Adipose and Circulating CCL18 Levels Associate With Metabolic Risk Factors in Women

J Clin Endocrinol Metab. 2016 Nov;101(11):4021-4029. doi: 10.1210/jc.2016-2390. Epub 2016 Jul 26.


Context: Cardiometabolic complications in obesity may be linked to white adipose tissue (WAT) dysfunction. Transcriptomic studies of Sc WAT have reported that CCL18, encoding the CC chemokine ligand 18 (CCL18), is increased in obesity/insulin resistance but its functional role is unknown.

Objective: Our objectives were to determine if CCL18 is secreted from Sc WAT and if secreted and/or serum levels associate with metabolic phenotypes. We also planned to define the primary cellular source and if CCL18 exerts effects on adipocytes.

Design: This is a cohort study.

Setting: The study took place in an outpatient academic clinic.

Participants: A total of 130 obese women scheduled for bariatric surgery and 35 nonobese controls were included.

Methods: Insulin sensitivity was assessed by hyperinsulinemic euglycemic clamp or homeostasis model assessment. CCL18 was analyzed in serum/WAT incubates by ELISA. Effects of recombinant CCL18 was determined in cultures of primary human adipocytes and the monocyte cell line THP-1 differentiated into M0/M1/M2 macrophages.

Main outcome measure: Association with metabolic risk factors was measured.

Results: CCL18 was secreted from WAT and the levels correlated positively with insulin resistance, Adult Treatment Panel III risk score and plasma triglycerides, independent of body mass index and better than other established adipocytokines. In 80 obese women, S-CCL18 levels were significantly higher in insulin resistant compared with insulin sensitive subjects. In WAT CCL18 mRNA was expressed in macrophages and correlated positively with immune-related genes, particularly those enriched in M2 macrophages. While CCL18 increased cyto-/chemokine expression in M0/M2-THP-1 cells, human adipocytes showed no responses in vitro.

Conclusions: Circulating and WAT-secreted CCL18 correlates with insulin resistance and metabolic risk score. Because CCL18 is macrophage-specific and associates with adipose immune gene expression, it may constitute a marker of WAT inflammation.

MeSH terms

  • Adiposity*
  • Adult
  • Bariatric Surgery
  • Biomarkers / blood
  • Biomarkers / metabolism
  • Body Mass Index
  • Cell Line
  • Cells, Cultured
  • Chemokines, CC / blood
  • Chemokines, CC / genetics
  • Chemokines, CC / metabolism*
  • Cohort Studies
  • Female
  • Gene Expression Regulation
  • Gene Ontology
  • Humans
  • Hypertriglyceridemia / etiology
  • Insulin Resistance
  • Macrophages / immunology
  • Macrophages / metabolism*
  • Macrophages / pathology
  • Metabolic Syndrome / epidemiology
  • Metabolic Syndrome / etiology*
  • Obesity, Morbid / immunology
  • Obesity, Morbid / metabolism*
  • Obesity, Morbid / pathology
  • Obesity, Morbid / physiopathology
  • Panniculitis / etiology*
  • Recombinant Proteins / metabolism
  • Risk Factors
  • Subcutaneous Fat, Abdominal / immunology
  • Subcutaneous Fat, Abdominal / metabolism*
  • Subcutaneous Fat, Abdominal / pathology
  • Sweden / epidemiology


  • Biomarkers
  • CCL18 protein, human
  • Chemokines, CC
  • Recombinant Proteins