The emerging endogenous peptide Apelin 13 in diabetes and its related complications: a narrative review

Apelin-13, an active peptide in the apelinergic system, is essential for glucose regulation, insulin sensitivity, and vascular homeostasis. Its significance lies in its ability to manage diabetes and its consequences through novel mechanistic insights.

This review investigates the therapeutic potential of Apelin-13, focusing on preclinical and emerging clinical evidence. A structured literature search was conducted using databases such as PubMed, Scopus, and Web of Science, with a focus on studies that reported molecular processes, signaling pathways, and disease-modifying effects of Apelin-13 in diabetes and related comorbidities. Key studies show that it improves insulin signaling, glucose uptake, and endothelial function via activating the PI3K/Akt, AMPK, and eNOS pathways.

Apelin-13 decreases oxidative stress and inflammation through the SIRT1/PGC-1α axis, protects against cardiac remodeling by inhibiting TGF-β/Smad and NF-κB pathways, and prevents renal fibrosis through AMPK-mediated autophagy. Regulating VEGF and TNF-α signaling helps reduce vascular leakage and neuroinflammation.