OBJECTIVE.Regional ventilation and perfusion were studied in patients with idiopathic pulmonary fibrosis (cryptogenic fibrosing alveolitis) to seek an explanation for the mismatched ventilation/perfusionseen on scintigrams, which may suggest pulmonary embolic disease. SUBJECTS

Obesity increases the risk of developing life-threatening metabolic diseases including cardiovascular disease, fatty liver disease, diabetes, and cancer. Efforts to curb the global obesity epidemic and its impact have proven unsuccessful in part by a limited understanding of these chronic progressive diseases. It is clear that low-grade chronic inflammation, or metaflammation, underlies the pathogenesis of obesity-associated type 2 diabetes and atherosclerosis. However, the mechanisms that maintain chronicity and prevent inflammatory resolution are poorly understood. Here, we show that inhibitor of κB kinase epsilon (IKBKE) is a novel regulator that limits chronic inflammation during metabolic disease and atherosclerosis. The pathogenic relevance of IKBKE was indicated by the colocalization with macrophages in human and murine tissues and in atherosclerotic plaques. Genetic ablation of IKBKE resulted in enhanced and prolonged priming of the NLRP3 inflammasome in cultured macrophages, in hypertrophic adipose tissue, and in livers of hypercholesterolemic mice. This altered profile associated with enhanced acute phase response, deregulated cholesterol metabolism, and steatoheptatitis. Restoring IKBKE only in hematopoietic cells was sufficient to reverse elevated inflammasome priming and these metabolic features. In advanced atherosclerotic plaques, loss of IKBKE and hematopoietic cell restoration altered plaque composition. These studies reveal a new role for hematopoietic IKBKE: to limit inflammasome priming and metaflammation.he metabolic syndrome is defined by the coexistence of central obesity, deregulated carbohydrate, and lipid metabolism and/or hypertension. Collectively these features increase the risk of developing type 2 diabetes, nonalcoholic fatty liver diseases, and atherosclerosis. These metabolic diseases have additional features in common; they are chronic disorders characterized by a state of persistent inflammation and tissue remodeling. In particular, chronic low-grade inflammation or "metaflammation" is now established as an important causative factor driving metabolic disease. Much progress has been made in our understanding of how metabolic stress or overnutrition induces metaflammation. However, the molecules involved in maintaining chronicity of low-grade inflammation remain unclear.As specialized mediators of host defense, macrophages express danger-sensing pattern recognition receptors (PRRs) that include transmembrane receptors of the Toll-like receptor/interleukin-1 receptor (TLR/IL-1R) superfamily and intracellular cytosolic receptors such as RIG-I-like receptors and nucleotide-binding oligomerization domain (NOD)-like receptors (1, 2). Numerous TLR/IL-1Rs and their downstream mediators have been implicated in the pathogenesis of obesity-associated diabetes (3, 4), fatty liver disease (5, 6), and atherosclerosis (7,8). In some cases, putative nonmicrobial, host-derived sterile ligands have also been identified. For example, TLR4 is a putative sensor for dietary saturated fatty acids (SF...

ObjectiveSurplus dietary fat cannot be converted into other macronutrient forms or excreted, so has to be stored or oxidized. Healthy mammals store excess energy in the form of triacylgycerol (TAG) in lipid droplets within adipocytes rather than oxidizing it, and thus ultimately gain weight. The ‘overflow hypothesis’ posits that the capacity to increase the size and number of adipocytes is finite and that when this limit is exceeded, fat accumulates in ectopic sites and leads to metabolic disease.MethodsHere we studied the energetic and biochemical consequences of short-term (2-day) excess fat ingestion in a lipodystrophic (A-ZIP/F-1) mouse model in which adipose capacity is severely restricted.ResultsIn wildtype littermates, this acute exposure to high fat diets resulted in excess energy intake and weight gain without any significant changes in macronutrient oxidation rates, glucose, TAG, or insulin levels. In contrast, hyperphagic lipodystrophic mice failed to gain weight; rather, they significantly increased hepatic steatosis and fat oxidation. This response was associated with a significant increase in hyperglycemia, hyperinsulinemia, glucosuria, hypertriglyceridemia, and worsening insulin tolerance.ConclusionsThese data suggest that when adipose storage reserves are saturated, excess fat intake necessarily increases fat oxidation and induces oxidative substrate competition which exacerbates insulin resistance resolving any residual energy surplus through excretion of glucose.