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To better understand the relationship between these epidemiological and immunological findings, we performed an<jats:italic>in vitro<\/jats:italic>study evaluating the sequential immunological reactions and viral load in the DENV infected mononuclear cells of adults with type 2 DM (T2DM group,<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M1\"><mml:mrow><mml:mi>n<\/mml:mi><mml:mo>=<\/mml:mo><mml:mn>33<\/mml:mn><\/mml:mrow><\/mml:math>) and normal adults (control group,<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M2\"><mml:mrow><mml:mi>n<\/mml:mi><mml:mo>=<\/mml:mo><mml:mn>29<\/mml:mn><\/mml:mrow><\/mml:math>). We found in the T2DM group significantly higher IL-4 level on the first<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M3\"><mml:mrow><mml:mo stretchy=\"false\">(<\/mml:mo><mml:mi>P<\/mml:mi><mml:mo>=<\/mml:mo><mml:mn>0.049<\/mml:mn><mml:mo stretchy=\"false\">)<\/mml:mo><\/mml:mrow><\/mml:math>and the third<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M4\"><mml:mrow><mml:mo stretchy=\"false\">(<\/mml:mo><mml:mi>P<\/mml:mi><mml:mo>=<\/mml:mo><mml:mn>0.022<\/mml:mn><mml:mo stretchy=\"false\">)<\/mml:mo><\/mml:mrow><\/mml:math>postinfection days, while higher IL-10<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M5\"><mml:mrow><mml:mo stretchy=\"false\">(<\/mml:mo><mml:mi>P<\/mml:mi><mml:mo>=<\/mml:mo><mml:mn>0.042<\/mml:mn><mml:mo stretchy=\"false\">)<\/mml:mo><\/mml:mrow><\/mml:math>and granulocyte-macrophage colony-stimulating factor (GM-CSF)<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M6\"><mml:mrow><mml:mo stretchy=\"false\">(<\/mml:mo><mml:mi>P<\/mml:mi><mml:mo>=<\/mml:mo><mml:mn>0.009<\/mml:mn><mml:mo stretchy=\"false\">)<\/mml:mo><\/mml:mrow><\/mml:math>were detected on the third postinfection day. No significant difference in DENV viral load between the cultured mononuclear cells from both groups was found on the first and third post-infection days. These data immunologically suggest that patients with T2DM are at higher risk for development of DHF\/severe dengue and strengthen the previously epidemiologically identified role of DM being a predictive risk factor for progressing into DHF\/severe dengue in DENV-affected patients.<\/jats:p>","DOI":"10.1155\/2013\/965853","type":"journal-article","created":{"date-parts":[[2013,9,2]],"date-time":"2013-09-02T21:03:26Z","timestamp":1378155806000},"page":"1-7","source":"Crossref","is-referenced-by-count":17,"title":["Increased Production of Interleukin-4, Interleukin-10, and Granulocyte-Macrophage Colony-Stimulating Factor by Type 2 Diabetes\u2019 Mononuclear Cells Infected with Dengue Virus, but Not Increased Intracellular Viral Multiplication"],"prefix":"10.1155","volume":"2013","author":[{"given":"Ing-Kit","family":"Lee","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, 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