Background: It is plausible that gene polymorphisms in tumor necrosis factor-α (TNF-α), interleukin (IL)-1, IL-6, IL-8, and IL-18 may affect predisposition to microvascular complications of diabetes mellitus (DM), but the results of the so far published studies remain controversial. Objectives: We conducted this meta-analysis to clarify relationships between TNF-α/IL-1/IL-4/IL-8/IL-18 polymorphisms and predisposition to microvascular complications of DM by pooling the findings of eligible studies. Methods: A comprehensive search of PubMed, Embase, Web of Science, and CNKI was endorsed by us to identify already published studies. Forty-nine studies were found to be eligible for the meta-analyses. Results: The pooled meta-analyses results showed that genotypic frequencies of TNF-α −238 G/A, TNF-α −308 G/A, TNF-α −1,031 T/C, IL-1A −889 C/T, IL-1B −511 C/T, IL-6 −572 G/C, and IL-18 −137 G/C polymorphisms among patients with diabetic nephropathy (DN) and controls differed significantly. Moreover, genotypic frequencies of TNF-α −238 G/A and IL-8 −251 A/T polymorphisms among patients with diabetic retinopathy (DR) and controls also differed significantly. Conclusions: This meta-analysis suggested that TNF-α −238 G/A, TNF-α −308 G/A, TNF-α −1,031 T/C, IL-1A −889 C/T, IL-1B −511 C/T, IL-6 −572 G/C, and IL-18 −137 G/C polymorphisms may affect predisposition of DN. Moreover, TNF-α −238 G/A and IL-8 −251 A/T polymorphisms may affect predisposition of DR.

1.
American Diabetes Association. Diagnosis and classification of diabetes mellitus.
Diabetes Care
. 2014;37(Suppl 1):S81–90.
2.
Thomas MC, Brownlee M, Susztak K, Sharma K, Jandeleit-Dahm KA, Zoungas S, et al. Diabetic kidney disease.
Nat Rev Dis Primers
. 2015;1:15018.
3.
Simó-Servat O, Hernández C, Simó R. Diabetic retinopathy in the context of patients with diabetes.
Ophthalmic Res
. 2019;62(4):211–7.
4.
Gupta R, Misra A. Epidemiology of microvascular complications of diabetes in South Asians and comparison with other ethnicities.
J Diabetes
. 2016;8(4):470–82.
5.
Ghandour R, Mikki N, Abu Rmeileh NME, Jerdén L, Norberg M, Eriksson JW, et al. Complications of type 2 diabetes mellitus in Ramallah and al-Bireh: the Palestinian Diabetes Complications and Control Study (PDCCS).
Prim Care Diabetes
. 2018;12(6):547–57.
6.
Abu Al-Halaweh A, Davidovitch N, Almdal TP, Cowan A, Khatib S, Nasser-Eddin L, et al. Prevalence of type 2 diabetes mellitus complications among palestinians with T2DM.
Diabetes Metab Syndr
. 2017;11(Suppl 2):S783–7.
7.
Sandholm N, Groop PH. Genetic basis of diabetic kidney disease and other diabetic complications.
Curr Opin Genet Dev
. 2018;50:17–24.
8.
Dahlström E, Sandholm N. Progress in defining the genetic basis of diabetic complications.
Curr Diab Rep
. 2017;17(9):80.
9.
Dinarello CA. Role of pro- and anti-inflammatory cytokines during inflammation: experimental and clinical findings.
J Biol Regul Homeost Agents
. 1997;11(3):91–103.
10.
Liu C, Feng X, Li Q, Wang Y, Li Q, Hua M. Adiponectin, TNF-α and inflammatory cytokines and risk of type 2 diabetes: a systematic review and meta-analysis.
Cytokine
. 2016;86:100–9.
11.
Sueud T, Hadi NR, Abdulameer R, Jamil DA, Al-Aubaidy HA. Assessing urinary levels of IL-18, NGAL and albumin creatinine ratio in patients with diabetic nephropathy.
Diabetes Metab Syndr
. 2019 Jan–Feb;13(1):564–8.
12.
Kaviarasan K, Jithu M, Arif Mulla M, Sharma T, Sivasankar S, Das UN, et al. Low blood and vitreal BDNF, LXA4 and altered Th1/Th2 cytokine balance are potential risk factors for diabetic retinopathy.
Metab Clin Exp
. 2015;64(9):958–66.
13.
Fathy SA, Mohamed MR, Ali MAM, El-Helaly AE, Alattar AT. Influence of IL-6, IL-10, IFN-γ and TNF-α genetic variants on susceptibility to diabetic kidney disease in type 2 diabetes mellitus patients.
Biomarkers
. 2019;24(1):43–55.
14.
Hameed I, Masoodi SR, Malik PA, Mir SA, Ghazanfar K, Ganai BA. Genetic variations in key inflammatory cytokines exacerbates the risk of diabetic nephropathy by influencing the gene expression.
Gene
. 2018;661:51–9.
15.
Sesti LF, Crispim D, Canani LH, Polina ER, Rheinheimer J, Carvalho PS, et al. The −308G>a polymorphism of the TNF gene is associated with proliferative diabetic retinopathy in Caucasian Brazilians with type 2 diabetes.
Invest Ophthalmol Vis Sci
. 2015;56(2):1184–90.
16.
Sikka R, Raina P, Matharoo K, K, R, S, et al. TNF-α (g.−308G>A) and ADIPOQ (g.+45T>G) gene polymorphisms in type 2 diabetes and microvascular complications in the region of Punjab (North-West India).
Curr Eye Res
. 2014;39:1042–51.
17.
Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
Ann Intern Med
. 2009;151(4):264–W64.
18.
Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses.
Eur J Epidemiol
. 2010;25(9):603–5.
19.
Chowdhury M I, Mondal U K, Paine K W, et al. Association of tumor necrosis factor-α, interleukin 6, and interleukin 10 promoter polymorphism with proliferative diabetic retinopathy in type 2 diabetic subjects.
Retina
. 2012;32(6):1197.
20.
Babel N, et al. Analysis of tumor necrosis factor-alpha, transforming growth factor-beta, interleukin-10, IL-6, and interferon-gamma gene polymorphisms in patients with chronic periodontitis.
J Periodontol
. 2006;77(12):1978–1983.
21.
Buraczynska DK, Koziol-Montewka M, Majdan M. Polymorphisms of tumor necrosis factor and myeloperoxidase genes in patients with chronic renal failure on peritoneal dialysis.
Mol Diagn
. 2003;7(3):175.
22.
Dabhi B, Mistry KN. Oxidative stress and its association with TNF-α-308 G/C and IL-1α-889 C/T gene polymorphisms in patients with diabetes and diabetic nephropathy.
Gene
. 1879-0038. 2015;562(2):197–202.
23.
Krayenbuehl P-A, Wiesli P, Schmid M, Schmid C, Ehses J A, Hersberger M, et al. TNF-alpha -308G>A polymorphism modulates cytokine serum concentrations and macrovascular complications in diabetic patients on aspirin.
Exp Clin Endocrinol Diabetes
. 2007;115(5):322–6.
24.
Kung W J, Lin C C, Liu S H, et al. Association of interleukin-10 polymorphisms with cytokines in type 2 diabetic nephropathy.
Diabetes Technol Ther
. 2010;12(10):809–813.
25.
Lee L, Xu B, Michie S, et al. The role of TNF-alpha in the pathogenesis of type 1 diabetes in the nonobese diabetic mouse: analysis of dendritic cell maturation.
Proc Natl Acad Sci USA
. 2005;102(44):15995–6000.
26.
Lindholm E, Ekaterina B, Corrado C, et al. Association between LTA, TNF and AGER polymorphisms and late diabetic complications.
PLoS One
. 2008;3(6):e2546.
27.
Peng Y, Li LJ. TNF-α-308G/A polymorphism associated with TNF-α protein expression in patients with diabetic nephropathy.
Int J Clin Exp Pathol
. 2015;8(3):3127–31.
28.
Prasad P, Tiwari A, Kumart A, et al. Association of TGFβ1, TNFα, CCR2 and CCR5 gene polymorphisms in type-2 diabetes and renal insufficiency among Asian Indians.
BMC Med Genet
. 2007;8(1):20.
29.
Song S E, Shin S K, Cho H W, et al. Tomatidine inhibits tumor necrosis factor-α-induced apoptosis in C2C12 myoblasts via ameliorating endoplasmic reticulum stress.
Mol Cell Biochem
. 2018;444(4):1–9.
30.
Umapathy D, Krishnamoorthy E, Mariappanadar V, et al. Increased levels of circulating (TNF-α) is associated with (-308G/A) promoter polymorphism of TNF-α gene in diabetic nephropathy.
Int J Biol Macromol
. 2018;(107):2113–21.
31.
Wang F, Lin X, Zhao Q, et al. Adverse symptoms with anti-TNF-alpha therapy in inflammatory bowel disease: systematic review and duration-response meta-analysis.
Eur J Clin Pharmacol
. 2015;71(8):911–19.
32.
Zhang J, Chi H, Xiao H, et al. Interleukin 6 (IL-6) and tumor necrosis factor-α (TNF-α) single nucleotide polymorphisms (SNPs), inflammation and metabolism in gestational diabetes mellitus in inner mongolia.
Med Sci Monit
. 2017;23:4149.
33.
Loughrey BV, Maxwell AP, Fogarty DG, et al. An interluekin 1B allele, which correlates with a high secretor phenotype, is associated with diabetic nephropathy.
Cytokine
. 1998;10(12):984.
34.
Buraczynska M, Ksiazek K, Wacinski P, et al. Interleukin-1β gene ( IL1B) polymorphism and risk of developing diabetic nephropathy.
Immunol Invest
. 2019 Aug;48(6):577–84.
35.
Lee SK, Hao H, Lee SW, et al. Involvement of iNOS-dependent NO production in the stimulation of osteoclast survival by TNF-alpha.
Exp Cell Res
. 2004;298(2):359–68.
36.
Lin CC, Yang CC, Wang CY, et al. NADPH oxidase/ROS-dependent VCAM-1 induction on TNF-α-challenged human cardiac fibroblasts enhances monocyte adhesion.
Front Pharmacol
. 2016;6:310.
37.
Stefanidis D, Fanelli RD, Price R, et al. SAGES guidelines for the introduction of new technology and techniques.
Surg Endoscopy
. 2014;28(8):2257–71.
38.
Wang Y, Chen P, Chang W, et al. Clinical significance of tumor necrosis factor-α inhibitors in the treatment of sciatica: a systematic review and meta-analysis.
PLoS One
. 2014;9(7):e103147.
39.
Abrahamian H, Endler G, Exner M, et al. Association of low-grade inflammation with nephropathy in type 2 diabetic patients: role of elevated CRP-levels and 2 different gene-polymorphisms of proinflammatory cytokines.
Exp Clin Endocrinol Diabetes
. 2007;115(01):38–41.
40.
Chang J, Frandsen S, Gadsby JE. Prostaglandin synthesis by the porcine corpus luteum: effect of tumor necrosis factor-α.
Domest Anim Endocrinol
. 2016;58:53–62.
41.
Karadeniz C, Akdeniz, et al. Cryoablation of septal accessory pathways in children: midterm results.
PACE
. 2014;37(9):1095–9.
42.
Neelofar K, Arif Z. Ahmad J, et al. Non-enzymatic glucosylation induced neo-epitopes on human serum albumin: a concentration based study.
PLoS One
. 2017;12(2):e0172074.
43.
Ng D, Nurbaya S, Ye S, et al. An IL-6 haplotype on human chromosome 7p21 confers risk for impaired renal function in type 2 diabetic patients.
Kidney Int
. 2008;74(4):521–7.
44.
Papaoikonomou S, Tentolouris N, Tousoulis D, et al. The association of the 174G>C polymorphism of interleukin 6 gene with diabetic nephropathy in patients with type 2 diabetes mellitus.
J Diabetes Comp
. 2013;27(6):576–9.
45.
Rodrigues K, Pietrani N, Sandrim V, et al. Association of a large panel of cytokine gene polymorphisms with complications and comorbidities in type 2 diabetes patients.
J Diabetes Res
. 2015;2015:1–9.
46.
Zambrano-Galván, Reyes-Romero MA, Lazalde B, et al. Risk of microalbuminuria in relatives of subjects with diabetic nephropathy: a predictive model based on multivariable dimensionality reduction approach.
Clin Nephrol
. 2015;36(26):146–9.
47.
An Y, Xiao YB. Growth hormone prevents acute liver injury induced by cardiopulmonary bypass in a rat model.
J Thorac Cardiovasc Surg
. 2007;134(2):342–50.
48.
Chen L, Ahmed E, Wang T, et al. TLR signals promote IL-6/IL-17-dependent transplant rejection.
J Immunol
. 2009;182(10):6217.
49.
Deng J, Muthu K, Gamelli R, et al. Adrenergic modulation of splenic macrophage cytokine release in polymicrobial sepsis.
Am J Physiol Cell Physiol
. 2004;287(3):C730-6.
50.
Kitamura A, Hasegawa G, Obayashi H, et al. Interleukin-6 polymorphism (-634C/G) in the promotor region and the progression of diabetic nephropathy in type 2 diabetes.
Diabetic Med
. 2002;19(12):1000–5.
51.
Li Q, Xu H, Yang H. Effect of proinflammatory factors TNF-α, IL-1β, IL-6 on neuropathic pain.
Zhongguo Zhong Yao Za Zhi
. 2017;42(19):3709–12.
52.
Lu Y, Lou J, Liu X, et al. Oxysophocarpine reduces oxygen-glucose deprivation-induced microglial activation and injury.
Am J Translat Res
. 2017;9(5):2266.
53.
Ahluwalia T, Khullar M, Ahuja M, et al. Common variants of inflammatory cytokine genes are associated with risk of nephropathy in type 2 diabetes among Asian Indians.
PLoS One
. 2009;4(4):e5168.
54.
Yahya J, Ismail PB, Nordin NB, et al. Association of CCL2, CCR5, ELMO1, and IL8 polymorphism with diabetic nephropathy in malaysian type 2 diabetic patients.
Int J Chronic Dis
. 2019;2019:2053015.
55.
Dong L, Bai J, Jiang X, et al. The gene polymorphisms of IL-8(-251T/A) and IP-10(-1596C/T) are associated with susceptibility and progression of type 2 diabetic retinopathy in northern Chinese population.
Eye
. 2017;31(4):601–7.
56.
Ji T, Takabayashi H, Mao M, et al. Regulation and function of bone morphogenetic protein signaling in colonic injury and inflammation.
Am J Physiol Gastrointest Liver Physiol
. 2017;312(1):00169.
57.
Chen O, Shan N, Zhu X, et al. The imbalance of IL-18/IL-18BP in patients with systemic juvenile idiopathic arthritis.
Acta Biochim Biophys Sin
. 2013;45(4):339–41.
58.
Kang M, Yoon C, Nam M, et al. Role of chitinase 3-like-1 in interleukin-18-induced pulmonary type 1, type 2, and type 17 inflammation; alveolar destruction; and airway fibrosis in the murine lung.
Am J Respir Cell Mol Biol
. 2015;53(6):863–71.
59.
Zhu P, Duan L, Chen J, et al. Gene silencing of NALP3 protects against liver ischemia-reperfusion injury in mice.
Human Gene Ther
. 2011;22(7):853.
60.
Smith AJ, Humphries SE. Cytokine and cytokine receptor gene polymorphisms and their functionality.
Cytokine Growth Factor Rev
. 2009;20(1):43–59.
61.
Qiao YC, Shen J, He L, Hong XZ, Tian F, Pan YH, et al. Changes of regulatory T cells and of proinflammatory and immunosuppressive cytokines in patients with type 2 diabetes mellitus: a systematic review and meta-aAalysis.
J Diabetes Res
. 2016;2016:3694957.
62.
Cui ZH, Lu XT, Xiao KL, Chen Y, Li HQ. Association of interleukin-6 −174 G/C polymorphism with the risk of diabetic nephropathy in type 2 diabetes: a meta-analysis.
Curr Med Sci
. 2019;39(2):250–8.
63.
Naing C, Htet NH, Basavaraj AK, Nalliah S. An association between IL-10 promoter polymorphisms and diabetic nephropathy: a meta-analysis of case-control studies.
J Diabetes Metab Disord
. 2018;17(2):333–43.
64.
Gonzalez-Salinas R, Garcia-Gutierrez MC, Garcia-Aguirre G, Morales-Canton V, Velez-Montoya R, Soberon-Ventura VR, et al. Evaluation of VEGF gene polymorphisms and proliferative diabetic retinopathy in Mexican population.
Int J Ophthalmol
. 2017;10(1):135–9.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.