WASHINGTON - Scientists trying to break the fat-and-disease link increasingly say inflammation is the key.
In the quest to prove it, a major study is under way testing whether an anti-inflammatory drug can fight the Type 2 diabetes spurred by obesity.
Diabetes and heart disease usually tag along with extra pounds. What isn't clear is what sets off the cascade of damage that ends in those illnesses. After all, there are examples of obese people who somehow stay metabolically fit.
"If fat cells functioned perfectly, you could be as obese as you want and not have heart disease," says Dr. Carey Lumeng of the University of Michigan. "It's something we don't understand, why some people are more susceptible and others are not so susceptible."
Solving that mystery could point to more targeted treatments for obesity's threats than today's effective but hard-to-follow advice to lose weight. The chief suspect: Inflammation that the immune system normally uses to fight infection runs amok with weight gain - simmering inside fat tissue before spreading to harm blood vessels and spur insulin resistance.
Dr. Steven Shoelson at the Harvard-affiliated Joslin Diabetes Center noted reports from 150 years ago that one of the oldest anti-inflammatories around - salsalate, from the aspirin family - could lower blood sugar. Shoelson discovered that salsalate inhibits what he calls a master switch in inflammation regulation.
Pilot trials found short-term use of salsalate, added to regular diabetes medication, helped poorly controlled Type 2 diabetics lower their blood sugar substantially.
Now an NIH-funded study is recruiting several hundred Type 2 diabetics at 21 medical centers around the country to take the drug or a dummy pill for a year, to track long-term effects.