Insulin-Induced Lipoatrophy in Type I Diabetes: A possible tumor necrosis factor-α-mediated dedifferentiation of adipocytes
- Catherine Atlan-Gepner, MD,
- Pierre Bongrand, MD, PHD,
- Catherine Farnarier, MD,
- Luc Xerri, MD, PHD,
- Régine Choux, MD,
- Jean-Francois Gauthier, MD,
- Thierry Brue, MD, PHD,
- Philippe Vague, MD,
- Jean-Jacques Grob, MD and
- Bernard Vialettes, MD
- Service de Nutrition, Maladies Metaboliques et Endocrinologie, Hôpital Saint-Louis Paris, France
- Laboratoire d'lmmunologie, Hôpital Saint-Louis Paris, France
- Laboratoire d'Anatomie Pathologique, Hôpital Saint-Louis Paris, France
- Service de Dermatologie, Hôpital Saint-Louis Paris, France
- Hôpital Sainte Marguerite, University of Marseille, Service d'Endocrinologie, Hôpital Saint-Louis Paris, France
- Service de Nutrition et Maladies Metaboliques, Hôpital Saint-Louis Paris, France
- Hôpital de la Timone, University of Marseille; and Service d'Endocrinologie, Hôpital Saint-Louis Paris, France
- Address correspondence and reprint requests to C. Atlan-Gepner, MD, Service de Nutrition, Maladies Metaboliques et Endocrinologie, Hôpital Sainte Marguerite, 270 Boulevard de Sainte Marguerite, 13009 Marseille, France.
Abstract
OBJECTIVE To test the hypothesis that tumor necrosis factor (TNF)-α may mediate the loss and the dedifferentiation of subcutaneous fat tissue in the insulin-induced lipoatrophies of a diabetic patient who presented extensive lesions.
RESEARCH DESIGN AND METHODS An in vitro exploration of cytokine production by peripheral blood mononuclear cells (PBMC) from the reported case was performed and compared with the same explorations of PBMC from three nondiabetic subjects and three diabetic patients without lipoatrophic lesions. A proliferation test and an evaluation of TNF-α and interleukin (IL)-6 production from PBMC in presence of insulin were studied.
RESULTS The production of TNF-α and IL-6 by the macrophages of the patient in presence of insulin were dramatically increased in comparison with control subjects. This process needed cooperation with other lymphoid cells and was abrogated by dexamethasone.
CONCLUSIONS In our reported case, a local hyperproduction of TNF-α from macrophages that was induced by the injected insulin could explain the dedifferentiation of the adipocytes of the subcutaneous tissue and the reversion that was induced by the local injection of dexamethasone.
- Received February 12, 1996.
- Revision received June 13, 1996.
- Accepted June 13, 1996.
- Copyright © 1996 by the American Diabetes Association
