony-stimulating activity (CSA), and granulocytic stimulating activity (GSA) were increased locally at the site of inflammation as well as in serum. The data obtained provide evidence that inducible granulopoiesis during the acute phase of inflammation is under the control of extramedullary-produced regulators, thus confirming their role in the regulation of granulocytic production in vivo.

Animals↗

Inflammation as a diagnostic keystone and its clinical implications, exemplified by the inflammatory bowel diseases.

Inflammation is a complex process following sublethal injury to tissue and ends with permanent destruction of tissue or with healing. Inflammation has long, long roots in the evolutionary process and as a concept reaches far back in the history of medicine. Inflammation can not be viewed solely in a teleological perspective. Refined by phylogenesis it serves the integrity and survival of groups (species etc.) and not primarily individuals. Inflammation has, in the history of science, been studied on the macroscopic, the microscopic, the dynamic cellular, the immunological, the biochemical/physiological, and the molecular level. Clinicians have for centuries relied on inflammatory signs and symptoms in their diagnostics, even to the extent of being seriously confused, when a subject's inflammatory preparedness is disturbed, as in agranulocytosis, alcoholism, HIV-infection etc. Chronic inflammatory bowel diseases (ulcerative colitis and Crohn's disease) have been studied intensively by inflammologists. The results are partly exchangeable with studies in, for instance, chronic rheumatoid arthritis. They try to answer the over-all question in these diseases: Are we dealing with a normal inflammatory preparedness confronted with a special (unknown) agent, or an abnormal inflammatory preparedness confronted with an ubiquitous agent? The answer will form the basis for the future treatment of these patients, whose diseases remind us of inflammation as man's fellow traveller on "the long phylogenetic march".

Humans↗

The release of interleukin-1-like activity by macrophages in two models of immunological inflammation in the rat.

Interleukin-1 (IL-1) is a putative mediator of inflammation released by activated macrophages in vitro. The IL-1 release by rat macrophages collected either from exudates in pertussis-induced air pouches or from the peritoneum during adjuvant arthritis has been investigated. In air pouch inflammation LPS-stimulated macrophages collected from sensitized animals release more IL-1 than cells from control rats at day 6 after challenge. This enhanced IL-1 release parallels the extent of mononuclear cell migration in the inflammatory lesion. In adjuvant arthritis LPS-stimulated macrophages collected from sensitized animals release more IL-1 than cells from control rats at days 16 and 23 after adjuvant injection. The secondary inflammation in arthritic rats was statistically significant at days 16 to 28. These results indicate that during immunological inflammation macrophages either from the inflamed area or from a non-inflamed region release more IL-1 than control cells. This release parallels the extent of the inflammation and may be important in its pathogenesis.

Air↗

Modification of adjuvant inflammation in rats deficient in essential fatty acids.

Rats deficient in essential fatty acids (EFA) did not develop as much foot swelling on receiving injections of complete Freund's adjuvant as did normal controls. Both the acute inflammation and the chronic inflammation were affected. This reduction in the chronic phase of adjuvant inflammation was restored to normal levels by feeding a small supplement of corn oil as a dietary source of EFA. Since the EFA are biologic precursors of prostaglandins (PG), the lack of EFA is thought to influence adjuvant-induced inflammation by reducing available PG mediators of inflammation.

Acute Disease↗

Lymphocyte migration in the mouse. II. Differential B and T-lymphocyte migration into a site of chronic inflammation.

Different patterns of B and T-lymphocyte migration were observed in normal mice and in animals with a site of chronic inflammation. The early migration of lymphocytes into a site of chronic inflammation, induced by sensitisation and challenge to Bordetella pertussis vaccine (BPV), comprised mainly B-cells. Subsequently, a greater influx of T-cells occurred as the inflammation progressed. The lymphocyte population in the inflammatory exudate was composed of equal numbers of B and T-cells throughout the 30 day time course. Preferential migration of B-cells to Peyer's patches (PP) and T-cells to peripheral lymph nodes (PLN) occurred in both normal mice and animals with a site of chronic inflammation. In contrast, B-cells migrated preferentially to the spleen in normal mice while in mice with chronic inflammation a greater migration of T-cell was observed. These findings indicate the presence of homing receptors for PP on B-cells and of PLN homing receptors on T-cells, with their distribution unaffected during the development of the inflammatory response. In contrast, the inflammatory process did alter the type of cell migrating into the spleen which may reflect an increase in antigen presentation in the mice challenged with BPV.

Animals↗

Airway inflammation induced by xanthine/xanthine oxidase in guinea pigs.

Airway inflammation is suggested to play an important role in bronchial asthma. However, there is poor documentation about the effects of reactive oxygens on airway tissues in aspect of airway inflammation. Presently, we investigated whether aerosolized xanthine (X)/xanthine oxidase (XOD) induces airway inflammation in anesthetized guinea pigs. Inhalation of X for 5 min followed by inhalation of XOD for 5 min was performed with an ultrasonic nebulizer in anesthetized animals. Airway inflammation was assessed by airway vascular permeability using Pontamine sky blue. Inhalation of X/XOD produced a marked Pontamine sky blue exudation in the trachea, main bronchus and lungs. The X/XOD-induced increase in Pontamine sky-blue exudation was attenuated by pretreatment with inhaled catalase, but not by superoxide dismutase. Additionally, in the bronchus and lungs, the increase in Pontamine sky-blue exudation was significantly suppressed by deferoxamine. The above results indicate that hydrogen peroxide and hydroxyl radical converted from superoxide anion cause an intense airway inflammation.

Administration, Inhalation↗

Adipose tissue inflammation induced by high-fat diet in obese diabetic mice is prevented by n-3 polyunsaturated fatty acids.

AIMS/HYPOTHESIS: Inflammatory alterations in white adipose tissue appear to underlie complications of obesity including diabetes mellitus. Polyunsaturated fatty acids (PUFA), particularly those of the n-3 series, modulate immune responses and may ameliorate insulin sensitivity. In this study, we investigated how PUFA affect white adipose tissue inflammation and gene expression in obese diabetic animals. MATERIALS AND METHODS: We treated db/db mice as well as lean non-diabetic mice (db/+) with either low-fat standard diet (LF) or high-fat diets rich in (1) saturated/monounsaturated fatty acids (HF/S), (2) n-6 PUFA (HF/6) and (3) the latter including purified marine n-3 PUFA (HF/3). RESULTS: Many genes involved in inflammatory alterations were upregulated in db/db mice on HF/S compared with LF in parallel with phosphorylation of c-Jun N-terminal kinase (JNK). In parallel, adipose tissue infiltration with macrophages was markedly enhanced by HF/S. When compared with HF/S, HF/6 showed only marginal effects on adipose tissue inflammation. However, inclusion of n-3 PUFA in the diet (HF/3) completely prevented macrophage infiltration induced by high-fat diet and changes in inflammatory gene expression, also tending to reduce JNK phosphorylation (p<0.1) in diabetic mice despite unreduced body weight. Moreover, high-fat diets (HF/S, HF/6) downregulated expression and reduced serum concentrations of adiponectin, but this was not the case with n-3 PUFA. CONCLUSIONS/INTERPRETATION: n-3 PUFA prevent adipose tissue inflammation induced by high-fat diet in obese diabetic mice, thereby dissecting obesity from adipose tissue inflammation. These data suggest that beneficial effects of n-3 PUFA on diabetes development could be mediated by their effect on adipose tissue inflammation.

Adiponectin↗