The present study aimed to evaluate changes in peripheral blood neutrophil apoptosis, phagocytosis and ROS production, in response to acute hyperglycemia, in horses with obesity and insulin resistance. Our results provide evidence that obesity per se can modulate neutrophil oxidative burst independently of insulin sensitivity. Moreover, obesity in association to IR impairs peripheral blood neutrophil phagocytosis but not ROS production. Induced hyperglycemia increased phagocytosis in the obese-IR group and diminished ROS production in all study groups, although this decrease was not significant for the obese-IR group. To the authors´ knowledge this is the first report regarding the effect of in vivo hyperglycemia, obesity and IR, on these aspects of neutrophil functionality.
The respiratory burst is an important oxygen-dependent function of neutrophils, highly involved in their bactericidal capacity [46]. In the present study, a marked increase in basal ROS production was observed in the obese-IS group when compared to both, the lean-IS and obese-IR groups. These results are consistent with those reported by Brotfain et al. (2015), who reported overproduction of ROS in morbidly obese non-diabetic human patients. Conversely, obese-IR horses showed a minimal increase in ROS production, with results similar to those observed in the lean-IS group. This was an interesting and unexpected result. In humans, IR is a condition characterized by high ROS production and is a key feature of type 2 diabetes mellitus [47]. Studies conducted in subjects with type 2 diabetes have widely documented this marked increase in ROS production [48, 49]. Furthermore, high levels of ROS have been linked to endothelial damage in humans suffering from metabolic disorders [50]. Likewise, endothelial dysfunction associated with endocrinophatic laminitis has been reported in horses with metabolic disturbances such as metabolic syndrome [51]. In horses few studies have explored the relation between metabolic disorders and neutrophil respiratory burst [13, 14]. Holbrook et al., (2012) observed a marked increase in ROS production in hyperinsulinemic obese horses when compared to a lean group. Although none of the animals tested in our study were hyperinsulinemic, the contradictory results obtained between Holbrook’s and the present study requires further research. On the other hand, in our study acute hyperglycemia induced a significant reduction of neutrophil ROS production in both insulin sensitive groups, but no significant decrease was observed in the obese-IR group. In healthy humans, induced acute hyperglycemia assessed through different clamp techniques failed to influence neutrophils oxidative burst response [52, 53]. However, in diabetic patients, hyperglycemia is described as an important priming factor of neutrophils responsible for their excessive response under stimulation, including an exaggerated production of ROS [54, 55]. Furthermore, hyperglycemia stimulates the activation of the polyol pathway, an alternative metabolic route, in which glucose at high concentrations is converted to sorbitol by the enzyme aldose reductase [31]. In diabetic patients the activation of this metabolic pathway has been linked with increased neutrophils ROS production, which levels were restored after the use of an aldose reductase inhibitor [56]. Although pancreatic exhaustion and consequent poor glycemic control are uncommon in horses [19], cases of type 2 diabetes have been reported [57] and an activation of this alternative pathway cannot be discarded. To date, no data is available regarding the effect of hyperglycemia and alternative metabolic routes activation on neutrophil functions of horses with metabolic disorders. Thus, these results suggest that metabolic status of horses and hyperglycemia affect the responsiveness of blood neutrophils, with an exacerbated oxidative burst response observed in the obese-IS group, which could play a detrimental role in horses´ health.
Regarding phagocytosis, the obese-IR group showed an important decrease in the phagocytic rate of neutrophils compared to the insulin-sensitive groups, regardless of their body condition score. Consistent with our results, a decreased PMNs phagocytic activity has been reported in humans and rats with type 2 diabetes [58–60]. Furthermore, results from the insulin sensitive groups (lean-IS and obese-IS) are consistent with those described by Brotfain et al., (2015), where no differences in neutrophil phagocytosis were found between lean and non-diabetic morbidly obese subjects. Few studies in horses have aimed to determinate the effect of metabolic diseases on neutrophil phagocytosis [13, 14]. In a study conducted in obese-hyperinsulinemic horses, no differences were reported in the phagocytosis of bacteria when compared to a lean-control group [13]. Although our results are not consistent with that previous report, our study population differed in that none of the animals were hyperinsulinemic, but rather, insulin resistant, which is a more prevalent condition in clinical patient populations. Interestingly, hyperglycemia in the obese-IR group appears to increase the phagocytic rate of neutrophils. This finding differs from available in vitro data, in which hyperglycemia has been reported to impair and decrease phagocytosis of human PMNs [33, 61]. On the other hand, apoptosis is an important neutrophil function for the maintenance of tissue homeostasis [62]. Alterations in the process of neutrophil programmed cell death has been associated with chronic inflammation, tissue injury and some diseases in humans [63]. In the present study, apoptotic capacity of neutrophils appears to not be influenced by either, hyperglycemia or the metabolic status of horses. Although a slightly decrease in the apoptotic rate was observed in the two obese groups, no significative differences were reached. Thus far, little information is known regarding the relation between metabolic disorders and neutrophil apoptosis in horses. Only one study reported an increased expression of apoptotic related proteins in adipose and hepatic tissue of horses with equine metabolic syndrome [64]. However, other reports have studied the effects of different diseases, such as asthma [65], colitis and lipopolysaccharide infusion [66, 67], upon neutrophil apoptosis. Interestingly, delayed neutrophil apoptotic rates have been reported in the studies mentioned above. Diverse studies in humans and mice had demonstrated that both, a dysfunctional metabolic status like type 2 diabetes mellitus and hyperglycemia are able to decrease the rate of neutrophil apoptosis [33, 68, 69]. Our study do not support similar findings in the equine species, but it must be acknowledged that only spontaneous neutrophil apoptosis was assessed, in absence of stimuli reagents. Stimuli are able to enhance the prolonged lifespan of neutrophils, and therefore differences are easier to observe when metabolic disturbances are present [69].
The low number of horses tested per group is the main limitation of the present study. A larger study population will be able to increase the power of the test and provide more robust evidence. Furthermore, the effect of hyperglycemia over neutrophils functions was determined at a single time point after the carbohydrate overdose. In vitro experiments with different glucose concentrations, and in vivo trials with persistent hyperglycemia, could provide more information on the effect of glucose on neutrophil functions. Additionally, only one laboratory technique was performed for the assessment of each neutrophil function in this study. Future experimental studies testing different techniques and stimuli, and including other neutrophil functions such as chemotaxis, adherence capacity and NETosis should be explored. Moreover, future studies should include insulin dysregulated animals, as this group was not included in the present report.