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Autophagic predisposition in the insulin resistant diabetic heart
Kimberley M Mellor1, Melissa E Reichelt, Lea M D Delbridge
1Department of Physiology, University of Melbourne, Melbourne, Victoria, Australia.
Insights
Diabetic hearts experience cell loss through autophagy, a programmed cell death mechanism. Chronic, excessive autophagy in insulin-resistant hearts contributes to cardiomyocyte attrition and diabetic cardiomyopathy.
Area of Science:
- Cardiology
- Cell Biology
- Metabolic Diseases
Background:
- Diabetic cardiomyopathy is characterized by cardiac dysfunction independent of vascular issues.
- Myocardial fibrosis and cardiomyocyte loss are hallmarks of diabetic heart disease.
- Autophagy, a cellular degradation process, plays a complex role in stress response.
Purpose of the Study:
- To investigate the role of autophagy in cardiomyocyte loss in diabetic cardiomyopathy.
- To explore the mechanisms linking insulin resistance to excessive autophagic activity.
Main Methods:
- Review of existing literature on diabetic cardiomyopathy and autophagy.
- Analysis of cellular signaling pathways involved in insulin resistance and autophagy.
- Examination of evidence for autophagic upregulation in the diabetic myocardium.
Main Results:
- Diabetic hearts exhibit characteristics favoring pro-autophagic states, including PI3K/Akt pathway suppression.
- Oxidative stress and metabolic dysregulation in insulin resistance promote autophagic activity.
- Evidence suggests a link between upregulated autophagy and cardiomyocyte attrition in diabetic hearts.
Conclusions:
- Excessive autophagy, driven by insulin resistance, is a key mechanism of cardiomyocyte loss in diabetic cardiomyopathy.
- Targeting autophagy may offer a therapeutic strategy for diabetic heart disease.
Abstract:
Existence of a diabetic cardiopathology, independent of vascular abnormalities, has been well reported. Diffuse interstitial fibrosis throughout the diabetic myocardium (even in the absence of an acute coronary event) suggests widespread cardiomyocyte attrition and cytokine activity. In addition to apoptotic and necrotic events, there is now good evidence that significant cardiomyocyte loss in the diabetic heart is driven by a different, non-apoptotic type of programmed cell death: autophagy. Although considered to be beneficial and pro-survival as a short term strategy to deal with acute stress, when chronically elevated or constitutive, excess autophagic activity has potential to be lethal. The insulin resistant myocardium exhibits various pro-autophagic characteristics: suppression of the PI3K(I)-Akt signaling pathway, oxidative stress and metabolic dysregulation, rendering the diabetic heart vulnerable to autophagic demise. There is compelling new evidence that in the diabetic myocardium cardiomyocyte attrition can be linked to autophagic upregulation.
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