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- W2801876219 abstract "To the Editor: The results of the recent meta-analysis by Bui et al have confirmed that hidradenitis suppurativa (HS) is significantly associated with an increased prevalence of type 2 diabetes mellitus (T2DM).1Bui T.L. Silva-Hirschberg C. Torres J. et al.Hidradenitis suppurativa and diabetes mellitus: a systematic review and meta-analysis.J Am Acad Dermatol. 2017; 78: 395-402Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar According to the authors, this association could be due to the fact that HS patients tend to be more obese.1Bui T.L. Silva-Hirschberg C. Torres J. et al.Hidradenitis suppurativa and diabetes mellitus: a systematic review and meta-analysis.J Am Acad Dermatol. 2017; 78: 395-402Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar In this regard, we think that altered mechanistic target of rapamycin complex 1 (mTORC1) signaling might contribute and explain the connection between HS and T2DM. mTOR is the core constituent of the phosphatidylinositol 3-kinase–related kinase protein family that forms at least 2 multiprotein complexes known as mTORC1 and mTORC2.2Blagosklonny M.V. TOR-centric view on insulin resistance and diabetic complications: perspective for endocrinologists and gerontologists.Cell Death Dis. 2013; 4: e964Crossref PubMed Scopus (95) Google Scholar mTORC1 is the major regulator of survival, growth, proliferation, and motility in response to mitogens, energy, and nutrient levels. Because of its central role in cellular functions, mTORC1 dysregulation is involved in a large number of diseases.2Blagosklonny M.V. TOR-centric view on insulin resistance and diabetic complications: perspective for endocrinologists and gerontologists.Cell Death Dis. 2013; 4: e964Crossref PubMed Scopus (95) Google Scholar Upregulation of mTORC1 has also been observed in common inflammatory dermatoses, such as psoriasis and HS.3Monfrecola G. Balato A. Caiazzo G. et al.Mammalian target of rapamycin, insulin resistance and hidradenitis suppurativa: a possible metabolic loop.J Eur Acad Dermatol Venereol. 2016; 30: 1631-1633Crossref PubMed Scopus (42) Google Scholar Interestingly, mTORC1 plays a key role in diabetes mellitus pathogenesis.2Blagosklonny M.V. TOR-centric view on insulin resistance and diabetic complications: perspective for endocrinologists and gerontologists.Cell Death Dis. 2013; 4: e964Crossref PubMed Scopus (95) Google Scholar Overactivated mTORC1 causes insulin resistance. First, mTORC1 activates S6 kinase, which in turn causes phosphorylation and degradation of insulin receptor substrate 1/2. This impairs insulin signaling. Second, mTORC1 causes insulin resistance by affecting growth factor receptor–bound protein 10. Thus, hyperactivation of mTORC1 causes insulin resistance by at least 2 mechanisms.2Blagosklonny M.V. TOR-centric view on insulin resistance and diabetic complications: perspective for endocrinologists and gerontologists.Cell Death Dis. 2013; 4: e964Crossref PubMed Scopus (95) Google Scholar Glucose activates mTORC1, thus causing expansion and hypertrophy of beta cells and increasing insulin secretion. Initially, this hyperfunction of beta cells compensates for insulin resistance, preventing hyperglycemia. However, it is hyperfunction that eventually causes beta-cell failure and manifests as diabetes. In fact, chronic hyperstimulation of mTORC1 renders beta cells resistant to insulin-like growth factor 1 and insulin, fostering cell death.2Blagosklonny M.V. TOR-centric view on insulin resistance and diabetic complications: perspective for endocrinologists and gerontologists.Cell Death Dis. 2013; 4: e964Crossref PubMed Scopus (95) Google Scholar Furthermore, the mTORC1 pathway is of pivotal importance for metabolic regulation and functioning of innate and adaptive immune cells, as clearly verified by the immune-suppressive function of mTORC1 inhibitors such as rapamycin. Notably, the differentiation of T helper 17 (TH17) cells is controlled and promoted by mTORC1.4De Vita V. Melnik B.C. The magnitude of mTORC1 signalling may predict the response to isotretinoin treatment in patients with hidradenitis suppurativa.Dermatology. 2017; 233: 399-400Crossref PubMed Scopus (6) Google Scholar Substantial infiltration of TH17 cells into lesional skin and increased IL-17 serum levels have been found in HS patients.5Matusiak Ł. Szczęch J. Bieniek A. et al.Increased interleukin (IL)-17 serum levels in patients with hidradenitis suppurativa: implications for treatment with anti-IL-17 agents.J Am Acad Dermatol. 2017; 76: 670-675Abstract Full Text Full Text PDF PubMed Scopus (105) Google Scholar Evidence shows that interleukin (IL)-17 also plays a key role in insulin resistance and diabetes mellitus.6Owczarczyk-Saczonek A. Placek W. Interleukin-17 as a factor linking the pathogenesis of psoriasis with metabolic disorders.Int J Dermatol. 2017; 56: 260-268Crossref PubMed Scopus (26) Google Scholar Obesity is one of the main known causes of the development of T2DM. In obese patients, increased plasma concentrations of insulin, insulin-like growth factor 1, and IL-17 are observed.6Owczarczyk-Saczonek A. Placek W. Interleukin-17 as a factor linking the pathogenesis of psoriasis with metabolic disorders.Int J Dermatol. 2017; 56: 260-268Crossref PubMed Scopus (26) Google Scholar Serum IL-17 is significantly higher in patients with T2DM than in controls. IL-17 deficiency increased glucose tolerance and sensitivity to insulin in young mice.6Owczarczyk-Saczonek A. Placek W. Interleukin-17 as a factor linking the pathogenesis of psoriasis with metabolic disorders.Int J Dermatol. 2017; 56: 260-268Crossref PubMed Scopus (26) Google Scholar Expression levels of tumor necrosis factor (TNF) alpha in lesional skin and serum are increased in HS. TNF-alpha activates the kinase IKKβ, which inactivates hamartin, a key negative regulator of mTORC1. Thus, TNF-alfa impairs insulin signaling and contributes to insulin resistance. Anti–TNF-alpha therapies, such as adalimumab, decrease mTORC1 activity and improve insulin sensitivity. Metformin, a drug that reduces insulin resistance, has been identified as an mTORC1 inhibitor and attenuates psoriasis vulgaris and HS.4De Vita V. Melnik B.C. The magnitude of mTORC1 signalling may predict the response to isotretinoin treatment in patients with hidradenitis suppurativa.Dermatology. 2017; 233: 399-400Crossref PubMed Scopus (6) Google Scholar In summary, evidence suggests that HS and T2DM share a common pathogenic substrate, namely hyperactivated mTORC1 signaling. Hidradenitis suppurativa and diabetes mellitus: A systematic review and meta-analysisJournal of the American Academy of DermatologyVol. 78Issue 2PreviewThe relationship between hidradenitis suppurativa and diabetes mellitus is not well understood. Full-Text PDF" @default.
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- W2801876219 title "Activated mTORC1 signaling: The common driving force of type 2 diabetes and hidradenitis suppurativa" @default.
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