The Metabolic Response to Ozone

The respiratory effects of O₃ are well established. High ambient O₃ concentrations are associated with respiratory symptoms, declines in pulmonary function, asthma exacerbations, and even mortality. The metabolic effects of O₃ are less well appreciated. Here we review data indicating that O₃ exposure leads to glucose intolerance and hyperlipidemia, characteristics of the metabolic syndrome. We also review the role of stress hormones in these events. We describe how the metabolic effects of O₃, including effects within the lungs, are exacerbated in the setting of the metabolic derangements of obesity and we discuss epidemiological data indicating an association between ambient O₃ exposure and diabetes. We conclude by describing the role of the gut microbiome in the regulation of metabolism and by discussing data indicating a link between the gut microbiome and pulmonary responses to O₃.