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Carey N. Lumeng, Jennifer L. Bodzin, Alan R. Saltiel
Published in Volume 117, Issue 1
J Clin Invest. 2007; 117(1):175–184 doi:10.1172/JCI29881
Abstract | Full text | PDF
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Figure 8
Proposed model for ATM polarization and its function in adipose tissue with progressive obesity.

In lean, insulin-sensitive states, ATMs are polarized toward an M2 state with IL-10 and arginase expression. Early during HFD treatment, adipocytes undergo hypertrophy, releasing chemokines that induce recruitment of M1-polarized ATMs with low IL-10 expression and increased iNOS and TNF-α production. In these early stages of mild obesity with retained insulin sensitivity, M2-polarized resident ATMs are able to partially protect adipocytes from these inflammatory factors and may block M1 polarization. With increased adiposity, recruited CCR2+ ATMs form crownlike structures (CLS) and overwhelm the protective effects of M2 macrophages, leading to a dominant role for TNF-α and iNOS. These factors generate insulin resistance in adipocytes, activate JNK and NF-κB, alter adipokine secretion, and lead to excess circulating levels of free fatty acids due to adipocyte lipolysis and impaired lipogenesis.