**10. Conclusions**

**8. Paraoxonase**

98 Ultimate Guide to Insulin

**8.1. Paraoxonase-1**

anti-inflammatory effects [75].

atherosclerotic lesion [34].

**9. Interleukin-10**

**8.2. Paraoxonase 1 and metabolic syndrome**

**9.1. Interleukin-10 and metabolic syndrome**

IL-10 in patients with MetS and diabetes mellitus [39].

PON-1 is an enzyme produced mostly by the liver that protects against lipid oxidation and exogenous toxics. PON-1 extends the lag phase of the oxidation process and reduces the aldehyde concentration, resulting in protective effects on LDL and HDL molecules [74]. Aharoni et al. in a murinic study demonstrated that PON-1 interacts with macrophages scavenger receptor class B type I, thus inhibiting IL-6 and TNF-α production and promoting PON-1

The anti-inflammatory role of PON-1 is mainly validated by its anti-atherogenic effect [32]. Likewise, in the study of Ikhlef et al., it has been found that PON-1 could regulate cholesterol homeostasis by stimulating cholesterol efflux via HDL and by potentiating inverse cholesterol transport [33]. On the contrary, in subjects with diabetes, it is assumed that PON-1 becomes malfunctional by excessive glycation, thus it lowers its protective effects and potentiates the

PON-1 has scientifically confirmed to be connected with MetS. A cross-sectional study conducted on 354 Caucasian subjects with MetS has shown that PON-1 activity was significantly lower among patients who met all five MetS criteria (p < 0.05). The same study revealed that lower levels of HDL cholesterol and ApoA1 decrease the PON-1 activity [35]. A like, in a study conducted on 2404 subjects with MetS criteria, it has been demonstrated that PON-1 activity followed a downward trend with increasing MetS components and increasing lipid peroxides [76]. In conclusion, it is assumed that PON-1 through its antioxidant and anti-inflammatory

IL-10 is a potent anti-inflammatory cytokine that modulates the immune response in order to prevent excessive activation and auto-damage [36]. Based on its properties, IL-10 plays important roles in modulating insulin resistance and atherosclerotic development and, in a cross-sectional study conducted on children and young adolescents, it has been found that plasmatic IL-10 levels were lower in overweight/obese children, and they concluded that IL-10 could be a marker of metabolic risk [37]. On the contrary, Esposito et al. found that IL-10 levels were lower in obese compared with normal weight women, but were lower in both groups that had MetS criteria [38]. Likewise, van Exel et al. found reduced plasmatic levels of

effects could have important roles in lowering of the progression of MetS.

The combined use of biomarkers of MetS could increase the rate of an early diagnosis and could prevent the complications of this disease. Associated usage of these biomarkers would increase their predictive value. However, to be able to create a diagnosis algorithm, their cutoff value for the presence of MetS and the causes that would yield false results should be determined. Last but not least, the usefulness of these biomarkers could be extended into guiding pharmacological and non-pharmacological therapeutic interventions. Also, treatment efficiency could be monitored by determining these biomarkers dynamically.
