Abstract
The incidence and prevalence of diabetes mellitus (DM) are increasing worldwide, and the resulting cardiac complications are the leading cause of death. Among these complications is diabetes-induced cardiomyopathy (DCM), which is the consequence of a pro-inflammatory condition, oxidative stress and fibrosis caused by hyperglycemia. Cardiac remodeling will lead to an imbalance in cell survival and death, which can promote cardiac dysfunction. Since the conventional treatment of DM generally does not address the prevention of cardiac remodeling, it is important to develop new alternatives for the treatment of cardiovascular complications induced by DM. Thus, therapy with mesenchymal stem cells has been shown to be a promising approach for the prevention of DCM because of their anti-apoptotic, anti-fibrotic and anti-inflammatory effects, which could improve cardiac function in patients with DM.
Highlights
The incidence and prevalence of diabetes mellitus (DM) worldwide are increasing rapidly, with 19.3% of the population aged 65–99 diagnosed with DM [1,2], and type 2 (DM2) accounts for 90–95% of cases [3]
diabetic cardiomyopathy (DCM) is characterized by cardiomyocyte apoptosis and myocardial fibrosis with increased deposition of accumulated extracellular matrix (ECM), which leads to rigidity in the diabetic heart, exerting a deleterious effect on diastolic function causing diastolic heart failure with preserved ejection fraction (HFpEF) [15]
Mesenchymal stem cells (MSCs) attenuate cardiac remodeling induced by DM, reducing cardiac fibrosis and improving systolic and diastolic function; MSCs are a promising therapeutic strategy for the prevention of DCM
Summary
The incidence and prevalence of diabetes mellitus (DM) worldwide are increasing rapidly, with 19.3% of the population aged 65–99 diagnosed with DM [1,2], and type 2 (DM2) accounts for 90–95% of cases [3]. Among the cardiac complications is diabetic cardiomyopathy (DCM), which consists of cardiac remodeling characterized by molecular, cellular and interstitial changes, interfering with the size, geometry and function of the heart. MSCs have a poor engraftment rate, and cellular replacement is complex and limited Instead, their therapeutic potential is attributed primarily to the paracrine action of their secretome, which consists of a rich and complex mixture of soluble molecules, such as cytokines, chemokines and growth factors, and extracellular vesicles loaded with proteins, peptides and genetic material (e.g., microRNAs) [14], which can support cell survival and tissue healing. The present review focuses on the mechanisms involved in DM-induced cardiac remodeling and, DCM and the potential of MSC therapy to treat DM complications
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