Aernoud Fiolet

22 Chapter 1 Figure 2. The cytokine cascade. Activated immune cells in the plaque produce inflammatory cytokines (interferon- γ , interleukin – 1, and tumour necrosis factor), which induce the production of substantial amounts of interleukin-6. These cytokines are also produced in various tissues in response to infection, as well as in the adipose tissue of patients with metabolic syndrome. Interleukin – 6, in turn, stimulates the production of large numbers of acute-phase reactants, including C-Reactive protein (CRP), serum amyloid A, and fibrinogen, especially in the liver. Although cytokines at all steps have important biological effects, their amplification at each step of the cascade makes the measurement of downstream mediators, such as CRP, particularly useful for clinical diagnosis. Adapted from Hansson. 3