Abstract
Air pollution represents an important environmental risk factor for a number of health conditions. Particulate matter and gaseous compounds increase the risk of chronic and acute respiratory diseases, cardiovascular disease and lung cancer. Additional studies indicate that long-term exposure to air pollutants also contributes to the development and progression of type 2 diabetes. As the most common metabolic disease, type 2 diabetes and its chronic complications are important determinants of morbidity and mortality worldwide.
This article aims to provide an overview of the currently available data on the relationship between air pollution and type 2 diabetes with specific focus on epidemiological studies. Inflammatory processes have been discussed as mechanisms that mediate this association. Therefore, we first discuss the role of subclinical inflammation in the pathogenesis of type 2 diabetes and subsequently the impact of air pollutants on the immune system. We conclude that despite accumulating evidence linking (i) air pollution and proinflammatory processes, (ii) air pollution and risk of type 2 diabetes and (iii) subclinical inflammation and type 2 diabetes, there is a surprising lack of studies addressing this complex relationship in prospective cohorts. Therefore, it is currently not possible to quantify which proportion of the risk of type 2 diabetes can be attributed to air pollution-related immune activation and to what extent the risk of type 2 diabetes can be reduced by reducing air pollution levels.
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References
Agustí A, Edwards LD, Rennard SI, MacNee W, Tal-Singer R, Miller BE, Vestbo J, Lomas DA, Calverley PMA, Wouters E, Crim C, Yates JC, Silverman EK, Coxson HO, Bakke P, Mayer RJ, Celli B (2012) Persistent systemic inflammation is associated with poor clinical outcomes in COPD: a novel phenotype. PLoS One 7(5):e37483
Andersen ZJ, Raaschou-Nielsen O, Ketzel M, Jensen SS, Hvidberg M, Loft S, Tjonneland A, Overvad K, Sorensen M (2012) Diabetes incidence and long-term exposure to air pollution: a cohort study. Diabetes Care 35(1):92–98
Bai N, Khazaei M, van Eeden SF, Laher I (2007) The pharmacology of particulate matter air pollution-induced cardiovascular dysfunction. Pharmacol Ther 113(1):16–29
Barzilay J, Abraham L, Heckbert S, Cushman M, Kuller L, Resnick H, Tracy R (2001) The relation of markers of inflammation to the development of glucose disorders in the elderly the Cardiovascular Health Study. Diabetes 50(10):2384–2389
Beavers KM, Brinkley TE, Nicklas BJ (2010) Effect of exercise training on chronic inflammation. Clin Chim Acta 411(11–12):785–793
Beelen R, Hoek G, Vienneau D, Eeftens M, Dimakopoulou K, Pedeli X, Tsai M-Y, Künzli N, Schikowski T, Marcon A, Eriksen KT, Raaschou-Nielsen O, Stephanou E, Patelarou E, Lanki T, Yli-Tuomi T, Declercq C, Falq G, Stempfelet M, Birk M, Cyrys J, Sv K, Nádor G, Varró MJ, Dėdelė A, Gražulevičienė R, Mölter A, Lindley S, Madsen C, Cesaroni G, Ranzi A, Badaloni C, Hoffmann B, Nonnemacher M, Krämer U, Kuhlbusch T, Cirach M, Nazelle AD, Nieuwenhuijsen M, Bellander T, Korek M, Olsson D, Strömgren M, Dons E, Jerrett M, Fischer P, Wang M, Brunekreef B, Hoogh KD (2013a) Development of NO2 and NOx land use regression models for estimating air pollution exposure in 36 study areas in Europe – The ESCAPE project. Atmos Environ 72(C):10–23
Beelen R, Raaschou-Nielsen O, Stafoggia M, Andersen Z, Weinmayr G, Hoffmann B, Wolf K, Samoli E, Fischer P, Nieuwenhuijsen M, Vineis P, Xun W, Katsouyanni K, Dimakopoulou K, Oudin A, Forsberg B, Modig L, Havulinna A, Lanki T, Turunen A, Oftedal B, Nystad W, Nafstad P, De Faire U, Pedersen N, Östenson C, Fratiglioni L, Penell J, Korek M, Pershagen G, Eriksen K, Overvad K, Ellermann T, Eeftens M, Peeters P, Meliefste K, Wang M, Bueno-de-Mesquita B, Sugiri D, Krämer U, Heinrich J, de Hoogh K, Key T, Peters A, Hampel R, Concin H, Nagel G, Ineichen A, Schaffner E, Probst-Hensch N, Künzli N, Schindler C, Schikowski T, Adam M, Phuleria H, Vilier A, Clavel-Chapelon F, Declercq C, Grioni S, Krogh V, Tsai M, Ricceri F, Sacerdote C, Galassi C, Migliore E, Ranzi A, Cesaroni G, Badaloni C, Forastiere F, Tamayo I, Amiano P, Dorronsoro M, Katsoulis M, Trichopoulou A, Brunekreef B, Hoek G (2013b) Effects of long-term exposure to air pollution on natural-cause mortality: an analysis of 22 European cohorts within the multicentre ESCAPE project. Lancet 383(9919):785–795
Belvisi M (2003) Sensory nerves and airway inflammation: role of Aδ and C-fibres. Pulm Pharmacol Ther 16(1):1–7
Berclaz P-Y, Gao H, Tobian J, Swanson D, Webb D, Crapo R, Jensen R (2009) The impact of diabetes and age on pulmonary function: data from the National Health and Nutrition Examination Survey. Diabetes Res Clin Pract 83(1):e1–e3
Bhatnagar A (2009) Could dirty air cause diabetes? Circulation 119(4):492–494
Block ML, Calderón-Garcidueñas L (2009) Air pollution: mechanisms of neuroinflammation and CNS disease. Trends Neurosci 32(9):506–516
Broekhuizen R, Vernooy J, Schols A, Dentener M, Wouters E (2005) Leptin as local inflammatory marker in COPD. Respir Med 99(1):70–74
Brook RD, Jerrett M, Brook JR, Bard RL, Finkelstein MM (2008) The relationship between diabetes mellitus and traffic-related air pollution. J Occup Environ Med 50(1):32–38
Brook RD, Rajagopalan S, Pope CA, Brook JR, Bhatnagar A, Diez-Roux AV, Holguin F, Hong Y, Luepker RV, Mittleman MA, Peters A, Siscovick D, Smith SC, Whitsel L, Kaufman JD (2010) Particulate matter air pollution and cardiovascular disease: an update to the scientific statement from the American Heart Association. Circulation 121(21):2331–2378
Brook R, Xu X, Bard R, Dvonch J, Morishita M, Kaciroti N, Sun Q, Harkema J, Rajagopalan S (2013) Reduced metabolic insulin sensitivity following sub-acute exposures to low levels of ambient fine particulate matter air pollution. Sci Total Environ 448:66–71
Brown D, Wilson M, MacNee W, Stone V, Donaldson K (2001) Size-dependent proinflammatory effects of ultrafine polystyrene particles: a role for surface area and oxidative stress in the enhanced activity of ultrafines. Toxicol Appl Pharmacol 175(3):191–199
Campbell A, Oldham M, Becaria A, Bondy S, Meacher D, Sioutas C, Misra C, Mendez L, Kleinman M (2005) Particulate matter in polluted air may increase biomarkers of inflammation in mouse brain. Neurotoxicology 26(1):133–140
Carpenter D (2008) Environmental contaminants as risk factors for developing diabetes. Rev Environ Health 23(1):59–74
Carstensen M, Herder C, Kivimäki M, Jokela M, Roden M, Shipley MJ, Witte DR, Brunner EJ, Tabák AG (2010) Accelerated increase in serum interleukin-1 receptor antagonist starts 6 years before diagnosis of type 2 diabetes Whitehall II prospective cohort study. Diabetes 59(5):1222–1227
Cavelti-Weder C, Babians-Brunner A, Keller C, Stahel MA, Kurz-Levin M, Zayed H, Solinger AM, Mandrup-Poulsen T, Dinarello CA, Donath MY (2012) Effects of gevokizumab on glycemia and inflammatory markers in type 2 diabetes. Diabetes Care 35(8):1654–1662
Cesaroni G, Badaloni C, Gariazzo C, Stafoggia M, Sozzi R, Davoli M, Forastiere F (2013) Long-term exposure to urban air pollution and mortality in a cohort of more than a million adults in Rome. Environ Health Perspect 121(3):324–331
Cesaroni G, Forastiere F, Stafoggia M, Andersen Z, Badaloni C, Beelen R, Caracciolo B, de Faire U, Erbel R, Eriksen K (2014) Long term exposure to ambient air pollution and incidence of acute coronary events: prospective cohort study and meta-analysis in 11 European cohorts from the ESCAPE Project. Br Med J 348:f7412
Chen H, Goldberg MS, Villeneuve PJ (2008) A systematic review of the relation between long-term exposure to ambient air pollution and chronic diseases. Rev Environ Health 23(4):243–298
Chen B-Y, Chan C-C, Lee C-T, Cheng T-J, Huang W-C, Jhou J-C, Han Y-Y, Chen C-C, Guo Y (2012a) The association of ambient air pollution with airway inflammation in schoolchildren. Am J Epidemiol 175(8):764–774
Chen L, Magliano D, Zimmet P (2012b) The worldwide epidemiology of type 2 diabetes mellitus – present and future perspectives. Nat Rev Endocrinol 8(4):228–236
Chen H, Burnett R, Kwong C, Villeneuve P, Goldberg M, Brook R, van Donkelaar A, Jerrett M, Martin R, Brook J, Copes R (2013) Risk of incident diabetes in relation to long-term exposure to fine particulate matter in Ontario, Canada. Environ Health Perspect 121(7):804–810
Chuang K-J, Yan Y-H, Chiu S-Y, Cheng T-J (2011) Long-term air pollution exposure and risk factors for cardiovascular diseases among the elderly in Taiwan. Occup Environ Med 68(1):64–68
Coogan PF, White LF, Jerrett M, Brook RD, Su JG, Seto E, Burnett R, Palmer JR, Rosenberg L (2012) Air pollution and incidence of hypertension and diabetes mellitus in black women living in Los Angeles. Circulation 125(6):767–772
Delfino RJ, Staimer N, Tjoa T, Polidori A, Arhami M, Gillen DL, Kleinman MT, Vaziri ND, Longhurst J, Zaldivar F, Sioutas C (2008) Circulating biomarkers of inflammation, antioxidant activity, and platelet activation are associated with primary combustion aerosols in subjects with coronary artery disease. Environ Health Perspect 116(7):898–906
Delfino RJ, Staimer N, Tjoa T, Gillen DL, Polidori A, Arhami M, Kleinman MT, Vaziri ND, Longhurst J, Sioutas C (2009) Air pollution exposures and circulating biomarkers of effect in a susceptible population: clues to potential causal component mixtures and mechanisms. Environ Health Perspect 117(8):1232–1238
Devlin R, Smith C, Schmitt M, Rappold A, Hinderliter A, Graff D, Carraway M (2014) Controlled exposure of humans with metabolic syndrome to concentrated ultrafine ambient particulate matter causes cardiovascular effects. Toxicol Sci 140(1):61–72
Diez Roux AV, Auchincloss AH, Astor B, Barr R, Cushman M, Dvonch T, Jacobs D, Kaufman J, Lin X, Samson P (2006) Recent exposure to particulate matter and C-reactive protein concentration in the multi-ethnic study of atherosclerosis. Am J Epidemiol 164(5):437–448
Dijkema MB, Mallant SF, Gehring U, Kvd H, Alssema M, van Strien RT, Fischer PH, Nijpels G, Stehouwer CD, Hoek G, Dekker JM, Brunekreef B (2011) Long-term exposure to traffic-related air pollution and type 2 diabetes prevalence in a cross-sectional screening-study in the Netherlands. Environ Health 10:76
Dimakopoulou K, Samoli E, Beelen R, Stafoggia M, Andersen Z, Hoffmann B, Fischer P, Nieuwenhuijsen M, Vineis P, Xun W, Hoek G, Raaschou-Nielsen O, Oudin A, Forsberg B, Modig L, Jousilahti P, Lanki T, Turunen A, Oftedal B, Nafstad P, Schwarze P, Penell J, Fratiglioni L, Andersson N, Pedersen N, Korek M, De Faire U, Eriksen K, Tjønneland A, Becker T, Wang M, Bueno-de-Mesquita B, Tsai M, Eeftens M, Peeters P, Meliefste K, Marcon A, Krämer U, Kuhlbusch T, Vossoughi M, Key T, de Hoogh K, Hampel R, Peters A, Heinrich J, Weinmayr G, Concin H, Nagel G, Ineichen A, Jacquemin B, Stempfelet M, Vilier A, Ricceri F, Sacerdote C, Pedeli X, Katsoulis M, Trichopoulou A, Brunekreef B, Katsouyanni K (2014) Air pollution and nonmalignant respiratory mortality in 16 cohorts within the ESCAPE Project. Am J Respir Crit Care Med 189(6):684–696
Donaldson G, Seemungal T, Patel I, Bhowmik A, Wilkinson T, Hurst J, MacCallum P, Wedzicha J (2005) Airway and systemic inflammation and decline in lung function in patients with COPD. Chest 128(4):1995–2004
Donath MY, Dalmas É, Sauter Nadine S, Böni-Schnetzler M (2013) Inflammation in obesity and diabetes: islet dysfunction and therapeutic opportunity. Cell Metab 17(6):860–872
Donath MY, Shoelson SE (2011) Type 2 diabetes as an inflammatory disease. Nat Rev Immunol 11(2):98–107
Dubowsky SD, Suh H, Schwartz J, Coull BA, Gold DR (2006) Diabetes, obesity, and hypertension may enhance associations between air pollution and markers of systemic inflammation. Environ Health Perspect 114(7):992–998
Dutta A, Roychoudhury S, Chowdhury S, Ray MR (2013) Changes in sputum cytology, airway inflammation and oxidative stress due to chronic inhalation of biomass smoke during cooking in premenopausal rural Indian women. Int J Hyg Environ Health 216(3):301–308
Echouffo-Tcheugui J, Dagogo-Jack S (2012) Preventing diabetes mellitus in developing countries. Nat Rev Endocrinol 8(9):557–562
Eeden SV, Tan W, Suwa T, Mukae H, Terashima T, Fujii T, Qui D, Vincent R, Hogg J (2001) Cytokines involved in the systemic inflammatory response induced by exposure to particulate matter air pollutants (PM10). Am J Respir Crit Care Med 164(5):826–830
Eeftens M, Beelen R, de Hoogh K, Bellander T, Cesaroni G, Cirach M, Declercq C, Dedele A, Dons E, de Nazelle A (2012) Development of land use regression models for PM2.5, PM2.5 absorbance, PM10 and PMcoarse in 20 European study areas; results of the ESCAPE project. Environ Sci Technol 46(20):11195–11205
Festa A, D’Agostino R, Tracy R, Haffner S (2002) Elevated levels of acute-phase proteins and plasminogen activator inhibitor-1 predict the development of type 2 diabetes the insulin resistance atherosclerosis study. Diabetes 51(4):1131–1137
Fonken LK, Xu X, Weil ZM, Chen G, Sun Q, Rajagopalan S, Nelson RJ (2011) Air pollution impairs cognition, provokes depressive-like behaviors and alters hippocampal cytokine expression and morphology. Mol Psychiatry 16(10):987–995
Frampton MW, Stewart JC, Oberdörster G, Morrow PE, Chalupa D, Pietropaoli AP, Frasier LM, Speers DM, Cox C, Huang L-S, Utell MJ (2006) Inhalation of ultrafine particles alters blood leukocyte expression of adhesion molecules in humans. Environ Health Perspect 114(1):51–58
Fujii T, Hayashi S, Hogg J, Vincent R, van Eeden S (2001) Particulate matter induces cytokine expression in human bronchial epithelial cells. Am J Respir Cell Mol Biol 25(3):265–271
Gehring U, Gruzieva O, Agius R, Beelen R, Custovic A, Cyrys J, Eeftens M, Flexeder C, Fuertes E, Heinrich J (2013) Air pollution exposure and lung function in children: the ESCAPE Project. Environ Health Perspect 121(11–12):1357–1364
Geiser M, Kreyling WG (2010) Deposition and biokinetics of inhaled nanoparticles. Part Fibre Toxicol 7:2
Gilmour P, Ziesenis A, Morrison E, Vickers M, Drost E, Ford I, Karg E, Mossa C, Schroeppel A, Ferron G (2004) Pulmonary and systemic effects of short-term inhalation exposure to ultrafine carbon black particles. Toxicol Appl Pharmacol 195(1):35–44
Gleeson M, Bishop NC, Stensel DJ, Lindley MR, Mastana SS, Nimmo MA (2011) The anti-inflammatory effects of exercise: mechanisms and implications for the prevention and treatment of disease. Nat Rev Immunol 11(9):607–615
Gold DR, Mittleman MA (2013) New insights into pollution and the cardiovascular system: 2010 to 2012. Circulation 127(18):1903–1913
Goldberg M, Burnett R, Yale J-F, Valois M-F, Brook J (2006) Associations between ambient air pollution and daily mortality among persons with diabetes and cardiovascular disease. Environ Res 100(2):255–267
Goldfine A, Fonseca V, Jablonski K, Pyle L, Staten M, Shoelson S (2010) The effects of salsalate on glycemic control in patients with type 2 diabetes: a randomized trial. Ann Intern Med 152(6):346–357
Gregor MF, Hotamisligil GS (2011) Inflammatory mechanisms in obesity. Annu Rev Immunol 29(1):415–445
Gruzieva O, Gehring U, Aalberse R, Agius R, Beelen R, Behrendt H, Bellander T, Birk M, de Jongste J, Fuertes E (2013) Meta-analysis of air pollution exposure association with allergic sensitization in European birth cohorts. J Allergy Clin Immunol 133(3):767–776
Guilherme A, Virbasius JV, Puri V, Czech MP (2008) Adipocyte dysfunctions linking obesity to insulin resistance and type 2 diabetes. Nat Rev Mol Cell Bio 9(5):367–377
Hansson GK, Hermansson A (2011) The immune system in atherosclerosis. Nat Immunol 12(3):204–212
Hectors TLM, Vanparys C, van der Ven K, Martens G, Jorens P, Van Gaal L, Covaci A, De Coen W, Blust R (2011) Environmental pollutants and type 2 diabetes: a review of mechanisms that can disrupt beta cell function. Diabetologia 54(6):1273–1290
Herder C, Baumert J, Thorand B, Koenig W, Jager W, Meisinger C, Illig T, Martin S, Kolb H (2006) Chemokines as risk factors for type 2 diabetes: results from the MONICA/KORA Augsburg study, 1984–2002. Diabetologia 49(5):921–929
Herder C, Brunner E, Rathmann W, Strassburger K, Tabák A, Schloot N, Witte D (2009a) Elevated levels of the anti-inflammatory interleukin-1 receptor antagonist precede the onset of type 2 diabetes. The Whitehall II study. Diabetes Care 32(3):421–423
Herder C, Lankisch M, Ziegler D, Rathmann W, Koenig W, Illig T, Doring A, Thorand B, Holle R, Giani G, Martin S, Meisinger C (2009b) Subclinical inflammation and diabetic polyneuropathy: MONICA/KORA Survey F3 (Augsburg, Germany). Diabetes Care 32(4):680–682
Herder C, Peltonen M, Koenig W, Sütfels K, Lindström J, Martin S, Ilanne-Parikka P, Eriksson JG, Aunola S, Keinänen-Kiukaanniemi S, Valle TT, Uusitupa M, Kolb H, Tuomilehto J (2009c) Anti-inflammatory effect of lifestyle changes in the Finnish Diabetes Prevention Study. Diabetologia 52(3):433–442
Herder C, Carstensen M, Ouwens D (2013) Anti‐inflammatory cytokines and risk of type 2 diabetes. Diabetes Obes Metab 15(s3):39–50
Herder C, Kowall B, Tabak AG, Rathmann W (2014) The potential of novel biomarkers to improve risk prediction of type 2 diabetes. Diabetologia 57(1):16–29
Hertel S, Viehmann A, Moebus S, Mann K, Bröcker-Preuss M, Möhlenkamp S, Nonnemacher M, Erbel R, Jakobs H, Memmesheimer M, Jöckel K-H, Hoffmann B (2010) Influence of short-term exposure to ultrafine and fine particles on systemic inflammation. Eur J Epidemiol 25(8):581–592
Hoffmann B, Moebus S, Dragano N, Stang A, Möhlenkamp S, Schmermund A, Memmesheimer M, Bröcker-Preuss M, Mann K, Erbel R, Jöckel K-H (2009) Chronic residential exposure to particulate matter air pollution and systemic inflammatory markers. Environ Health Perspect 117(8):1302–1308
Hoffmann B, Luttmann-Gibson H, Cohen A, Zanobetti A, de Souza C, Foley C, Suh H, Coull B, Schwartz J, Mittleman M (2012) Opposing effects of particle pollution, ozone, and ambient temperature on arterial blood pressure. Environ Health Perspect 120(2):241–246
Howren MB, Lamkin DM, Suls J (2009) Associations of depression with C-reactive protein, IL-1, and IL-6: a meta-analysis. Psychosom Med 71(2):171–186
Huang Y-CT, Schmitt M, Yang Z, Que LG, Stewart JC, Frampton MW, Devlin RB (2010) Gene expression profile in circulating mononuclear cells after exposure to ultrafine carbon particles. Inhal Toxicol 22(10):835–846
Hurst JR, Perera WR, Wilkinson TMA, Donaldson GC, Wedzicha JA (2006) Systemic and upper and lower airway inflammation at exacerbation of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 173(1):71–78
IDF Diabetes Atlas Group (2013) IDF diabetes atlas, 6th edn. International Diabetes Federation, Brussels
Jeon CY, Murray MB (2008) Diabetes mellitus increases the risk of active tuberculosis: a systematic review of 13 observational studies. PLoS Med 5(7), e152
Jerrett M, Burnett RT, Ma R, Pope CA, Krewski D, Newbold KB, Thurston G, Shi Y, Finkelstein N, Calle EE, Thun MJ (2005) Spatial analysis of air pollution and mortality in Los Angeles. Epidemiology 16(6):727–736
Kahn SE, Cooper ME, Del Prato S (2014) Pathophysiology and treatment of type 2 diabetes: perspectives on the past, present, and future. Lancet 383(9922):1068–1083
Kampfrath T, Maiseyeu A, Ying Z, Shah Z, Deiuliis JA, Xu X, Kherada N, Brook RD, Reddy KM, Padture NP, Parthasarathy S, Chen LC, Moffatt-Bruce S, Sun Q, Morawietz H, Rajagopalan S (2011) Chronic fine particulate matter exposure induces systemic vascular dysfunction via NADPH oxidase and TLR4 pathways. Circ Res 108(6):716–726
Kelishadi R, Mirghaffari N, Poursafa P, Gidding SS (2009) Lifestyle and environmental factors associated with inflammation, oxidative stress and insulin resistance in children. Atherosclerosis 203(1):311–319
Khafaie MA, Salvi SS, Ojha A, Khafaie B, Gore SS, Yajnik CS (2013) Systemic inflammation (C-reactive protein) in type 2 diabetic patients is associated with ambient air pollution in Pune city, India. Diabetes Care 36(3):625–630
Khandekar M, Cohen P, Spiegelman B (2011) Molecular mechanisms of cancer development in obesity. Nat Rev Cancer 11(12):886–895
Kolb H, Mandrup-Poulsen T (2005) An immune origin of type 2 diabetes? Diabetologia 48(6):1038–1050
Kolb H, Mandrup-Poulsen T (2010) The global diabetes epidemic as a consequence of lifestyle-induced low-grade inflammation. Diabetologia 53(1):10–20
Kolb M, Margetts P, Anthony D, Pitossi F, Gauldie J (2001) Transient expression of IL-1β induces acute lung injury and chronic repair leading to pulmonary fibrosis. J Clin Invest 107(12):1529–1536
Krämer U, Herder C, Sugiri D, Strassburger K, Schikowski T, Ranft U, Rathmann W (2010) Traffic-Related air pollution and incident type 2 diabetes: results from the SALIA cohort study. Environ Health Perspect 118(9):1273–1279
Larsen C, Faulenbach M, Vaag A, Vølund A, Ehses J, Seifert B, Mandrup-Poulsen T, Donath M (2007) Interleukin-1–receptor antagonist in type 2 diabetes mellitus. N Engl J Med 356(15):1517–1526
Lee JK, Bettencourt R, Brenner D, Le T-A, Barrett-Connor E, Loomba R (2012) Association between serum interleukin-6 concentrations and mortality in older adults: the Rancho Bernardo Study. PLoS One 7(4):e34218
Levy H, Murphy A, Zou F, Gerard C, Klanderman B, Schuemann B, Lazarus R, García K, Celedón J, Drumm M (2009) IL1B polymorphisms modulate cystic fibrosis lung disease. Pediatr Pulmonol 44(6):580–593
Li S, Shin H, Ding E, van Dam R (2009) Adiponectin levels and risk of type 2 diabetes: a systematic review and meta-analysis. JAMA 302(2):179–188
Lindsay R, Funahashi T, Hanson R, Matsuzawa Y, Tanaka S, Tataranni P, Knowler W, Krakoff J (2002) Adiponectin and development of type 2 diabetes in the Pima Indian population. Lancet 360(9326):57–58
Lippmann M (2014) Toxicological and epidemiological studies of cardiovascular effects of ambient air fine particulate matter (PM 2.5) and its chemical components: coherence and public health implications. Crit Rev Toxicol 44(4):299–347
Lippmann M, Yeates D, Albert R (1980) Deposition, retention, and clearance of inhaled particles. Br J Ind Med 37(4):337–362
Liu C, Flexeder C, Fuertes E, Cyrys J, Bauer C-P, Koletzko S, Hoffmann B, Von Berg A, Heinrich J (2013a) Effects of air pollution on exhaled nitric oxide in children: results from the GINIplus and LISAplus studies. Int J Hyg Environ Health 217(4–5):483–491
Liu C, Fuertes E, Tiesler C, Birk M, Babisch W, Bauer C-P, Koletzko S, Von Berg A, Hoffmann B, Heinrich J (2013b) The associations between traffic-related air pollution and noise with blood pressure in children: results from the GINIplus and LISAplus studies. Int J Hyg Environ Health 217(4–5):499–505
Liu C, Ying Z, Harkema J, Sun Q, Rajagopalan S (2013c) Epidemiological and experimental links between air pollution and type 2 diabetes. Toxicol Pathol 41(2):361–373
Liu C, Xu X, Bai Y, Wang T, Rao X, Wang A, Sun L, Ying Z, Gushchina L, Maiseyeu A, Morishita M, Sun Q, Harkema J, Rajagopalan S (2014) Air pollution–mediated susceptibility to inflammation and insulin resistance: influence of CCR2 pathways in mice. Environ Health Perspect 122(1):17–26
Ljungman P, Bellander T, Schneider A, Breitner S, Forastiere F, Hampel R, Illig T, Jacquemin B, Katsouyanni K, Von Klot S, Koenig W, Lanki T, Nyberg F, Pekkanen J, Pistelli R, Pitsavos C, Rosenqvist M, Sunyer J, Peters A (2009) Modification of the interleukin-6 response to air pollution by interleukin-6 and fibrinogen polymorphisms. Environ Health Perspect 117(9):1373–1379
Lockwood A (2002) Diabetes and air pollution. Diabetes Care 25(8):1487–1488
Luo L, Hong X, Chen C, Brooks SP, Song Y (2013) Identification of pathology from diesel exhaust particles in the bladder in a rat model by aspiration of particles from the pharynx. Environ Toxicol Pharmacol 35(3):380–387
MacIntyre E, Gehring U, Mölter A, Fuertes E, Klümper C, Krämer U, Quass U, Hoffmann B, Gascon M, Brunekreef B (2013) Air pollution and respiratory infections during early childhood: an analysis of 10 European birth cohorts within the ESCAPE project. Environ Health Perspect 122(1):107
Meigs J, Hu F, Rifai N, Manson J (2004) Biomarkers of endothelial dysfunction and risk of type 2 diabetes mellitus. JAMA 291(16):1978–1986
Michael S, Montag M, Dott W (2013) Pro-inflammatory effects and oxidative stress in lung macrophages and epithelial cells induced by ambient particulate matter. Environ Pollut 183(c):19–29
Miyata R, van Eeden SF (2011) The innate and adaptive immune response induced by alveolar macrophages exposed to ambient particulate matter. Toxicol Appl Pharmacol 257(2):209–226
Nemmar A, Vanbilloen H, Hoylaerts M, Hoet P, Verbruggen A, Nemery B (2001) Passage of intratracheally instilled ultrafine particles from the lung into the systemic circulation in hamster. Am J Respir Crit Care Med 164(9):1665–1668
Nemmar A, Hoet PHM, Vanquickenborne B, Dinsdale D, Thomeer M, Hoylaerts M, Vanbilloen H, Mortelmans L, Nemery B (2002) Passage of inhaled particles into the blood circulation in humans. Circulation 105(4):411–414
Nimmo M, Leggate M, Viana J, King J (2013) The effect of physical activity on mediators of inflammation. Diabetes Obes Metab 15(s3):51–60
O’Neill MS, Veves A, Zanobetti A, Sarnat JA, Gold DR, Economides PA, Horton ES, Schwartz J (2005) Diabetes enhances vulnerability to particulate air pollution–associated impairment in vascular reactivity and endothelial function. Circulation 111(22):2913–2920
Oberdörster G, Utell M (2002) Ultrafine particles in the urban air: to the respiratory tract – and beyond? Environ Health Perspect 110(8):A440–A441
Oberdörster G, Sharp Z, Atudorei V, Elder A, Gelein R, Kreyling W, Cox C (2004) Translocation of inhaled ultrafine particles to the brain. Inhal Toxicol 16(6–7):437–445
Osborn O, Olefsky JM (2012) The cellular and signaling networks linking the immune system and metabolism in disease. Nat Med 18(3):363–374
Park S, O’Neill M, Vokonas P, Sparrow D, Schwartz J (2005) Effects of air pollution on heart rate variability: the VA Normative Aging Study. Environ Health Perspect 113(3):304–309
Pearson JF, Bachireddy C, Shyamprasad S, Goldfine AB, Brownstein JS (2010) Association between fine particulate matter and diabetes prevalence in the U.S. Diabetes Care 33(10):2196–2201
Pedersen M, Giorgis-Allemand L, Bernard C, Aguilera I, Andersen A-MN, Ballester F, Beelen RMJ, Chatzi L, Cirach M, Danileviciute A, Dedele A, Eijsden MV, Estarlich M, Fernández-Somoano A, Fernández MF, Forastiere F, Gehring U, Grazuleviciene R, Gruzieva O, Heude B, Hoek G, Hoogh KD, Van Den Hooven EH, Håberg SE, Jaddoe VWV, Klümper C, Korek M, Krämer U, Lerchundi A, Lepeule J, Nafstad P, Nystad W, Patelarou E, Porta D, Postma D, Raaschou-Nielsen O, Rudnai P, Sunyer J, Stephanou E, Sørensen M, Thiering E, Tuffnell D, Varró MJ, Vrijkotte TGM, Wijga A, Wilhelm M, Wright J, Nieuwenhuijsen MJ, Pershagen G, Brunekreef B, Kogevinas M, Slama R (2013) Ambient air pollution and low birthweight: a European cohort study (ESCAPE). Lancet Respir Med 1(9):695–704
Péry ARR, Brochot C, Hoet PHM, Nemmar A, Bois FY (2009) Development of a physiologically based kinetic model for 99m-technetium-labelled carbon nanoparticles inhaled by humans. Inhal Toxicol 21(13):1099–1107
Pope CA, Dockery DW (2006) Health effects of fine particulate air pollution: lines that connect. J Air Waste Manage Assoc 56(6):709–742
Pouwer F, Kupper N, Adriaanse M (2010) Does emotional stress cause type 2 diabetes mellitus? A review from the European Depression in Diabetes (EDID) research consortium. Discov Med 9(45):112–118
Pradhan A, Manson J, Rifai N, Buring J, Ridker P (2001) C-reactive protein, interleukin 6, and risk of developing type 2 diabetes mellitus. JAMA 286(3):327–334
Provoost S, Maes T, Willart M, Joos G, Lambrecht B, Tournoy K (2010) Diesel exhaust particles stimulate adaptive immunity by acting on pulmonary dendritic cells. J Immunol 184(1):426–432
Puett R, Hart J, Schwartz J, Hu F, Liese A, Laden F (2011) Are particulate matter exposures associated with risk of type 2 diabetes? Environ Health Perspect 119(3):384–389
Raaschou-Nielsen O, Sørensen M, Ketzel M, Hertel O, Loft S, Tjønneland A, Overvad K, Andersen ZJ (2012) Long-term exposure to traffic-related air pollution and diabetes-associated mortality: a cohort study. Diabetologia 56(1):36–46
Raaschou-Nielsen O, Andersen Z, Beelen R, Samoli E, Stafoggia M, Weinmayr G, Hoffmann B, Fischer P, Nieuwenhuijsen M, Brunekreef B (2013) Air pollution and lung cancer incidence in 17 European cohorts: prospective analyses from the European Study of Cohorts for Air Pollution Effects (ESCAPE). Lancet Oncol 14(9):813–822
Rajagopalan S, Brook RD (2012) Air pollution and type 2 diabetes: mechanistic insights. Diabetes 61(12):3037–3045
Ridker P, Howard C, Walter V, Everett B, Libby P, Hensen J, Thuren T (2012) Effects of interleukin-1β inhibition with canakinumab on hemoglobin A1c, lipids, C-reactive protein, interleukin-6, and fibrinogen: a phase IIb randomized, placebo-controlled trial. Circulation 126(23):2739–2748
Röpcke S, Holz O, Lauer G, Müller M, Rittinghausen S, Ernst P, Lahu G, Elmlinger M, Krug N, Hohlfeld JM (2012) Repeatability of and relationship between potential COPD biomarkers in bronchoalveolar lavage, bronchial biopsies, serum, and induced sputum. PLoS One 7(10):e46207
Rückerl R, Ibald-Mulli A, Koenig W, Schneider A, Woelke G, Cyrys J, Heinrich J, Marder V, Frampton M, Wichmann H (2006) Air pollution and markers of inflammation and coagulation in patients with coronary heart disease. Am J Respir Crit Care Med 173(4):432–441
Rückerl R, Greven S, Ljungman P, Aalto P, Antoniades C, Bellander T, Berglind N, Chrysohoou C, Forastiere F, Jacquemin B, Von Klot S, Koenig W, Küchenhoff H, Lanki T, Pekkanen J, Perucci CA, Schneider A, Sunyer J, Peters A (2007) Air pollution and inflammation (interleukin-6, C-reactive protein, fibrinogen) in myocardial infarction survivors. Environ Health Perspect 115(7):1072–1080
Rückerl R, Schneider A, Breitner S, Cyrys J, Peters A (2011) Health effects of particulate air pollution: a review of epidemiological evidence. Inhal Toxicol 23(10):555–592
Salvi S, Blomberg A, Rudell B, Kelly F, Sandstrom T, Holgate S, Frew A (1999) Acute inflammatory responses in the airways and peripheral blood after short-term exposure to diesel exhaust in healthy human volunteers. Am J Respir Crit Care Med 159(3):702–709
Salvi S, Nordenhall C, Blomberg A, Rudell B, Pourazar J, Kelly F, Wilson S, Sandstrom T, Holgate S, Frew A (2000) Acute exposure to diesel exhaust increases IL-8 and GRO-α production in healthy human airways. Am J Respir Crit Care Med 161(2):550–557
Sapey E, Ahmad A, Bayley D, Newbold P, Snell N, Rugman P, Stockley RA (2009) Imbalances between interleukin-1 and tumor necrosis factor agonists and antagonists in stable COPD. J Clin Immunol 29(4):508–516
Schikowski T, Adam M, Marcon A, Cai Y, Vierkötter A, Carsin A, Jacquemin B, Al Kanani Z, Beelen R, Birk M (2014) Association of ambient air pollution with the prevalence and incidence of COPD. Eur Respir J 44(3):614–626
Schmidt M, Duncan B, Sharrett A, Lindberg G, Savage P, Offenbacher S, Azambuja M, Tracy R, Heiss G (1999) Markers of inflammation and prediction of diabetes mellitus in adults (Atherosclerosis Risk in Communities study): a cohort study. Lancet 353(9165):1649–1652
Schneider A, Alexis N, Diaz-Sanchez D, Neas L, Harder S, Herbst M, Cascio W, Buse J, Peters A, Devlin R (2011) Ambient PM2.5 exposure up-regulates the expression of costimulatory receptors on circulating monocytes in diabetic individuals. Environ Health Perspect 119(6):778–783
Schwartz J (2001) Air pollution and blood markers of cardiovascular risk. Environ Health Perspect 109(Suppl 3):405–409
Seaton A, Soutar A, Crawford V, Elton R, McNerlan S, Cherrie J, Watt M, Agius R, Stout R (1999) Particulate air pollution and the blood. Thorax 54(11):1027–1032
Sell H, Habich C, Eckel J (2012) Adaptive immunity in obesity and insulin resistance. Nat Rev Endocrinol 8(12):709–716
Seshasai S, Kaptoge S, Thompson A, Di Angelantonio E, Gao P, Sarwar N, Whincup P, Mukamal K, Gillum R, Holme I (2011) Diabetes mellitus, fasting glucose, and risk of cause-specific death. N Engl J Med 364(9):829–841
Shoelson S, Herrero L, Naaz A (2007) Obesity, inflammation, and insulin resistance. Gastroenterology 132(6):2169–2180
Sidawi B, Al-Hairi MTA (2012) The impact of built environment on diabetic patients: the case of Eastern Province, Kingdom of Saudi Arabia. Glob J Health Sci 4(4):126–138
Sima C, Glogauer M (2013) Diabetes mellitus and periodontal diseases. Curr Diab Rep 13(3):445–452
Sinden NJ, Stockley RA (2010) Systemic inflammation and comorbidity in COPD: a result of ‘overspill’ of inflammatory mediators from the lungs? Review of the evidence. Thorax 65(10):930–936
Singh D, Edwards L, Tal-Singer R, Rennard S (2010) Sputum neutrophils as a biomarker in COPD: findings from the ECLIPSE study. Respir Res 11:77
Spranger J, Kroke A, Möhlig M, Hoffmann K, Bergmann M, Ristow M, Boeing H, Pfeiffer A (2003) Inflammatory cytokines and the risk to develop type 2 diabetes results of the prospective population-based European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam Study. Diabetes 52(3):812–817
Steinvil A, Kordova-Biezuner L, Shapira I, Berliner S, Rogowski O (2008) Short-term exposure to air pollution and inflammation-sensitive biomarkers. Environ Res 106(1):51–61
Stringhini S, Batty GD, Bovet P, Shipley MJ, Marmot MG, Kumari M, Tabak AG, Kivimäki M (2013) Association of lifecourse socioeconomic status with chronic inflammation and type 2 diabetes risk: the Whitehall II prospective cohort study. PLoS Med 10(7):e1001479
Sullivan J, Hubbard R, Liu SL-J, Shepherd K, Trenga C, Koenig J, Chandler W, Kaufman J (2007) A community study of the effect of particulate matter on blood measures of inflammation and thrombosis in an elderly population. Environ Health 6:3
Sun Q, Yue P, Deiuliis JA, Lumeng CN, Kampfrath T, Mikolaj MB, Cai Y, Ostrowski MC, Lu B, Parthasarathy S, Brook RD, Moffatt-Bruce SD, Chen LC, Rajagopalan S (2009) Ambient air pollution exaggerates adipose inflammation and insulin resistance in a mouse model of diet-induced obesity. Circulation 119(4):538–546
Tabák AG, Herder C, Rathmann W, Brunner EJ, Kivimäki M (2012) Prediabetes: a high-risk state for diabetes development. Lancet 379(9833):2279–2290
Tamayo T, Rathmann W, Krämer U, Sugiri D, Grabert M, Holl R (2014a) Is particle pollution in outdoor air associated with metabolic control in type 2 diabetes? PLoS One 9(3):e91639
Tamayo T, Rosenbauer J, Wild SH, Spijkerman AMW, Baan C, Forouhi NG, Herder C, Rathmann W (2014b) Diabetes in Europe: an update. Diabetes Res Clin Pract 103(2):206–217
Taylor KW, Novak RF, Anderson HA, Birnbaum LS, Blystone C, Devito M, Jacobs D, Köhrle J, Lee D-H, Rylander L, Rignell-Hydbom A, Tornero-Velez R, Turyk ME, Boyles AL, Thayer KA, Lind L (2013) Evaluation of the association between persistent organic pollutants (POPs) and diabetes in epidemiological studies: a national toxicology program workshop review. Environ Health Perspect 121(7):774–783
Teichert T, Vossoughi M, Vierkötter A, Sugiri D, Schikowski T, Schulte T, Roden M, Luckhaus C, Herder C, Krämer U (2013) Association between traffic-related air pollution, subclinical inflammation and impaired glucose metabolism: results from the SALIA study. PLoS One 8(12):e83042
Terzano C, Di Stefano F, Conti V, Graziani E, Petroianni A (2010) Air pollution ultrafine particles: toxicity beyond the lung. Eur Rev Med Pharmacol Sci 14(10):809–821
Thiering E, Cyrys J, Kratzsch J, Meisinger C, Hoffmann B, Berdel D, Berg A, Koletzko S, Bauer C-P, Heinrich J (2013) Long-term exposure to traffic-related air pollution and insulin resistance in children: results from the GINIplus and LISAplus birth cohorts. Diabetologia 56(8):1696–1704
Thorand B, Kolb H, Baumert J, Koenig W, Chambless L, Meisinger C, Illig T, Martin S, Herder C (2005) Elevated levels of interleukin-18 predict the development of type 2 diabetes results from the MONICA/KORA Augsburg study, 1984–2002. Diabetes 54(10):2932–2938
Törnqvist H, Mills NL, Gonzalez M, Miller MR, Robinson SD, Megson IL, MacNee W, Donaldson K, Söderberg S, Newby DE, Sandström T, Blomberg A (2007) Persistent endothelial dysfunction in humans after diesel exhaust inhalation. Am J Respir Crit Care Med 176(4):395–400
Turer AT, Scherer PE (2012) Adiponectin: mechanistic insights and clinical implications. Diabetologia 55(9):2319–2326
United States Environmental Protection Agency (2014) Particulate matter. http://www.epa.gov/ncer/science/pm/. Accessed 7 Apr 2014
Valavanidis A, Fiotakis K, Vlachogianni T (2008) Airborne particulate matter and human health: toxicological assessment and importance of size and composition of particles for oxidative damage and carcinogenic mechanisms. J Environ Sci Health C Environ Carcinog Ecotoxicol Rev 26(4):339–362
Vernooy JH, Küçükaycan M, Jacobs JA, Chavannes NH, Buurman WA, Dentener MA, Wouters EF (2002) Local and systemic inflammation in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 166(9):1218–1224
Wang G, Jiang R, Zhao Z, Song W (2013a) Effects of ozone and fine particulate matter (PM2.5) on rat system inflammation and cardiac function. Toxicol Lett 217(1):23–33
Wang Y-B, Watts AB, Peters JI, Iii ROW (2013b) The impact of pulmonary diseases on the fate of inhaled medicines – a review. Int J Pharm 461(1–2):112–128
Wang M, Beelen R, Stafoggia M, Raaschou-Nielsen O, Andersen ZJ, Hoffmann B, Fischer P, Houthuijs D, Nieuwenhuijsen M, Weinmayr G, Vineis P, Xun WW, Dimakopoulou K, Samoli E, Laatikainen T, Lanki T, Turunen AW, Oftedal B, Schwarze P, Aamodt G, Penell J, Faire UD, Korek M, Leander K, Pershagen G, Pedersen NL, Östenson C-G, Fratiglioni L, Eriksen KT, Sørensen M, Tjønneland A, Bueno-De-Mesquita B, Eeftens M, Bots ML, Meliefste K, Krämer U, Heinrich J, Sugiri D, Key T, Kd H, Wolf K, Peters A, Cyrys J, Jaensch A, Concin H, Nagel G, Tsai M-Y, Phuleria H, Ineichen A, Künzli N, Probst-Hensch N, Schaffner E, Vilier A, Clavel-Chapelon F, Declerq C, Ricceri F, Sacerdote C, Marcon A, Galassi C, Migliore E, Ranzi A, Cesaroni G, Badaloni C, Forastiere F, Katsoulis M, Trichopoulou A, Keuken M, Jedynska A, Kooter IM, Kukkonen J, Sokhi RS, Brunekreef B, Katsouyanni K, Hoek G (2014) Long-term exposure to elemental constituents of particulate matter and cardiovascular mortality in 19 European cohorts: results from the ESCAPE and TRANSPHORM projects. Environ Int 66(C):97–106
Whitsel EA, Quibrera PM, Christ SL, Liao D, Prineas RJ, Anderson GL, Heiss G (2009) Heart rate variability, ambient particulate matter air pollution, and glucose homeostasis: the environmental epidemiology of arrhythmogenesis in the Women’s Health Initiative. Am J Epidemiol 169(6):693–703
World Health Organisation (2013) Burden of disease: deaths data by region. http://apps.who.int/gho/data/node.main.156?lang=en. Accessed 7 Apr 2014
World Health Organisation (2014a) 7 million premature deaths annually linked to air pollution. http://www.who.int/mediacentre/news/releases/2014/air-pollution/en/. Accessed 7 Apr 2014
World Health Organisation (2014b) Global Health Observatory (GHO). http://www.who.int/gho/phe/outdoor_air_pollution/exposure/en/. Accessed 7 Apr 2014
Xu G, Zhou Z, Zhu W, Fan X, Liu X (2009) Plasma C-reactive protein is related to cognitive deterioration and dementia in patients with mild cognitive impairment. J Neurol Sci 284(1–2):77–80
Xu X, Liu C, Xu Z, Tzan K, Zhong M, Wang A, Lippmann M, Chen L-C, Rajagopalan S, Sun Q (2011a) Long-term exposure to ambient fine particulate pollution induces insulin resistance and mitochondrial alteration in adipose tissue. Toxicol Sci 124(1):88–98
Xu Z, Xu X, Zhong M, Hotchkiss IP, Lewandowski RP, Wagner JG, Bramble LA, Yang Y, Wang A, Harkema JR, Lippmann M, Rajagopalan S, Chen L-C, Sun Q (2011b) Ambient particulate air pollution induces oxidative stress and alterations of mitochondria and gene expression in brown and white adipose tissues. Part Fibre Toxicol 8:20
Xu X, Rao X, Wang T-Y, Jiang S, Ying Z, Liu C, Wang A, Zhong M, Deiuliis J, Maiseyeu A (2012) Effect of co-exposure to nickel and particulate matter on insulin resistance and mitochondrial dysfunction in a mouse model. Part Fibre Toxicol 9:40
Xu X, Jiang SY, Wang T-Y, Bai Y, Zhong M, Wang A, Lippmann M, Chen L-C, Rajagopalan S, Sun Q (2013) Inflammatory response to fine particulate air pollution exposure: neutrophil versus monocyte. PLoS One 8(8):e71414
Zanobetti A, Schwartz J (2002) Cardiovascular damage by airborne particles: are diabetics more susceptible? Epidemiology 13(5):588–592
Zeng M, Wen Y, Liu L-Y, Wang H, Guan K-P, Huang X (2009) Role of TNF-α, sTNF-R55 and sTNF-R75 in inflammation of acute exacerbations of chronic obstructive pulmonary disease. Respiration 78(4):399–403
Zhao J, Gao Z, Tian Z, Xie Y, Xin F, Jiang R, Kan H, Song W (2013) The biological effects of individual-level PM2. 5 exposure on systemic immunity and inflammatory response in traffic policemen. Occup Environ Med 70(6):426–431
Zheng Z, Xu X, Zhang X, Wang A, Zhang C, Hüttemann M, Grossman LI, Chen LC, Rajagopalan S, Sun Q, Zhang K (2013) Exposure to ambient particulate matter induces a NASH-like phenotype and impairs hepatic glucose metabolism in an animal model. J Hepatol 58(1):148–154
Ziccardi P, Nappo F, Giugliano G, Esposito K, Marfella R, Cioffi M, D’Andrea F, Molinari AM, Giugliano D (2002) Reduction of inflammatory cytokine concentrations and improvement of endothelial functions in obese women after weight loss over one year. Circulation 105(7):804–809
Acknowledgements
This study was supported by research grants from the Deutsche Forschungsgemeinschaft (DFG; HE-4510/2-1, KR 1938/3-1, LU 691/4-1). This work was supported by the Ministry of Innovation, Science and Research of the State of North Rhine-Westphalia (MIWF NRW) and the German Federal Ministry of Health (BMG). This study was supported in part by a grant from the German Federal Ministry of Education and Research (BMBF) to the German Center for Diabetes Research (DZD e.V.). We thank Kirti Kaul (German Diabetes Center) for critically reading the manuscript and for helpful discussions.
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Teichert, T., Herder, C. (2016). Air Pollution, Subclinical Inflammation and the Risk of Type 2 Diabetes. In: Esser, C. (eds) Environmental Influences on the Immune System. Springer, Vienna. https://doi.org/10.1007/978-3-7091-1890-0_11
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