The impact of Streptococcus pneumoniae infection on hormonal balance, metabolic indicators, and gene expression (TLR4, INS, IL6) in patients with type 2 diabetes mellitus | ||
Microbes and Infectious Diseases | ||
Articles in Press, Accepted Manuscript, Available Online from 22 October 2025 | ||
Document Type: Original Article | ||
DOI: 10.21608/mid.2025.413931.3112 | ||
Authors | ||
Rokan Hazem Hamad* 1; Shukran Abdulhussein Mohammed2; Noor Jasem Mohammed3 | ||
1Directorate of Education, Kirkuk, Iraq | ||
2Kirkuk, Iraq | ||
3Kirkuk Teaching Hospital, Kirkuk, Iraq | ||
Abstract | ||
Background: Diabetic patients with impaired alveolar macrophage function are highly susceptible to Streptococcus pneumoniae infection, which can exacerbate metabolic disturbances through reduced insulin and elevated stress hormones, promoting immune evasion. This study aimed to investigate the effects of pneumococcal infection on hormone balance, metabolic parameters, and the expression of INS, IL6, and TLR4 in T2DM patients, focusing on glucose-metabolism-related pathways. Methods: A cross-sectional study in medical clinics and Al-Jumhori Hospital of Kirkuk with 90 previously diagnosed suffering individuals. Exist about 90 patients and were allocated to an infected group (70 S. pneumoniae infected patients) and a non-infected group, healthy with 20 control . The hormonal levels (insulin, cortisol, adrenaline, noradrenaline, glucagon) and metabolic indicators (glucose, cholesterol, triglycerides) were followed during the test taking blood sample. Real-time polymerase chain reaction was used to assess the mRNA expression of TLR4, insulin (INS) and interleukin 6 (IL-6). Results: As a result, the infected patients had significantly reduced insulin levels (12.5 ± 4.35 µU/mL) compared to the non-infected group (20.17 ± 5.12 µU/mL). Furthermore, concentrations of cortisol, adrenaline, and noradrenaline were significantly higher in the infected group. Gene expression analysis showed increased TLR4 (2.88 ± 0.52) and IL6 (3.52 ± 0.6) gene expressions; however, this was accompanied by a significantly lower INS gene expression (0.57 ± 0.16) in the infected group compared to the non-infected control group. Conclusions: Infected individuals showed low insulin levels and elevated stress hormones (cortisol, adrenaline, noradrenaline), indicating activation of the HPA axis and sympathetic nervous system. Gene expression analysis revealed up-regulation of TLR4 and IL6 and down-regulation of INS, suggesting impaired insulin synthesis. These findings highlight the importance of early diagnosis and optimal management of S. pneumoniae infections in diabetics to prevent metabolic disturbances and further complications. | ||
Keywords | ||
Keywords: Streptococcus pneumoniae; Type 2 Diabetes Mellitus (T2DM); Gene Expression; Metabolic Dysregulation; Inflammatory Markers | ||
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