Fig. 2.

Schematic representation of hyperglycemia-induced lung diseases. Hyperglycemia promotes airway hyperresponsiveness via the Rho-associated protein kinase (Rock) pathway. Hyperglycemia accelerates lung fibrosis through the activation of signal transducer and activator of transcription 3 (STAT3), connective tissue growth factor (CTGF) and transforming growth factor beta (TGFβ). Hyperglycemia increases cancer cell growth, chronic inflammation, inflammatory cytokine release and oxidative stress through activation of the nuclear factor kappa-light-chain-enhancer of activated B-cells (NFκB) pathway and NADPH oxidase (NOX) as well as the production of reactive oxygen species (ROS) and reactive nitrogen species (RNS). Higher glucose concentrations in airway surface liquid (ASL) and lung immune cell dysfunction due to hyperglycemia promote a susceptibility to pulmonary infections