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Understanding diabetes-induced cardiomyopathy from the perspective of renin angiotensin aldosterone system

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Abstract

Experimental and clinical evidence suggests that diabetic subjects are predisposed to a distinct cardiovascular dysfunction, known as diabetic cardiomyopathy (DCM), which could be an autonomous disease independent of concomitant micro and macrovascular disorders. DCM is one of the prominent causes of global morbidity and mortality and is on a rising trend with the increase in the prevalence of diabetes mellitus (DM). DCM is characterized by an early left ventricle diastolic dysfunction associated with the slow progression of cardiomyocyte hypertrophy leading to heart failure, which still has no effective therapy. Although the well-known “Renin Angiotensin Aldosterone System (RAAS)” inhibition is considered a gold-standard treatment in heart failure, its role in DCM is still unclear. At the cellular level of DCM, RAAS induces various secondary mechanisms, adding complications to poor prognosis and treatment of DCM. This review highlights the importance of RAAS signaling and its major secondary mechanisms involving inflammation, oxidative stress, mitochondrial dysfunction, and autophagy, their role in establishing DCM. In addition, studies lacking in the specific area of DCM are also highlighted. Therefore, understanding the complex role of RAAS in DCM may lead to the identification of better prognosis and therapeutic strategies in treating DCM.

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Acknowledgements

This study was made possible by a Rapid Response Call (RRC) award (RRC2-076) to H. C. Y. from the Qatar National Research Fund (a member of The Qatar Foundation). Venkatesh Sundararajan’s laboratory work is partially supported by the American Heart Association grants (20CDA35260096 and 20TPA3542000)

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  1. Biomedical Research Center, Qatar University, Al-Tarfa, 2371, Doha, Qatar

    Vijayakumar Sukumaran & Huseyin C. Yalcin

  2. Department of Bioscience Research, University of Tennessee Health Science Center, Memphis, TN, USA

    Narasimman Gurusamy

  3. Department of Microbiology, Biochemistry and Molecular Genetics, Rutgers-New Jersey Medical School, Newark, NJ, USA

    Sundararajan Venkatesh

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Sukumaran, V., Gurusamy, N., Yalcin, H.C. et al. Understanding diabetes-induced cardiomyopathy from the perspective of renin angiotensin aldosterone system. Pflugers Arch - Eur J Physiol 474, 63–81 (2022). https://doi.org/10.1007/s00424-021-02651-x

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