Inflammation and immunity in diabetic vascular complications

Diabetes is associated with an increased risk for cardiovascular disease. The purpose of this review is to discuss possible mechanisms through which diabetes can contribute to a more aggressive atherosclerotic disease process with a particular focus on the role of innate and adaptive immunity.

The observation that adaptive immune responses to oxidized LDL modulate atherosclerotic plaque development has led to development of pilot vaccines that inhibit atherosclerosis in experimental animals. Recent studies have shown that similar immune responses operate against self-antigens modified by glycation in diabetes. Diabetes has also been shown to activate proinflammatory innate immune receptors and intracellular oxidative stress.

There are many similarities between the autoimmune responses against oxidized LDL and proteins modified by glycation. The role of autoimmune responses against modified self-antigens in the development of diabetic vascular complications represents a relatively unexplored concept that potentially could provide significant new mechanistic insight into the underlying disease process and identify novel targets for intervention.