Diabetic vascular diseases: molecular mechanisms and therapeutic strategies

Silicified curcumin microspheres Combats cardiovascular diseases via Nrf2/HO-1 pathway

Diabetes and chemotherapy frequently give rise to severe cardiovascular complications, including chemotherapy-induced cardiotoxicity and diabetes-associated vascular remodeling. Nevertheless, the precise epidemiological features of these cardiovascular ailments remain incompletely elucidated, resulting in a dearth of effective therapeutic strategies in clinical settings. To tackle this intricate challenge, we have delved extensively into database resources, conducted comprehensive analyses of pertinent epidemiological data, and designed silicified curcumin (Si/Cur) microspheres as a novel therapeutic approach for cardiovascular diseases. By harnessing the alkaline microenvironment generated by silicon (Si), Si/Cur markedly elevates the bioavailability of curcumin (Cur). Further investigations have elucidated that Si/Cur exerts its therapeutic actions primarily via the Nrf2/HO-1 signaling pathway, effectively suppressing vascular remodeling and mitigating myocardial injury, thus disrupting the vicious cycle of persistent cardiovascular damage. In conclusion, this study integrates clinical cohort research to dissect epidemiological characteristics, directs the design and application of biomaterials, and paves the way for a novel and efficacious therapeutic avenue for the management of cardiovascular diseases.

Lipoic acid improves wound healing through its immunomodulatory and anti-inflammatory effects in a diabetic mouse model

Objectives

Diabetes mellitus is a chronic disease that has become more prevalent worldwide because of lifestyle changes. It leads to serious complications, including increased atherosclerosis, protein glycosylation, endothelial dysfunction, and vascular denervation. These complications impair neovascularization and wound healing, resulting in delayed recovery from injuries and an elevated risk of infections. The present study aimed to investigate the effect of lipoic acid (LA) on the key mediators involved in the wound healing process, specifically CD4 + CD25 + T cell subsets, CD4 + CD25 + Foxp3 + regulatory T (Treg) cells, T-helper-17 (Th17) cells that generate IL-17 A, glucocorticoid-induced tumor necrosis factor receptor (GITR) expressing cells, as well as cytokines such as IL-2, IL-1β, IL-6, and TNF-α and IFN-γ. These mediators play crucial roles in epidermal and dermal proliferation, hypertrophy, and cell migration.

Methods

We divided mice into 5 groups: the non-diabetic (normal control; NC), wounded non-diabetic mice (N + W), wounded diabetic mice (D + W), wounded diabetic mice treated with 50 mg/kg lipoic acid (D + W + L50) for 14 days, and wounded diabetic mice treated with 100 mg/kg lipoic acid (D + W + L100) for 14 days.

Results

Flow cytometric analysis indicated that lipoic acid-treated mice exhibited a significant decrease in the frequency of intracellular cytokines (IL-17 A, TNF-α and IFN-γ) in CD4 + T cells, as well as a reduction in the number of GITR-expressing cells. Conversely, a significant upregulation in the number CD4+, CD25+, FOXp3 + and CD4 + CD25 + Foxp3 + regulatory T (Treg) cells was observed in this group compared to both the normal + wounded (N + W) and diabetic + wounded (D + W) groups. Additionally, the mRNA Levels of inflammatory mediators (IL-2, IL-1β, IL-6, and TNF-α) were downregulated in lipoic acid-treated mice compared to other groups. T thereby he histological findings of diabetic skin wounds treated with lipoic acid showed well-healed surgical wounds.

Conclusions

These findings support the beneficial role of lipoic acid in fine-tuning the balance between anti-inflammatory and pro-inflammatory cytokines, influencing both their release and gene expression.

Exploration of metformin-based drug combination for mitigating diabetes-associated atherosclerotic diseases

Diabetes mellitus is a substantial global health threat due to its high prevalence and its serious complications. The hyperglycemic state causes damage to vascular endothelial cells and disturbance of lipid metabolism, thus contributing to the development of vascular disorders, especially atherosclerotic diseases. Aggressive glycemic control combined with vascular intervention is critical to the prevention and treatment of diabetes-associated atherosclerosis. It is suggested that metformin should be combined with hypoglycemic agents with proven vascular benefits for treating type 2 diabetes (T2DM) complicated with atherosclerotic diseases. Clinical studies indicates that the preferred combination is metformin with either glucagon-like peptide-1 receptor agonist or sodium/glucose cotransporter-2 inhibitor, which could offer additional vascular benefits and reduce the risk of atherosclerotic complications. Likewise, combination therapy with metformin and hypolipidemic agents has also shown additive effects on glucose control and lipid-lowering in patients with both diabetes and dyslipidemia, whereas extensive clinical trials using atherosclerotic-associated outcomes are required to support the vascular benefits. Moreover, co-administration of metformin with systemic antioxidant or anti-inflammatory therapy may also provide additional vascular benefits as indicated by several animal studies. For instance, a recent study found that additional supplementation of cholecalciferol and taurine enhanced metformin efficacy in controlling diabetes while reducing the risk of associated atherosclerotic complications. However, these potential benefits remain need validation by the evidence from clinical studies. Despite the limitations, such as heterogeneity across different patient populations, and deficiency in long-term outcomes, such efforts can contribute to finding optimal drug combinations to improve the management of T2DM and reduce its atherosclerotic complications.

Body composition markers are more strongly associated with type 2 diabetes than inflammatory markers-Results from the study of health in Pomerania

BACKGROUND AND AIMS

Evidence links body composition and inflammatory markers with type 2 diabetes (T2D). However, the comparative analysis of body composition markers derived from different modalities and inflammatory markers in relation to T2D remains unexplored. This study aims to evaluate and compare the association of body composition and inflammatory markers with T2D.

METHODS

We included 4043 participants (2081 female, 51.4%) aged 20-84 enrolled in the population-based Study of Health in Pomerania. Multivariable logistic regression models adjusted for confounding were used to analyse associations of standardized body composition markers derived from classic anthropometry, bioelectrical impedance analysis, magnetic resonance imaging as well as inflammatory markers C-reactive protein, white blood cell count, fibrinogen, ferritin and CRP-to-albumin ratio with prevalent T2D.

RESULTS

Body composition markers were more strongly associated with T2D than inflammatory markers. Waist circumference exhibited the strongest association with T2D (female: odds ratio (OR) = 2.55; 95% confidence interval [CI]: 2.17-3.00; male: OR = 2.20; 95% CI: 1.86-2.60). Similarly, body weight (female: 2.07; 1.78-2.41; male: OR = 1.99; 95% CI = 1.71-2.31), waist-to-height ratio (female: OR = 2.39; 95% CI = 2.05-2.77; male: 2.28; 1.92-2.70) and visceral adipose tissue (female: 3.02; 95% CI = 2.11-4.32; male: 1.50; 1.19-1.89) showed strong associations with T2D. Among inflammatory markers, white blood cell count in male and CRP-to-albumin ratio in female exhibit the strongest association with T2D.

CONCLUSIONS

Body composition markers seem to be more tightly associated with prevalent T2D compared to inflammatory markers.

A Single H2S-Releasing Nanozyme for Comprehensive Diabetic Wound Healing through Multistep Intervention

Diabetic wound healing presents a significant medical challenge and requires multistep interventions due to comprehensive wound environments, such as hyperglycemia, bacterial infection, and impaired angiogenesis. However, current multistep interventions are complicated and need on-demand sequential release and synergy of multicomponents. Herein, a H2S-releasing cascade nanozyme (FeS@Au), which is composed of ultrasmall gold nanocluster (AuNC) loaded on ferrous sulfide nanoparticle (FeSNP), is developed as a single component to regulate glucose level, eliminate infection, and promote angiogenesis, achieving multistep interventions for comprehensive diabetic wound treatment. The glucose oxidase-like activity of AuNC catalyzes glucose into gluconic acid and H2O2, which not only lowers the local glucose level but also decreases the local pH and increases H2O2 level to boost the peroxidase-like activity of FeSNP to generate abundant hydroxyl radical (reactive oxygen species, ROS), inducing ferroptosis-like death in drug-resistant bacteria. Additionally, FeSNP release H2S in the acidified environment to upregulate hypoxia-inducible factor-1 to enhance vascularization through upregulating the expression of vascular endothelial growth factor (VEGF) and other angiogenesis-related genes, reducing the damage to endothelial cells caused by excessive ROS produced by the nanozyme. In a full-thickness MRSA-infected diabetic rat model, FeS@Au significantly eliminates bacteria, enhances angiogenesis, promotes collagen deposition, and accelerates wound healing. This work presents a single nanozyme with H2S-release for multistep interventions, providing a versatile strategy for healing extensive tissue damage caused by diabetes.

Targeting Diabetic Atherosclerosis: The Role of GLP-1 Receptor Agonists, SGLT2 Inhibitors, and Nonsteroidal Mineralocorticoid Receptor Antagonists in Vascular Protection and Disease Modulation

Atherosclerosis is a closely related complication of diabetes mellitus (DM), driven by endothelial dysfunction, inflammation, and oxidative stress. The progression of atherosclerosis is accelerated by hyperglycemia, insulin resistance, and hyperlipidemia. Novel antidiabetic agents, SGLT2 inhibitors, and GLP-1 agonists improve glycemic control and offer cardiovascular protection, reducing the risk of major adverse cardiovascular events (MACEs) and heart failure hospitalization. These agents, along with nonsteroidal mineralocorticoid receptor antagonists (nsMRAs), promise to mitigate metabolic disorders and their impact on endothelial function, oxidative stress, and inflammation. This review explores the potential molecular mechanisms through which these drugs may prevent the development of atherosclerosis and cardiovascular disease (CVD), supported by a summary of preclinical and clinical evidence.

Peripheral Arterial Disease in Diabetic Foot: One Disease with Multiple Patterns

Peripheral arterial disease (PAD) is a major complication in individuals with diabetes and is increasingly prevalent in those with diabetic foot ulcers (DFUs). Despite this, the characterisation of PAD in diabetic patients remains insufficiently refined, leading to suboptimal management and outcomes. This review underscores the necessity for a more nuanced understanding of PAD's anatomical and biological aspects in diabetic patients. The distribution of atherosclerotic plaques varies significantly among individuals, influencing prognosis and treatment efficacy. We describe three key patterns of PAD in diabetes: pattern 1 PAD-below-the-knee (BTK) disease (with infrageniculate disease where present); pattern 2-below-the-ankle (BTA) disease; and pattern 3-small artery disease (SAD), each presenting unique challenges and require tailored therapeutic approaches. BTK PAD, characterised by occlusions in the anterior tibial, posterior tibial, and peroneal arteries, necessitates targeted revascularisation to improve foot perfusion. BTA PAD, involving the pedal and plantar arteries, is associated with higher risks of amputation and requires advanced revascularisation techniques. SAD, affecting the small arteries of the foot, remains an enigma and is challenging to treat with the current mechanical methods, highlighting the potential of autologous cell therapy as a promising alternative. A refined characterisation of PAD in diabetes is crucial for developing effective, individualised treatment strategies, ultimately improving patient outcomes, and reducing the burden of diabetic foot complications. In light of these complexities, it is incredulous that we often use a single term, "peripheral arterial disease", to describe such a diverse array of disease patterns. This oversimplification can be perilous, as it may lead to inadequate therapeutic approaches and suboptimal patient care.

GPR30-driven fatty acid oxidation targeted by ginsenoside Rd maintains mitochondrial redox homeostasis to restore vascular barrier in diabetic retinopathy

Blood-retinal barrier (BRB) breakdown, a pivotal contributor to multiple retinal vascular diseases, manifests as a progressive increase in vascular permeability induced by various pathological stimuli. The functional plasticity of retinal endothelial cells can be intricately shaped by metabolic alteration. However, little is known about the mechanisms through which endothelial metabolic disorders trigger the dissolution of inter-vascular junctions and the selective approaches to targeting metabolic homeostasis. Herein, we identify AMPK-associated fatty acid oxidation (FAO) inhibition as a critical driver of vascular barrier dysfunction via exacerbating redox imbalance. Pharmacological facilitation of FAO by ginsenoside Rd (Rd) suppresses BRB collapse and other secondary retinal damage in diabetic retinopathy (DR). Mechanistically, Rd targets GPR30 to phosphorylate AMPK via the PKA-LKB1-AMPK kinase cascade. The AMPK activation induced by Rd revitalizes hyperglycemia-compromised FAO, and then sustains mitochondrial NADPH regeneration by emphasis on IDH2 at various levels, including substrate supply, transcription, and post-translational modifications. Therefore, Rd alleviates the disruption of BRB integrity driven by mitochondrial oxidative stress, with the vasculoprotection of Rd diminished by GPR30 knockdown and pharmacological attenuation of AMPK. These findings collectively reveal the previously-unanticipated role of endothelial FAO in heightened retinal vascular leakage, and highlight the potential translational application of GPR30 agonism with Rd to mitigate barrier dysfunction, providing a metabolic regulatory therapeutic strategy for DR.

In-shoe plantar temperature, normal and shear stress relationships during gait and rest periods for people living with and without diabetes

Diabetic foot ulcers (DFUs) are a common complication of diabetes. This study aims to investigate the relationships between in-shoe plantar temperature, normal and shear stress during walking and rest periods for participants with and without diabetes. For this purpose, a novel temperature, normal and shear stress sensing system was developed and embedded in an insole at the hallux, first metatarsal head and calcaneus region. Ten participants living with diabetes with no history of previous ulceration and ten healthy participants were recruited. Participants walked on a treadmill for 15 min and then rested for 20 min wearing the sensing insole. Results showed high correlation (Spearman's rs ≥ 0.917) between heat energy, total plantar temperature change, during walking and strain energy, cumulative stress squared in all participants. Importantly, between-group comparisons showed indications of thermal regulation differences in participants with and without diabetes, with the first metatarsal head site showing significantly higher temperature at the end of the active period (P = 0.0097) although walking speed and mechanical stress were similar. This research demonstrates for the first time the correlation between strain energy and heat energy in-shoe during gait. Further research is needed to quantify relationships and investigate thermal regulation as a mechanism for DFU formation.

Effect of SGLT2i on kidney outcomes of individuals with type 2 diabetes according to body mass index: nationwide cohort study

AIMS

To investigate the clinical significance of the modification of the kidney protective effects of sodium-glucose cotransporter-2 (SGLT2) inhibitors by baseline body mass index (BMI).

METHODS AND RESULTS

We included individuals with SGLT2 inhibitors or dipeptidyl peptidase-4 (DPP4) inhibitors newly prescribed for type 2 diabetes using a nationwide epidemiological cohort and performed propensity score matching (1:2). The primary outcome was the annual eGFR decline, assessed using a linear mixed-effects model, compared between individuals with SGLT2 inhibitors and DPP4 inhibitors. We investigated the interaction effect of BMI at the time of prescription using a three-knot restricted cubic spline model. We analysed 2165 individuals with SGLT2 inhibitor prescriptions and 4330 individuals with DPP4 inhibitor prescriptions. Overall, the annual decline in eGFR was less pronounced in the group treated with SGLT2 inhibitors than in those treated with DPP4 inhibitors (-1.34 mL/min/1.73 m2 vs. -1.49 mL/min/1.73 m2). The advantage of SGLT2 inhibitors in mitigating eGFR decline was augmented in the individuals with higher BMI (P-value for interaction 0.0017). Furthermore, even upon adjusting the definition of outcomes to encompass a 30 or 40% reduction in eGFR, the potential advantages of SGLT2 inhibitors over DPP4 inhibitors persisted, with a trend of augmented effects with higher BMI. This interaction effect was evident in the individuals with preserved kidney function.

CONCLUSION

Our nationwide epidemiological study substantiated the improved kidney outcomes in the SGLT2 inhibitor users compared with the DPP4 inhibitor users across a wide range of BMI, which was pronounced for individuals with higher BMI.

Blockade of HSP70 Improves Vascular Function in a Mouse Model of Type 2 Diabetes

Type 2 diabetes (T2D) is a chronic disease that damages blood vessels and increases the risk of cardiovascular disease (CVD). Heat-shock protein 70 (HSP70), a family of chaperone proteins, has been recently reported as a key player in vascular reactivity that affects large blood vessels like the aorta. Hyperglycemia, a hallmark of diabetes, correlates with the severity of vascular damage and circulating HSP70 levels. In diabetes, blood vessels often show impaired contractility, contributing to vascular dysfunction. However, HSP70's specific role in T2D-related vascular contraction remains unclear. We hypothesized that blocking HSP70 would improve vascular function in a widely used diabetic mouse model (db/db). To test this, we measured both vascular intracellular and serum circulating HSP70 levels in control and diabetic male mice using immunofluorescence and Western blotting. We also examined the aorta's contractile response using a wire myograph system, which measured the force produced in response to phenylephrine (PE), both with and without VER155008, a pharmacological inhibitor that targets the ATPase domain of HSP70, and after removing extracellular calcium. Our findings show that intracellular HSP70 (iHSP70) levels were similar in control and diabetic groups, while circulating HSP70 (eHSP70) levels were higher in the serum of diabetic mice, altering the iHSP70/eHSP70 ratio. Even though VER155008 attenuated both phases of the contractile curve in the diabetic and control groups, enhanced vasoconstriction to PE was only observed in the tonic phase of the curve in the db/db group, which was prevented by iHSP70 inhibition. This effect involved calcium mobilization, as both the maximal and total contraction forces to PE were restored in groups treated with VER155008. Additionally, internal calcium levels in aortic rings treated with VER155008 decreased, as observed in force generation upon calcium reintroduction, which was further corroborated using a biochemical calcium assay. In conclusion, our study demonstrates that blocking HSP70 improves vascular reactivity in the hyperglycemic state of T2D by restoring proper vascular contraction.

Do people with diabetes have a higher risk of developing postoperative endophthalmitis after cataract surgery? A systematic review and meta-analysis

PURPOSE

Postoperative endophthalmitis (POE) is a rare but severe complication of cataract surgery. While diabetes mellitus may increase the risk of POE, the relationship remains unclear.

METHODS

A systematic review and meta-analysis were conducted following PRISMA guidelines. PubMed, Scopus, Medline, Embase, and Google Scholar were searched for relevant studies up to September 10, 2024. The study included both randomized controlled trials and observational studies that evaluated POE outcomes in cataract surgery patients, comparing people with and without diabetes. Random-effects models were used to calculate pooled odds ratios (OR) with 95% confidence intervals (CI).

RESULTS

Nine studies were included in the systematic review, with seven analyzed in the meta-analysis. The review on POE in people with diabetes undergoing cataract surgery revealed a higher incidence in this group, with a pooled odds ratio (OR) of 1.174 (95% CI: 1.109 to 1.242; p = 0.000) and an incidence rate of 0.261%, compared to 0.242% in people without diabetes. Males with diabetes had a 1.634 times higher risk of POE (p = 0.048), while diabetes and hypertension together increased risk by 3.961 times (p < 0.001). Posterior capsule rupture (PCR) was associated with a significantly higher risk of developing POE, which was also more common in people with diabetes, with an OR of 3.434 (95% CI: 1.789 to 6.591; p = 0.0001). The use of postoperative intracameral and topical antibiotics significantly reduced the risk of POE in both people with and without diabetes (OR: 0.231; p = 0.00).

CONCLUSIONS

This meta-analysis shows that people with diabetes undergoing cataract surgery have a significantly higher risk of POE and PCR compared to those without diabetes, with odds ratios of 1.174 and 3.434, respectively. The administration of intracameral and topical antibiotics significantly reduces the risk of POE in both groups. Our study highlights the importance of maintaining well-controlled blood sugar and blood pressure before surgery. Additionally, extra caution should be taken during surgery to prevent PCR, and appropriate antibiotic use should be considered to minimize the risk of POE.

Therapeutic Potential of Green Synthesized Polyherbal Formulated Silver Nanoparticles in Alloxan-Induced Diabetes Mellitus-An In Vivo Strategy

Diabetes mellitus (DM) is a non-communicable, life-threatening syndrome prevalent worldwide. One effective treatment for DM is the medicinal use of green synthesized silver nanoparticles (AgNPs), which are eco-friendly and cost-effective. This study investigates the antidiabetic potential of greensynthesizedAgNPs derived from a polyherbal formulation (PHF). Characterization of PHF-AgNPs included UV-Vis spectroscopy, FTIR, XRD, SEM, and EDX. Diabetes was induced in albino Wistar rats (N = 30, n = 6/group, 150-200 g, 8 weeks old) via intraperitoneal alloxan injection (150 mg). Groups are as follows: 1) untreated control, 2) diabetic control (150 mg/kg b.w. alloxan), 3) glibenclamide (0.5 mg/kg), 4) PHF-AgNPs (10 mg/kg), and 5) PHF-AgNPs (20 mg/kg). Blood glucose levels (BGL) were monitored on days 0, 7, 14, and 21. Blood samples were collected for the liver, kidney, and lipid profile analysis before euthanization. The results showed that PHF-AgNPs had an average size of 20 nm and exhibited significant reductions in BGL, with PHF-AgNPs at both 10 mg/kg and 20 mg/kg demonstrating superior effects compared to glibenclamide. Histopathological analysis revealed tissue regeneration in the liver, kidney, and pancreas, indicating healing of alloxan-induced damage. Additionally, treatment improved liver and kidney function markers, and lipid profiles, with reductions in cholesterol, triglycerides, ALT, AST, and creatinine levels compared to the diabetic control group. These findings suggest that green synthesized PHF-AgNPs effectively improved blood glucose control, body weight, and organ health, positioning them as a promising antidiabetic agent with potential for further clinical development.

Cross-sectional study on the association between the fibrosis-4 index and co-occurring myocardial infarction in Chinese patients with type 2 diabetes mellitus

Background

Previous studies indicated that the Fibrosis-4 Index (FIB-4), an evaluation metric for liver fibrosis, is associated with adverse outcomes in coronary artery disease. However, the correlation between FIB-4 and myocardial infarction (MI) in Chinese patients with Type 2 Diabetes Mellitus (T2DM) has not been well-defined. Thus, this study aims to elucidate the association between FIB-4 and MI in Chinese T2DM patients.

Methods

Cross-sectional data were collected from T2DM patients at two hospitals in China, designated as the discovery and validation centers. The exposure variable, FIB-4 index, was derived from patient age, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and platelet count. This index was stratified into four distinct clusters via k-means clustering analysis. The primary outcome was defined as the incidence of co-occurring MI. Logistic and restricted cubic spline regression was conducted to assess the association between the FIB-4 index and MI in Chinese T2DM patients.

Results

In the discovery phase, data were analyzed from 2,980 T2DM patients, including 1,114 females (37.38%), with 58 years average age (SD: 10.4). Among them, 190 were also MI patients. Based on the fully adjusted logistic regression analysis, the odds ratio (OR) for the second cluster was 1.00 (95% CI, 0.60-1.40); for the third cluster, it was 1.94 (95% CI, 1.32-2.57), and for the poorest controlled cluster it was 16.18 (95% CI, 14.97-17.39) in comparison to the best-controlled cluster of FIB-4. Restricted cubic spline regression revealed a linear relationship between the FIB-4 index and MI risk. Subgroup analysis demonstrated that this association was significant in elderly adults, females with high BMI, and those with comorbidities such as hypertension, coronary artery disease, and chronic heart failure. These findings yield consistent results in the validation set (n = 224).

Conclusions

Among Chinese patients with T2DM, elevated FIB-4 levels have been independently associated with MI, particularly among females and individuals with concomitant hypertension. Consequently, the FIB-4 index is anticipated to serve as a promising tool for early detection and risk stratification in this population.

Diabetes status, duration, and risk of dementia among ischemic stroke patients

BACKGROUND

The influence of duration of type 2 diabetes mellitus (T2DM) on the likelihood of developing new-onset dementia in post-stroke population is not well understood. Therefore, we aimed to clarify the relationship between the duration of T2DM and the risk of developing dementia in the post-stroke population.

METHODS

Leveraging the Korean National Health Insurance Database, this study included 118,790 individuals with a history of stroke but no previous dementia diagnosis. We classified diabetes status into five categories: normoglycemia, impaired fasting glucose (IFG), newly diagnosed T2DM, and established T2DM with durations of less than 5 years and 5 years or more. The primary endpoint was the incidence of all-cause dementia.

RESULTS

Among 118,790 participants (average age 64.26 ± 9.95 years, 48% male), 16.7% developed dementia during an average follow-up of 7.3 ± 2.3 years. Participants with a history of T2DM for less than five years at cohort entry had a 26.7% higher risk of developing all-cause dementia compared to those with normoglycemia. Those with T2DM for five years or longer had a 46.7% increased risk, with an adjusted hazard ratio (aHR) of 1.466 (95% confidence interval [CI], 1.408-1.527). Specifically, the risk of developing Alzheimer's disease (AD) and vascular dementia (VaD) rose by 43.4% and 51.4%, respectively, for individuals with T2DM lasting more than five years (aHR 1.434, 95% CI 1.366-1.505; aHR 1.514, 95% CI 1.365-1.679, respectively).

CONCLUSIONS

Our findings demonstrated a significant association between an extended duration of T2DM and an increased risk of developing all-cause dementia, including AD and VaD in post-stroke population. These results emphasize proactive dementia prevention approaches in stroke survivors, particularly those with longstanding T2DM.

The Role of Th17/Treg Axis in Retinal Pathology Associated with Diabetes and Treatment Options

Diabetic retinopathy (DR) is a major complication of diabetes, leading to vision impairment and blindness. The pathogenesis of DR involves multiple factors, including hyperglycemia-induced vascular damage, hypertension, obesity, anemia, immune dysregulation, and disruption of the blood-retinal barrier (BRB). Th17 and Treg cells, two types of CD4+ T cells, play opposing roles in inflammation. Th17 cells are pro-inflammatory, producing cytokines such as IL-17A, while Treg cells help suppress immune responses and promote anti-inflammatory effects. Recent studies highlight the importance of the Th17/Treg balance in retinal inflammation and disease progression in DR. Our literature review reveals an imbalance in DR, with increased Th17 activity and reduced Treg function. This shift creates a pro-inflammatory environment in the retina, worsening vascular leakage, neovascularization, and vision loss. The limited infiltration of Treg cells suggests that Th17 cells may uniquely infiltrate the retina by overwhelming or outnumbering Tregs or increasing the expression of recruiting chemokines, rather than only taking advantage of a damaged BRB. Therapeutic strategies, such as neutralizing IL-17A and enhancing Treg function with compounds like IL-35 or curcumin, may reduce inflammation and retinal damage. Restoring the balance between Th17 and Treg cells could provide new approaches for treating DR by controlling inflammation and preventing further retinal damage.

Long-term trajectory of estimated glomerular filtration rate in ambulatory patients with type 2 diabetes and heart failure: clinical insights and prognostic implications

BACKGROUND

Although previous studies have evaluated renal function decline in patients with heart failure (HF), there is limited evidence on long-term renal trajectories, especially in patients with concomitant HF and type 2 diabetes (T2D). This study aims to provide a detailed analysis of renal function decline over an extended follow-up period in a well-characterized cohort of patients with HF and T2D.

METHODS

This is a post hoc subanalysis of a prospective registry involving ambulatory patients with HF and T2D referred to a specialized HF clinic. The estimated glomerular filtration rate (eGFR) was assessed at baseline and during scheduled follow-up visits every three months using the Chronic Kidney Disease Epidemiology Collaboration formula. Loess curves were plotted for predefined subgroups, and multivariable longitudinal Cox regression analyses were performed to evaluate the associations between eGFR trajectories and all-cause mortality.

RESULTS

A total of 1,114 patients with HF and T2D were included, with a mean age of 69.3 ± 10.3 years, and 68.2% were men. In total, 10,830 scheduled creatinine measurements were analysed, with a mean of 15.8 ± 9.4 measurements per patient. A significant progressive decline in the eGFR was observed, with an average annual rate of - 2.05 (95% CI - 2.11 to - 1.95, p < 0.001) ml/min/1.73 m2. Subgroup analysis indicated that older age, nonischaemic HF aetiology, HFpEF or HFmrEF, poor glycaemic control, and higher baseline eGFRs were associated with a more pronounced decline in renal function. Furthermore, a decrease in the eGFR was independently associated with an increased risk of all-cause mortality.

CONCLUSIONS

This study offers novel insights into long-term renal function trajectories in patients with HF and T2D and identifies key clinical factors associated with accelerated renal decline. Future research is warranted to validate these results in larger, more diverse cohorts and to explore potential therapeutic interventions.

External stimuli-driven catalytic hydrogels for biomedical applications

Hydrogels, bearing three-dimensional networks formed through chemical or physical crosslinking of hydrophilic macromolecules, benefit from their biocompatibility, tunable properties, and high loading capacities, and thus hold great promise for biomedical applications. Recent advancements have increasingly focused on the integration of non-invasive external stimuli-such as light, heat, electricity, magnetism, and ultrasound-into hydrogel design. These external stimuli-driven catalytic hydrogels can dynamically respond to these stimuli, allowing for high spatial and temporal precision in their application. This capability enables in situ activation, controlled degradation, and catalytic reactions, making them ideal for next-generation clinical interventions. This review discusses the design strategies for external stimuli-driven catalytic hydrogels, concentrating on essential mechanisms of catalytic processes aimed at optimizing therapeutic efficacy. The discussion highlights the importance of precise control over the chemical and physical properties of hydrogels in response to specific stimuli, elucidating the regulatory mechanisms that dictate hydrogel behavior and deepening the understanding of their applications with enhanced spatial and temporal resolution.

Three-Dimensional Choroidal Vessels Assessment in Diabetic Retinopathy

Purpose

To evaluate choroidal vasculature in eyes with diabetic retinopathy (DR) using a novel three-dimensional algorithm.

Methods

Patients with DR and healthy controls underwent clinical examinations and swept-source optical coherence tomography (PlexElite-9000). The choroidal layer was segmented using the ResUNet model. Phansalkar thresholding was used to binarize the choroidal vasculature. The macular area was divided into 5 sectors by a custom grid, and the 15 largest vessels in each sector were measured for mean choroidal vessel diameter (MChVD). Volumetric choroidal thickness (ChT) and the choroidal vascularity index (CVI) were calculated. A linear mixed model was used for analysis.

Results

This retrospective cross-sectional study analyzed 73 eyes of 45 patients with DR (36 proliferative vs. 37 nonproliferative DR, and 42 with diabetic macular edema [DME] vs. 31 without DME), and 27 eyes of 21 age-match controls. The average MChVD was decreased in DR compared with healthy (200.472 ± 28.246 µm vs. 240.264 ± 22.350 µm; P < 0.001), as well as lower sectoral MChVD (P < 0.001); however, there was no difference in average ChT between the groups (P > 0.05). The global CVI was reduced in DR, especially in temporal and central sectors (P < 0.05). Compared with nonproliferative, proliferative DR exhibited decreased ChT (temporal, P < 0.05; other sectors, P > 0.05), CVI (P > 0.05), and MChVD (P > 0.05). DME eyes demonstrated lower but not statistically significant MChVD (196.449 ± 27.221 µm vs. 205.922 ± 29.134 µm; P > 0.05) and significantly reduced average CVI (0.365 ± 0.032 vs. 0.389 ± 0.040; P = 0.008) compared with non-DME eyes.

Conclusions

DR and DME eyes showed reduced MChVD and CVI, likely owing to microvascular changes leading to ischemia. These findings highlight the need for new choroidal biomarkers to better understand DR's pathogenic mechanisms.

ETV5-Mediated Transcriptional Repression of DDIT4 Blocks Macrophage Pro-Inflammatory Activation in Diabetic Atherosclerosis

Atherosclerosis risk is elevated in diabetic patients, but the underlying mechanism such as the involvement of macrophages remains unclear. Here, we investigated the underlying mechanism related to the pro-inflammatory activation of macrophages in the development of diabetic atherosclerosis. Bioinformatics tools were used to analyze the macrophage-related transcriptome differences in patients with atherosclerosis and diabetic mice. LDLR-/- mice with DDIT4 depletion were generated and fed a Western diet to induce atherosclerosis. DDIT4 expression was elevated in diabetic mice and patients with atherosclerosis. Macrophage proinflammatory factors F4/80, Il-6, and TNFα were reduced in DDIT4-/-LDLR-/- mice and necrotic areas were decreased in the aortic root. Atherosclerotic plaque stability was increased in DDIT4-/-LDLR-/- mice, as evidenced by increased collagen and smooth muscle cell content. DDIT4, regulated by ETV5, acted on macrophages, affecting lipid accumulation, migration capacity, and pro-inflammatory responses. Knockdown of ETV5 increased expression of DDIT4 and pro-inflammatory factors in macrophages, increased necrotic core area in the aortic root, and decreased stability of atherosclerotic plaques in mice, which was abated by DDIT4 knockdown. The findings provide new insight into how diabetes promotes atherosclerosis and support a model wherein loss of ETV5 sustains transcription of DDIT4 and the pro-inflammatory activation of macrophages.

Vascular actions of Ang 1-7 and Ang 1-8 through EDRFs and EDHFs in non-diabetes and diabetes mellitus

The renin-angiotensin system (RAS) plays a pivotal role in regulating vascular homeostasis, while angiotensin 1-8 (Ang 1-8) traditionally dominates as a vasoconstrictor factor. However, the discovery of angiotensin 1-7 (Ang 1-7) and Ang 1-8 has revealed counter-regulatory mechanisms mediated through endothelial-derived relaxing factors (EDRFs) and endothelial-derived hyperpolarizing factors (EDHFs). This review delves into the vascular actions of Ang 1-7 and Ang 1-8 in both non-diabetes mellitus (non-DM) and diabetes mellitus (DM) conditions, highlighting their effects on vascular endothelial cell (VECs) function as well. In a non-DM vasculature context, Ang 1-8 demonstrate dual effect including vasoconstriction and vasodilation, respectively. Additionally, Ang 1-7 induces vasodilation upon nitric oxide (NO) production as a prominent EDRFs in distinct mechanisms. Further research elucidating the precise mechanisms underlying the vascular actions of Ang 1-7 and Ang 1-8 in DM will facilitate the development of tailored therapeutic interventions aimed at preserving vascular health and preventing cardiovascular complications.

Placental expression of GLUT-1, GLUT-3, and GLUT-4 mRNA and transcriptome profiling in pregnant women with diabetes

AIMS/INTRODUCTION

Placental glucose transport is regulated by glucose transporter proteins (GLUTs). The study aimed to examine placental expression of GLUT-1, GLUT-3, and GLUT-4 mRNA in patients with type 1 diabetes, early gestational diabetes (eGDM), and healthy controls, and to investigate correlations between GLUTs expression and clinical parameters. Additionally, we compared placental transcriptome profiles in recruited subgroups.

MATERIALS AND METHODS

We recruited 59 pregnant women: 23 with type 1 diabetes, 17 with eGDM, and 19 controls. Patients with diabetes attended follow-up visits at each trimester. Transcriptome studies were performed in 4 patients per subgroup.

RESULTS

The mean age was similar across all subgroups. eGDM patients had significantly higher BMI and were predominantly obese. We observed a significant 2-fold (P = 0.009) decrease in placental GLUT-3 mRNA expression in the type 1 diabetes and eGDM groups. GLUT-4 mRNA expression was significantly lower in the eGDM group compared to type 1 diabetes (3-fold) and controls (6-fold) (P = 0.007). There was a significant negative correlation between GLUT-3 (R = -0.29) and GLUT-4 (R = -0.27) mRNA expression and neonatal birth weight. GLUT-4 expression was negatively correlated with 1st trimester HbA1c (R = -0.72) and OGTT 120' (R = -0.82) results in eGDM patients, and 3rd trimester glycemic variability (R = -0.49) in type 1 diabetes. Microarray analysis revealed significant transcriptomic changes, with 45 down-regulated and 365 up-regulated genes in type 1 diabetes, and 21 significant changes in eGDM.

CONCLUSIONS

Placental samples from patients with diabetes exhibit changes in GLUTs expression, which correlates with neonatal growth and several glycemic parameters. Additionally, multiple changes in transcriptomic profiles are observed in hyperglycemic patients.

Estimated glucose disposal rate and microvascular complications of diabetes mellitus type I: A systematic review and meta-analysis

Objectives: This study aims to assess the association between the estimated glucose disposal rate (eGDR) and the risk of diabetic microvascular complications in patients with T1DM.Methods: A systematic search of PubMed, Scopus, and Web of Science was conducted up to August 2024, including studies that examined the relationship between eGDR and diabetic retinopathy (DR), diabetic kidney disease (DKD), and diabetic neuropathy (DN) in patients with T1DM. A meta-analysis was performed to compare the eGDR values in patients with and without microvascular complications and assess the risk of these complications.Results: 22 studies were included. Lower eGDR values were significantly associated with a higher risk of microvascular complications. Specifically, a one-unit increase in eGDR was associated with a 18% reduction in the risk of DKD (ES: 0.82, 95% CI: 0.74-0.92), a 21% reduction in the risk of DR (OR: 0.79, 95% CI: 0.73-0.85). Patients with DKD, DR, and DN had eGDR values significantly lower by 1.29, 0.75, and 0.64 units, respectively, compared to those without complications.Conclusion: This meta-analysis highlights the potential role of eGDR as a non-invasive marker for the early detection of microvascular complications, highlighting the importance of regular eGDR monitoring to facilitate timely interventions.

Salvianolic acid B drives gluconeogenesis and peroxisomal redox remodeling in cardiac ischemia/reperfusion injury: A metabolism regulation by metabolite signal crosstalk

Cardiac metabolism relies on glycogen conversion by glycolysis. Glycolysis intersects fatty acid oxidation and often directs a signal crosstalk between redox metabolites. Myocardium with ischemia/reperfusion significantly diverts from normal metabolism. Prospectively, peroxisome lies central to metabolism and redox changes, but mechanisms underlying in ischemia/reperfusion remain undefined. This work aims at investigating the potential effects and mechanisms of Salvianolic acid B (Sal B) in cardioprotection through metabolic remodeling. Following experiments, we found that Sal B is absorbed in blood and rat hearts and its cardiac absorption prevents ischemia/reperfusion injury. Sal B cardioprotection relates to gluconeogenesis activation and peroxisomal redox remodeling. Gluconeogenesis compensates glycogen synthesis through upregulating pyruvate carboxylase (PC) and phosphoenolpyruvate carboxykinase. Gluconeogenic PC activity drives peroxisomal Pex2/Pex3 expressions and promotes the proliferation of peroxisome. Peroxisome quality control is enhanced with Pex5/Pex14/Pex13/Pex2 transcriptions. Nono, a non-POU domain-containing octamer-binding protein, promotes upregulation of gluconeogenic PC and peroxisomal gene transcripts through transcriptionally splicing their pre-RNAs at octamer duplex. Nono also controls the expression of SARM1/PARP1/sirtuin1 for catalyzing nicotinamide adenine dinucleotide (NAD+) consumption, leading to endurable redox capacities of peroxisome. Peroxisomal redox remodeling alters reactive oxygen species (ROS) and NAD+ contents, following which NAD+ affects cardiac accumulation of physiologically harmful glucocorticoid. In the tests of Sal B combinational treatments, results indicate ROS upregulation whereas NAD+ downregulation with glucocorticoid, ROS scavenging and glucocorticoid elimination with NAD+ precursor, and NAD+ promotion with ROS scavenger, respectively. This metabolite signal crosstalk alternatively antagonizes/agonizes Sal B cardioprotective functions on electrocardiographic output and infarction. Taken together, we reported a cardiac metabolism regulation with Sal B, capable of preventing myocardium from ischemia/reperfusion injury. The metabolite signal crosstalk was achieved by coupling reaction cascades between gluconeogenesis and peroxisomal redox remodeling.

Injectable Glucose-Releasing Microgels Enhance the Survival and Therapeutic Potential of Transplanted MSCs Under Ischemic Conditions

Mesenchymal stem cell (MSC)-based therapies show potential to treat ischemic diseases owing to their versatile functions. However, sustaining MSC viability and therapeutic efficacy in ischemic tissues postengraftment remains a significant challenge. This is because, although MSCs are metabolically flexible, they fail to adapt to hypoxic conditions in the absence of glucose, leading to cell death. To overcome these issues, it is aimed to establish an injectable glucose delivery system using starch and amyloglucosidase embedded in alginate microgels. Here, starch/amyloglucosidase (S/A) microgels are engineered to continuously release glucose for seven days via enzymatic hydrolysis, thereby supporting MSC functions under ischemic conditions. In vitro tests under oxygen/glucose-deprived conditions revealed that the S/A microgels not only maintained the viability and intracellular energy but also enhanced the pro-angiogenic and immunomodulatory functions of MSCs. In vivo data further confirmed the pro-survival and pro-angiogenic effects of S/A microgels on MSCs following subcutaneous engraftment in mice. Overall, the developed S/A microgel significantly enhanced the survival and therapeutic potential of MSCs via sustained glucose delivery, highlighting its potential use in advancing MSC-based therapies for ischemic conditions.

Cellular crosstalk in organotypic vasculature: mechanisms of diabetic cardiorenal complications and SGLT2i responses

BACKGROUND

Diabetic panvascular disease (DPD) is the leading clinical complication of diabetes mellitus (DM), characterized by atherosclerosis across multiple organ vessels. It is a major cause of high disability and mortality rates in DM. However, the pathological mechanisms and key mediators of DPD remain unclear.

METHODS

This study constructed a single-cell organotypic atlas of the vasculature containing 321,358 cells by integrating 14 single-cell datasets from 8 major mouse organs and tissues. A total of 63 cell types were identified, including 9 vascular cell subtypes, whereas the cell-to-cell interaction (CCI) patterns of the organotypic vasculature were systematically analyzed.

RESULTS

Endothelial cells (ECs) were identified as the major cell type involved in CCI within the vasculature, with their ligands interacting with receptors of various cell types, which contribute to multiple biological processes such as stem cell differentiation and immune regulation. Notably, the study examined the cellular communication characteristics of different EC subtypes. Additionally, the inter-organ communication between the heart and kidney-key tissues in DPD-was analyzed. The BMP signaling pathway emerged as a critical communication pathway leading to cardiorenal complications in DM, with SGLT2i having a regulatory role in BMP6 modulation.

CONCLUSIONS

The study provides, for the first time, a single-cell analysis of the CCI patterns of the organotypic vasculature and highlights the central role of ECs. Moreover, the key role of BMP6 in diabetic cardiorenal complications is elucidated. These findings offer new insights into the mechanisms underlying DPD co-morbidities and provide a novel scientific basis for clinical prevention, treatment strategies for DPD, and the understanding of the action mechanism of SGLT2i.

Roles and mechanisms of histone methylation in vascular aging and related diseases

The global aging trend has posed significant challenges, rendering healthcare for older adults a crucial focus in medical research. Among the numerous health concerns related to aging, vascular aging and dysfunction are important risk factors and underlying causes of age-related diseases. Histone methylation and demethylation, which are involved in gene expression and cellular senescence, are closely associated with the occurrence and development of vascular aging. Consequently, this review aimed to identify the role of histone methylation in the pathogenesis of vascular aging and its potential for treating age-related vascular diseases and provided new insights into therapeutic strategies targeting the vascular system.

The Nutritional Status of Patients with Heart Failure and Its Impact on Patient' Outcomes-The Center's Own Experience

Background. The nutritional status of patients in hospitals has a significant impact on the effectiveness of treatment, the occurrence of complications, and the length of hospitalization. The purpose of this study was to evaluate the nutritional status of patients with heart failure (HF) and its impact on patient outcomes. Material and Methods. This study included 213 patients (153 men, 71.8%) aged 74.7 ± 14.3 years treated for HF at the cardiology clinic of the 4th Military Clinical Hospital between 2018 and 2021. Sociodemographics, clinical data, the Model for End-Stage Liver Disease (MELD), CHILD-PUGH, and the Nutritional Risk Score (NRS) were analyzed. Results. Patients at high nutritional risk (NRS ≥ 3 score) were older (85 years vs. 75 years; p < 0.001), had longer hospitalizations (12 days vs. 9 days, p = 0.027), lower hemoglobin (10.5 g/dL vs. 11.7 g/dL, p = 0.001), lower TIBC (292 vs. 336; p = 0.012), and iron (32 mg/nL vs. 39 ng/mL, p = 0.009) compared with patients at low risk (NRS < 3 score). Patients hospitalized ≤7 days had significantly lower CHILD-PUGH score compared with patients hospitalized >7 days. Patients hospitalized ≥14 days were significantly more likely to die compared with other groups of HF patients (10.6% vs. 0.0%, p = 0.004). Conclusions. Abnormal nutritional status among hospitalized HF patients is associated with longer hospitalization duration and higher rates of death. In addition to clinical factors, the CHILD-PUGH scale can be helpful in estimating the length of hospitalization of HF patients. It is necessary to determine the impact of nutritional status on the outcome of patients with heart failure in further multicenter prospective or interventional studies.

Unveiling the Negative Synergistic Effect of Wall Shear Stress and Insulin on Endothelial NO Dynamics by Mathematical Modeling

Diabetic vascular complications (DVCs) are diabetes-induced vascular dysfunction and pathologies, leading to the major causes of morbidity and mortality in millions of diabetic patients worldwide. DVCs are provoked by endothelial dysfunction which is closely coordinated with two important hallmarks: one is the insufficient insulin secretion or insulin resistance, and another is the decrease in intracellular nitric oxide (NO) influenced by dynamic wall shear stress (WSS). Although the intracellular NO dynamics in endothelial cells (ECs) is crucial for endothelial function, the regulation of NO production by dynamic WSS and insulin is still poorly understood. In this study, we have proposed a mathematical model of intracellular NO production in ECs under the stimulation of dynamic WSS combined with insulin. The model integrates simultaneously the biochemical signaling pathways of insulin and the mechanotransduction pathways induced by dynamic WSS. The accuracy and reliability of the model to quantitatively describe NO production in ECs were compared and validated with reported experimental data. According to the validated model, inhibition of protein kinase B (AKT) phosphorylation and Ca2+ influx by dynamic oscillatory WSS disrupts the dual nature of endothelial nitric oxide synthase (eNOS) enzyme activation. This disruption leads to the decrease in NO production and the bimodal disappearance of NO waveforms. Moreover, the results reveal that dynamic WSS combined with insulin promote endothelial NO production through negative synergistic effects, which is resulted from the temporal differences in mechanical and biochemical signaling. In brief, the proposed model elucidates the mechanism of NO generation activated by dynamic WSS combined with insulin, providing a potential target and theoretical framework for future treatment of DVCs.

Caveolin and oxidative stress in cardiac pathology

Caveolins interact with signaling molecules within caveolae and subcellular membranes. Dysregulation of caveolin function and protein abundance contributes to cardiac pathophysiological processes, driving the development and progression of heart disease. Reactive oxygen species (ROS) play a critical role in maintaining cellular homeostasis and are key contributors to the pathophysiological mechanisms of cardiovascular disorders. Caveolins have been shown to modulate oxidative stress and regulate redox homeostasis. However, the specific roles of caveolins, particularly caveolin-1 and caveolin-3, in regulating ROS production during cardiac pathology remain unclear. This mini-review article highlights the correlation between caveolins and oxidative stress in maintaining cardiovascular health and modulating cardiac diseases, specifically in myocardial ischemia, heart failure, diabetes-induced metabolic cardiomyopathy, and septic cardiomyopathy. A deeper understanding of caveolin-mediated mechanisms may pave the way for innovative therapeutic approaches to treat cardiovascular diseases.

Uncovering the potential mechanism and bioactive compounds of Salviae Miltiorrhizae Radix et Rhizoma in attenuating diabetic retinopathy

BACKGROUND

Diabetic retinopathy (DR) is a serious microangiopathy resulting from diabetes. Salviae Miltiorrhizae Radix et Rhizoma (Danshen) is commonly used to treat cardiovascular diseases in clinics in China. However, whether it can also be used for DR treatment, along with its primary active compounds and underlying mechanisms of action, remains unclear.

PURPOSE

To evaluate the alleviation of water extract of Salvia miltiorrhiza Radix et Rhizoma (SWE) on DR, elucidate the underlying mechanisms, and identify the primary active compounds.

METHODS

Mice were intraperitoneally injected with streptozotocin (STZ) to induce diabetes. Blood-retina barrier (BRB) breakdown was detected. The potential underlying mechanisms were predicted by network pharmacology and further validated by Western blot, leukostasis assay and real-time polymerase chain reaction (PCR). The primary active compounds in SWE were identified by integrating in vitro activity analysis and molecular docking.

RESULTS

SWE attenuated BRB breakdown in STZ-induced DR mice. Results of network pharmacology and further experimental validation implied that inhibiting retinal inflammation and angiogenesis, and reversing endothelial barrier dysfunction were involved in the SWE-provided alleviation of DR, and the key involved signaling pathways were PI3K-AKT, VEGF, TNF, and NFκB pathways. Further results in vitro demonstrated that salvianolic acid A (SalA), salvianolic acid B (SalB), salvianolic acid C (SalC), and Tanshinone IIA (TanIIA) not only reduced the expression of pro-inflammatory cytokines but also inhibited the adhesion of inflammatory cells. However, danshensu (DSS), cryptotanshinone (CTS), and tanshinone I (TanI) only downregulated the expression of pro-inflammatory cytokines. SalA, SalB, and CTS reversed endothelial barrier dysfunction in vitro. SalA, SalB, SalC, CTS, DSS, and TanIIA decreased VEGF mRNA expression, and TanIIA also inhibited VEGF-induced angiogenesis in vitro. Molecular docking predicted potential interactions between these active compounds and several key molecules involved in regulating inflammation, angiogenesis, and cell-cell junctions. These compounds abrogated hyperglycemia-induced phosphorylation of AKT1 and PI3 K in vitro. Furthermore, the interactions of SalA, SalB, SalC, and TanIIA with TNFR1 were further validated using cellular thermal shift assay (CETSA).

CONCLUSION

SWE alleviated DR via reversing BRB breakdown and suppressing retinal inflammation and angiogenesis. SalA, SalB, SalC, TanIIA, and CTS might be primary active compounds in SWE, and they contributed greatly to the improvement of SWE against DR via reversing endothelial barrier injury, inhibiting inflammation and angiogenesis.

Arterial Stiffness and Subclinical Inflammation in Children with Familial Mediterranean Fever: A Comprehensive Analysis

Background/Objectives: Familial Mediterranean fever (FMF) is a chronic autoinflammatory disease. Throughout the disease, subclinical inflammation persists into the remission period. It is known that chronic inflammation causes endothelial dysfunction and, as a consequence, arterial stiffness occurs. In this study, carotid and aortic intima-media thicknesses (IMT) and arterial stiffness were measured in FMF patients to evaluate the risk of possible vascular damage due to chronic inflammation. Methods: The study included pediatric patients with FMF who had been in remission for a minimum of 3 months. Carotid and aortic IMT and arterial stiffness measurements were conducted using sonoelastography. The acute-phase reactants were also evaluated in all participants. Results: Carotid artery stiffness measurements by strain elastography were significantly higher in the patient group than in the control group. However, the aortic and carotid IMT were similar between the two groups. The acute-phase reactants were significantly higher in the patient group than in the control group. Conclusions: This study demonstrated that arterial stiffness increased in pediatric FMF patients. According to the results of the present study, the effects of chronic inflammation on arterial tissues may lead to atherosclerotic changes in the later stages of the disease and may pose a risk for coronary diseases. Arterial ultrasonographic and elastographic measurements to be performed periodically in children with FMF are noninvasive methods that can be used to evaluate the course of endothelial damage. We aimed to show that arterial stiffness may be a marker of early cardiovascular disease.

SGLT2 Inhibitors: The First Endothelial-Protector for Diabetic Nephropathy

Sodium-glucose co-transporter type 2 inhibitors (SGLT2i) have emerged as a class of agents relevant for managing diabetic nephropathy and cardiopathy. In a previous report, we noticed that these drugs share, with other drugs with "nephroprotective" effects, the ability to reduce the glomerular filtration rate (GFR), thus suggesting the kidney hemodynamic effect as a proxy for optimal drug dosage. We also noticed that all known nephroprotective drugs exert cardioprotective functions, suggesting the possibility of activities not mediated by the kidney. Finally, we observe that nephroprotective drugs can be grouped according to their effects on hemoglobin levels, thus suggesting their mechanism of action. While the primary mechanism of SGLT2i involves glycosuria and natriuria, growing evidence suggests broader therapeutic effects beyond hemodynamic modulation. Specifically, the evidence that SGLT2 can be expressed in several atypical regions under pathological conditions, supports the possibility that its inhibition has several extratubular effects. Evidence supports the hypothesis that SGLT2i influence mitochondrial function in various cell types affected by diabetes, particularly in the context of diabetic nephropathy. Notably, in SGLT2i-treated patients, the extent of albumin-creatinine ratio (ACR) reduction post-treatment may be correlated with mitochondrial staining intensity in glomerular endothelial cells. This implies that the anti-proteinuric effects of SGLT2i could involve direct actions on glomerular endothelial cell. Our investigation into the role of SGLT2 inhibitors (SGLT2i) in endothelial function suggests that the aberrant expression of SGLT2 in endothelial cells in T2DM would lead to intracellular accumulation of glucose; therefore, SGLT2i are the first type of endothelial protective drugs available today, with potential implications for ageing-related kidney disease. The review reveals two major novel findings: SGLT2 inhibitors are the first known class of endothelial-protective drugs, due to their ability to prevent glucose accumulation in endothelial cells where SGLT2 is aberrantly expressed in Type 2 Diabetes. Additionally, the research demonstrates that SGLT2 inhibitors share a GFR-reducing effect with other nephroprotective drugs, suggesting both a mechanism for optimal drug dosing and potential broader applications in ageing-related kidney disease through their effects on mitochondrial function and glomerular endothelial cells.

Sub-Clinical Regional Macular Changes in Self-Reported Diabetic Subjects: Vascular and Retinal Layer Analysis Using Swept-Source OCT

Aim

To assess and compare subclinical alterations in superficial capillary plexus vessel density (SCPVD) and retinal layers thickness in the macular region between individuals with type 2 diabetes mellitus (DM) and healthy controls.

Methods

Swept-source OCT images were obtained from 29 control subjects and 24 diabetic subjects. Macular thickness (MT), retinal nerve fiber layer (RNFL) thickness, and ganglion cell layer (GCL) thickness were measured in the central macula and four quadrants of macular region using a 6.0 × 6.0 mm radial macular scan centered on the fovea. OCTA acquisition included a 3.0 × 3.0 mm macular scan for the foveal avascular zone (FAZ) and a 4.5 × 4.5 mm macular scan for SCPVD. The FAZ was manually mapped at the SCP on OCTA images.

Results

In diabetic subjects, the superficial capillary plexus vessel density (SCPVD) was significantly lower in both the central (P = 0.04) and inferior (P = 0.01) regions compared to the control group. Additionally, diabetic patients showed a significant reduction in temporal macular thickness (MT) and thinning of the ganglion cell layer (GCL) in all three quadrants except in the central and inferior macula (P < 0.05). There was also significant thinning of the superior macular retinal nerve fiber layer (RNFL) in diabetics compared to controls (P = 0.02). While the foveal avascular zone (FAZ) was larger in diabetic subjects, this difference was not statistically significant (P = 0.78). Duration of diabetes has shown a significantly high positive correlation (r = 0.77, P < 0.01) with superior macular VD.

Conclusion

The findings of this study suggest that the diabetic macula experiences significant ganglion cell layer (GCL) thinning and reduced superficial capillary plexus (SCP) vascular density even before the onset of clinical retinopathy. Swept-source OCT proves to be an essential tool for detecting these early changes in diabetic patients.

Clinical Outcomes in Diabetic Patients with Zinc Deficiency: A Multi-Institutional Population-Based Study

OBJECTIVE

This study aimed to investigate the association between zinc deficiency (ZD) and the risks of all-cause mortality, major adverse cardiovascular events (MACEs), major adverse kidney events (MAKEs), and all-cause hospitalization in diabetic patients.

METHODS

This retrospective cohort study utilized the TriNetX research network to identify adult patients with diabetes mellitus (DM) between January 1, 2010, and August 31, 2024. Propensity score matching was used to match patients with serum zinc levels below 70 µg/dL (ZD group) to those with serum zinc levels between 70 and 120 µg/dL (control group).

RESULTS

Each group comprised 11,698 matched patients with balanced baseline characteristics. During the 1-year follow-up period, the ZD group exhibited significantly higher risks of all-cause mortality (hazard ratio [HR]: 1.788, 95% confidence interval [CI]: 1.591-2.009), MACEs (HR: 1.641, 95% CI: 1.278-2.105), and MAKEs (HR: 1.534, 95% CI: 1.293-1.821), as well as a higher risk of hospitalization (HR: 1.272, 95% CI: 1.216-1.330).

CONCLUSION

Zinc deficiency in diabetic patients is associated with increased risks of all-cause mortality, MACEs, MAKEs, and all-cause hospitalization. These findings underscore the importance of assessing zinc status in the clinical management of patients with DM.

Physiological mechanisms of neuromuscular impairment in diabetes-related complications: Can physical exercise help prevent it?

Diabetes mellitus is a chronic disorder that progressively induces complications, compromising daily independence. Among these, diabetic neuropathy is particularly prevalent and contributes to substantial neuromuscular impairments in both types 1 and 2 diabetes. This condition leads to structural damage affecting both the central and peripheral nervous systems, resulting in a significant decline in sensorimotor functions. Alongside neuropathy, diabetic myopathy also contributes to muscle impairment and reduced motor performance, intensifying the neuromuscular decline. Diabetic neuropathy typically implicates neurogenic muscle atrophy, motoneuron loss and clustering of muscle fibres as a result of aberrant denervation-reinervation processes. These complications are associated with compromised neuromuscular junctions, where alterations occur in pre-synaptic vesicles, mitochondrial content and post-synaptic signalling. Neural damage is intensified by chronic hyperglycaemia and oxidative stress, exacerbating vascular dysfunction and reducing oxygen delivery. These complications imply a severe decline in neuromuscular performance, evidenced by reductions in maximal force and power output, rate of force development and muscle endurance. Furthermore, diabetes-related complications are compounded by age-related degenerative changes in long-term patients. Aerobic and resistance training offer promising approaches for managing blood glucose levels and neuromuscular function. Aerobic exercise promotes mitochondrial biogenesis and angiogenesis, supporting metabolic and cardiovascular health. Resistance training primarily enhances neural plasticity, muscle strength and hypertrophy, which are crucial factors for mitigating sarcopenia and preserving functional independence. This topical review examines current evidence on the physiological mechanisms underlying diabetic neuropathy and the potential impact of physical activity in counteracting this decline.

Stress-Induced Hyperglycemia Predicts Poor Outcomes in Primary Intracerebral Hemorrhage Patients

INTRODUCTION

The current literature suggests hyperglycemia can predict poor outcomes in patients with primary intracerebral hemorrhage (ICH). Chronic hyperglycemia is seen in patients with pre-existing diabetes (DM); however, acute hyperglycemia in non-diabetic patients is defined as stress-induced hyperglycemia (SIH). This study explored the influence of hyperglycemia on outcomes of primary ICH patients both in the presence and absence of pre-existing DM.

METHODS

Data regarding admission glucose, pre-existing DM, inpatient mortality, and modified Rankin Scale (mRS) scores at discharge were available for 636 patients admitted to Stony Brook Hospital from January 2011 to December 2022 with a primary diagnosis of ICH. Regression models were used to compare outcomes between patients with admission hyperglycemia and/or pre-existing DM to a control group of normoglycemic and non-diabetic ICH patients.

RESULTS

Patients with SIH had higher inpatient mortality rates and worse mRS scores at discharge (p < 0.001). An association with higher mortality and worse mRS scores at discharge was also seen in patients with hyperglycemia secondary to DM, although the strength of this association was weaker when compared to patients with SIH.

CONCLUSIONS

Our findings suggest that SIH may play a greater role in predicting poor outcomes at discharge rather than a history of poorly controlled DM with chronic hyperglycemia. To develop a more thorough understanding of this topic, prospective studies evaluating the effect of changes in serum glucose during hospital stay on short and long-term outcomes is needed.

The impact of diabetes mellitus on the outcomes of revascularization for chronic limb-threatening ischemia in the BEST-CLI trial

OBJECTIVE

Several observational studies have demonstrated an association between diabetes mellitus (DM) and above-ankle amputation after lower extremity revascularization (LER). However, data from prospective randomized trials is lacking. This analysis compares the outcomes of patients with and without DM enrolled in the Best Endovascular vs Best Surgical Therapy in patients with Chronic Limb-Threatening Ischemia (BEST-CLI) trial.

METHODS

Baseline characteristics were compared between patients with and without DM in the BEST-CLI trial. Cox regression was used to determine the association between DM and major outcomes of major adverse limb events (MALE), reintervention, above-ankle amputation, and all-cause death.

RESULTS

Among 1777 patients who underwent LER, 69.2% had DM. Compared with patients without DM, those with DM were significantly younger, less likely to be White, and more likely to be Hispanic. Patients with DM were more likely to have hypertension, hyperlipidemia, coronary artery disease, congestive heart failure, and renal disease and be on optimal medical therapy (antiplatelets and statins), whereas patients without DM were significantly more likely to be smokers and have chronic obstructive pulmonary disease. Patients with DM were significantly more likely to present with late Wound Ischemia foot Infection (WIfI) stages (3-4) (73.7% vs 45.9%; P < .001) that were driven predominantly by differences in wound and infection grade. Conversely, patients without DM had significantly lower ankle pressures and toe pressures and were significantly more likely to have WIfI ischemia grade 3 compared with patients with DM (60% vs 52.5%; P = .016). At 3 years, patients with DM exhibited higher rates of above-ankle amputation and all-cause death compared with patients without DM. Kaplan-Meier analysis demonstrated significantly higher MALE or all-cause death compared with patients without DM (3-year estimate: 53.5% vs 46.4%; P < .001). After adjusting for potential confounders, regression analysis demonstrated that DM was independently associated with increased above-ankle amputation (1.75 [1.22-2.51]), all-cause death (1.63 [1.31-2.03]), and MALE or all-cause death (1.24 [1.04-1.47]).

CONCLUSIONS

Patients with DM undergoing LER for chronic limb-threatening ischemia experienced a greater incidence of MALE or all-cause death compared with patients without DM. The impact of DM seems to be mediated by more severe wounds and infections at the time of presentation, and a higher prevalence of cardiac and renal disease.

Alternative splicing: Therapeutic target for vasculopathy in diabetic complications

It is becoming increasingly evident that diabetic vascular complications seriously threaten human health. The most prevalent microvascular complications include kidney disease, retinal disease, cardiovascular diseases and amputation. Conventional treatments can only relieve the progression of the diseases, and is no longer appropriate for the long-term management of diabetic patients. Exploring a novel therapeutic regimens and improvements in management of Diabetic Complications is required. Alternative splicing has been found to play a crucial role in the occurrence and treatment of diseases, including the destruction and generation of blood vessels in diabetes. Alternative splicing is an important factor in the high complexity of multicellular eukaryotic transcriptome, and angiogenesis, which is an important process controlled by alternative splicing mechanism. This review mainly introduces the current understanding of alternative splicing and the role that alternative splicing plays in the diabetic complications, with a special focus on vascular system. In this study, we summarized alternative splicing in relation to diabetes complications and the pathogenesis of diabetic vasculopathy. It discussed potential treatment strategies for correcting aberrant splicing and suggested novel approaches for addressing diabetes complications.

The irreversible, towards fatalic neuropathy: from the genesis of diabetes

Diabetic neuropathy is the most prevalent diabetes-associated complication that negatively impacts the quality of life of the patients. The extensive complications of diabetic peoples in the world are the leading cause of neuropathic pain, and over-activation of different biochemical signalling process induces the pathogenic progression and are also corresponding the epidemic painful symptom of diabetic neuropathy. The main prevalent abnormality is neuropathy, which further causing distal symmetric polyneuropathy and focal neuropathy. The exact pathological complication of diabetes associated neuropathic algesia is still unclear, but the alteration in micro-angiopathy associated nerve fibre loss, hyper polyol formation, MAPK signalling, WNT signalling, tau-derived insulin signalling processes are well known. Furthermore, the post-translational modification of different ion channels, oxidative and nitrosative stress, brain plasticity and microvascular changes can contributes the development of neuropathic pain. However, in the current review we discussed about these pathogenic development of neuropathic pain from the genesis of diabetes, and how diabetes affects the physiological and psychological health, and quality of life of the patients. Furthermore, the treatment of diabetic neuropathy with conventional monotherapy and emerging therapy are discussed. In addition, the treatment with phytochemical constituents their mechanisms and clinical evidences are also reported. The future investigation is required on pathological alteration occurs in neuropathic individuals, and on molecular mechanisms as well as the adverse effect of phytochemicals to determine all aspects of neuropathic algesia including effective treatments, which will prevents the sympathetic pain in patients.

Development of 3D Muscle Cell Culture-Based Screening System for Metabolic Syndrome Drug Research

Developing effective drug screening methods for type 2 diabetes requires physiologically relevant models. Traditional 2D cell cultures have limitations in replicating in vivo conditions, leading to challenges in assessing drug efficacy. To overcome these issues, we developed a 3D artificial muscle model that induces insulin resistance, a hallmark of type 2 diabetes. Using C2C12 myoblasts cultured in a scaffold of 1% alginate and 1 mg/mL collagen type 1, we optimized conditions for differentiation and structural stability. Insulin resistance was induced using palmitic acid (PA), and glucose uptake was assessed using the fluorescent glucose analog 2-NBDG. The 3D model demonstrated superior glucose uptake responses compared with 2D cultures, with a threefold increase in insulin-stimulated glucose uptake on days 4 and 8 of differentiation. Induced insulin resistance was observed with 0.1 mM PA, which maintained cell viability and differentiation capacity. The model was validated through comparative drug screening using rosiglitazone and metformin, as well as 165 candidate compounds provided by Korea Chemical Bank. Drug screening revealed that three out of five hit compounds identified in both 2D and 3D models exhibited greater efficacy in 3D cultures, with results consistent with ex vivo assays using mouse soleus muscle. This model closely mimics in vivo conditions, offering a robust platform for type 2 diabetes drug discovery while supporting ethical research practices.

Determination diabetes mellitus disease markers in tear fluid by photothermal AFM-IR analysis

The tear fluids from three healthy individuals and three patients with diabetes mellitus were examined using atomic force microscopy-infrared spectroscopy (AFM-IR) and Fourier transform infrared spectroscopy (FTIR). The dried tear samples showed different surface morphologies: the control sample had a dense network of heart-shaped dendrites, while the diabetic sample had fern-shaped dendrites. By using the AFM-IR technique we identified spatial distribution of constituents, indicating how diabetes affects the structural characteristics of dried tears. FTIR showed that the dendritic structures gradually disappeared over time due to glucose-induced lysozyme damage. The tear fluid from diabetes mellitus patients has a higher concentration of glucose, which accelerates the breakdown of lysozyme and, as a result, the quick loss of the dendritic structure. Our study shows that analysis of dry tear fluid can be promising technique for the detection of glycated proteins that reveal long lasting hyperglycemia and diabetes mellitus.

Vascular endothelial cell injury: causes, molecular mechanisms, and treatments

Vascular endothelial cells form a single layer of flat cells that line the inner surface of blood vessels, extending from large vessels to the microvasculature of various organs. These cells are crucial metabolic and endocrine components of the body, playing vital roles in maintaining circulatory stability, regulating vascular tone, and preventing coagulation and thrombosis. Endothelial cell injury is regarded as a pivotal initiating factor in the pathogenesis of various diseases, triggered by multiple factors, including infection, inflammation, and hemodynamic changes, which significantly compromise vascular integrity and function. This review examines the causes, underlying molecular mechanisms, and potential therapeutic approaches for endothelial cell injury, focusing specifically on endothelial damage in cardiac ischemia/reperfusion (I/R) injury, sepsis, and diabetes. It delves into the intricate signaling pathways involved in endothelial cell injury, emphasizing the roles of oxidative stress, mitochondrial dysfunction, inflammatory mediators, and barrier damage. Current treatment strategies-ranging from pharmacological interventions to regenerative approaches and lifestyle modifications-face ongoing challenges and limitations. Overall, this review highlights the importance of understanding endothelial cell injury within the context of various diseases and the necessity for innovative therapeutic methods to improve patient outcomes.

Integrating Polygenic Risk Scores (PRS) for Personalized Diabetes Care: Advancing Clinical Practice with Tailored Pharmacological Approaches

The rising global prevalence of diabetes poses a serious threat to public health, national economies, and the healthcare system. Despite a high degree of disease heterogeneity and advancing techniques, there is still an unclear diagnosis of patients with diabetes compounded by the array of long-term microvascular and macrovascular complications associated with the disease. In addition to environmental variables, diabetes susceptibility is significantly influenced by genetic components. The risk stratification of genetically predisposed individuals may play an important role in disease diagnosis and management. Precision medicine methods are crucial to reducing this global burden by delivering a more personalised and patient-centric approach. Compared to the European population, genetic susceptibility variants of type 2 diabetes mellitus (T2DM) are still not fully understood in other major populations, including South Asians, Latinos, and people of African descent. Polygenic risk scores (PRS) can be used to identify individuals who are more susceptible to complex diseases such as diabetes. PRS is selective and effective in developing novel diagnostic interventions. This comprehensive predictive approach facilitates the understanding of distinct response profiles, resulting in the development of more effective management strategies. The targeted implementation of PRS is especially advantageous for people who fall into a higher-risk category for diabetes. Through early risk assessment and the creation of individualised diabetes treatment plans, the integration of PRS in clinical practice shows potential for reducing the prevalence of diabetes and its complications. Diabetes self-management depends significantly on patient empowerment, with behavioural monitoring emerging as a vital facilitator. The main aim of this review article is to formulate a more structured intervention strategy by advocating for increased awareness of the clinical utility of PRS and counseling among healthcare practitioners, patients, and individuals at risk of diabetes.

Microenvironmental determinants of endothelial cell heterogeneity

During development, endothelial cells (ECs) undergo an extraordinary specialization by which generic capillary microcirculatory networks spanning from arteries to veins transform into patterned organotypic zonated blood vessels. These capillary ECs become specialized to support the cellular and metabolic demands of each specific organ, including supplying tissue-specific angiocrine factors that orchestrate organ development, maintenance of organ-specific functions and regeneration of injured adult organs. Here, we illustrate the mechanisms by which microenvironmental signals emanating from non-vascular niche cells induce generic ECs to acquire specific inter-organ and intra-organ functional attributes. We describe how perivascular, parenchymal and immune cells dictate vascular heterogeneity and capillary zonation, and how this system is maintained through tissue-specific signalling activated by vasculogenic and angiogenic factors and deposition of matrix components. We also discuss how perturbation of organotypic vascular niche cues lead to erasure of EC signatures, contributing to the pathogenesis of disease processes. We also describe approaches that use reconstitution of tissue-specific signatures of ECs to promote regeneration of damaged organs.

Association Between Glycemic Control and Complications With Concentration of Urinary Exfoliated Proximal Tubule Kidney Cells in People With Diabetes Mellitus

Background: Emerging evidence suggests cell exfoliation could be operating under the control of cell metabolism. It is unclear if there are associations between the concentration of exfoliated kidney proximal tubule cells (PTCs) in urine with glycemic control and complications. Our study is aimed at exploring this. Methods: Urine samples were collected from 122 adult study participants and stored at -80°C. Exfoliated PTCs were extracted from thawed urine using a validated specific immunomagnetic separation method based on anti-CD13 and anti-SGLT-2 antibodies. The number of PTCs was assessed using brightfield microscopy. Study participants were grouped into those with no diabetes mellitus (DM) and those with DM. Individuals with DM were further subgrouped into those with and without retinopathy. Adjusted Poisson regression analysis was conducted for the DM cohort, investigating associations between demographic, clinical, and biochemical parameters with mean urinary exfoliated PTCs. Results: The adjusted Poisson regression analysis noted sex to have a significant association with mean number of urinary exfoliated PTCs, with a lower incidence rate in males compared to females (incidence rate ratio (IRR) 0.56, 95% CI 0.35-0.89, p = 0.014). Each 1% increase in glycated haemoglobin (HbA1c) was associated with an increase of 1.03 times in mean exfoliated PTCs (IRR 1.03, 95% CI 1.01-1.04, p = 0.007), and DM patients with retinopathy had an increase of 1.68 times in mean exfoliated PTCs compared to those without retinopathy (IRR 1.68, 95% CI 1.07-2.62, p = 0.024). No significant associations were observed with albuminuria or estimated glomerular filtration rate (eGFR). Conclusions: Our results indicate increased shedding of PTCs into the urinary tract in patients with poorer glycemic control, particularly those with diabetic retinopathy and in females.

Diabetes-related cognitive impairment: Mechanisms, symptoms, and treatments

Background

Diabetes-related cognitive impairment is increasingly recognized as a significant complication, profoundly impacting patients' quality of life. This review aims to examine the pathophysiological mechanisms, clinical manifestations, risk factors, assessment and diagnosis, management strategies, and future research directions of cognitive impairment in diabetes.

Methodology

A comprehensive literature search was conducted using PubMed, Medline, and other medical databases to identify, review, and evaluate published articles on cognitive impairment in diabetes. The search focused on studies examining pathophysiology, clinical presentations, risk factors, diagnostic approaches, and management strategies.

Results

The review of current literature revealed that chronic hyperglycemia, insulin resistance, and vascular factors are major contributing factors to cognitive deficits in diabetes. Clinical manifestations include impairments in attention, memory, executive function, visuospatial abilities, and language. Risk factors encompass disease duration, glycemic control, presence of complications, age, education level, and comorbidities. Assessment tools include cognitive screening instruments, neuropsychological testing, and neuroimaging techniques. Management strategies involve glycemic control optimization, lifestyle modifications, cognitive training, and pharmacological interventions.

Conclusion

This review highlights the significant prevalence and impact of cognitive impairment in diabetes, resulting from complex metabolic and vascular disturbances. Early detection and multifaceted interventions are crucial for preserving cognitive function and improving patient outcomes. Future research should focus on neuroprotective strategies, biomarker identification, and personalized approaches. Collaborative efforts between clinicians and researchers are essential to effectively address this growing healthcare challenge and enhance the quality of life for individuals with diabetes-related cognitive impairment.

Impact of remnant cholesterol on short-term and long-term prognosis in patients with prediabetes or diabetes undergoing coronary artery bypass grafting: a large-scale cohort study

BACKGROUND

Remnant cholesterol (remnant-C) contributes to atherosclerotic cardiovascular disease (ASCVD), particularly in individuals with impaired glucose metabolism. Patients with impaired glucose metabolism and ASCVD remain at significant residual risk after coronary artery bypass grafting (CABG). However, the role of remnant-C in this population has not yet been investigated.

METHODS

Adult patients with prediabetes or diabetes undergoing isolated CABG were consecutively enrolled in a longitudinal cohort between 2013 and 2018. The impact of remnant-C on short-term and long-term outcomes after CABG was evaluated. The short-term outcomes included major perioperative complications. The long-term outcomes were major adverse cardiovascular and cerebrovascular events (MACCEs). Remnant-C was analyzed as both a categorical and continuous variable. Logistic regression, Cox regression, and restricted cubic spline analyses were performed with multivariate adjustments.

RESULTS

In terms of perioperative outcomes, patients with elevated remnant-C had a higher incidence of acute kidney injury (AKI) stage 2/3 (high vs. low remnant-C: 3.2% vs. 2.4%; OR: 1.404, 95% CI 1.080-1.824). Each 1-standard deviation (SD) increase in remnant-C was associated with a 16.6% higher risk of AKI stage 2/3 (OR: 1.160, 95% CI 1.067-1.260). Long-term outcomes were assessed after a median follow-up of 3.2 years, during which 1,251 patients (9.3%) experienced MACCEs. Each 1-SD increase in remnant-C was associated with a 6.6% higher risk of MACCEs (HR: 1.066, 95% CI 1.012-1.124), a 7.1% higher risk of all-cause death (HR: 1.071, 95% CI 1.008-1.209), and an 11.2% higher risk of myocardial infarction (HR: 1.112, 95% CI 1.011-1.222). These associations remained consistent when remnant-C was treated as a categorical variable. Importantly, the association between remnant-C and MACCEs was independent of LDL-C levels; higher remnant-C levels were associated with increased MACCE risk regardless of whether LDL-C was ≤ 2.6 mmol/L or > 2.6 mmol/L. Subgroup analysis indicated that this risk was more pronounced in insulin-treated patients.

CONCLUSIONS

Remnant-C is associated with AKI and MACCEs in patients with diabetes or prediabetes undergoing CABG. The MACCE risk associated with remnant-C is independent of LDL-C and is more pronounced in insulin-treated patients.

N 6-Methyladenosine Demethylase FTO Controls Macrophage Homeostasis in Diabetic Vasculopathy

Diabetic vasculopathy, encompassing complications such as diabetic retinopathy, represents a significant source of morbidity, with inflammation playing a pivotal role in the progression of these complications. This study investigates the influence of N6-methyladenosine demethylase (m6A) modification and the m6A demethylase fat mass and obesity-associated (FTO) protein on macrophage polarization and its subsequent effects on diabetic microvasculopathy. We found that diabetes induces a shift in macrophage polarization toward a proinflammatory M1 phenotype, which is associated with a reduction in m6A modification levels. Notably, FTO emerges as a critical regulator of m6A under diabetic conditions. In vitro experiments reveal that FTO not only modulates macrophage polarization but also mediates their interactions with vascular endothelial cells. In vivo experiments demonstrate that FTO deficiency exacerbates retinal inflammation and microvascular dysfunction in diabetic retinas. Mechanistically, FTO stabilizes mRNA through an m6A-YTHDF2-dependent pathway, thereby activating the PI3K/AKT signaling cascade. Collectively, these findings position FTO as a promising therapeutic target for the management of diabetic vascular complications.

ARTICLE HIGHLIGHTS