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Table 3 The energy appeal reaction

From: Energy metabolism and rheumatic diseases: from cell to organism

Known reaction Physiological meaning in transient inflammatory episodes Pathophysiological problem in chronic inflammatory diseases
Fatigue Stop of energy expenditure for brain and muscles, stop of courtship and foraging behavior Depressive symptoms/longstanding fatigue (sickness behavior)
Anorexia Stop of energy expenditure for gut function Reduced or stopped uptake of energy-rich substrates
Malnutrition Stop of energy expenditure for gut function Reduced or stopped uptake of vitamins and trace elementsa
Muscle breakdown Stop of energy expenditure for muscles, and redirection of muscle proteins to gluconeogenesis Cachexia
Increased muscle relative to fat breakdown Stop of energy expenditure for muscles, and redirection of muscle proteins to gluconeogenesis Cachectic obesity
Insulin (insulin-like growth factor-1) resistance in liver, muscle, and fat tissue Redirection of glucose and free fatty acids to immune cells, which do not become insulin (insulin-like growth factor-1) resistant Insulin resistance as part of the metabolic syndrome
Appearance of a proinflammatory form of HDL cholesterol Acute-phase reaction of lipid metabolism leading to higher delivery of cholesterol and other lipids to macrophages Dyslipidemia as part of the metabolic syndrome
Alterations of steroid hormone axes Cytokine/leptin-driven hypoandrogenemia supports muscle breakdown and protein delivery for gluconeogenesis and support of an activated immune system (alanine, glutamine) Cortisol-to-androgen preponderance in chronic inflammation is catabolic and gluconeogenetic
Elevated sympathetic tone and local sympathetic nerve fiber loss, decreased parasympathetic tone Cytokine-driven increase of sympathetic nervous system activity increases gluconeogenesis and lipolysis. The parallel loss of sympathetic nerve fibers in inflamed tissue supports local inflammation and local lipolysis Hypertension as part of the metabolic syndrome
Increase of body water Cytokine-driven activation of the water retention system due to systemic water loss during inflammation Hypertension as part of the metabolic syndrome
Inflammation-related anemia Stop of energy expenditure for brain and muscle activity Anemia
Inflammation-related provision of calcium and phosphorus High calcium and phosphorus are mandatory for energy-consuming reactions (think of ATP) Local and general osteopenia
  1. Data taken from [2, 90]. HDL, high-density lipoprotein. aHypovitaminosis D and others, deficiency in zinc, iron, copper, magnesium, and similar.