The role of oxidative stress in the pathogenesis of type 2 diabetes mellitus micro-and macrovascular complications: Avenues for a mechanistic-based therapeutic approach

Franco Folli, Domenico Corradi, Paolo Fanti, Alberto Davalli, Ana Paez, Andrea Giaccari, Carla Perego, Giovanna Muscogiuri

Research output: Contribution to journalArticle

Abstract

A growing body of evidence suggests that oxidative stress plays a key role in the pathogenesis of micro-and macrovascular diabetic complications. The increased oxidative stress in subjects with type 2 diabetes is a consequence of several abnormalities, including hyperglycemia, insulin resistance, hyperinsulinemia, and dyslipidemia, each of which contributes to mitochondrial superoxide overproduction in endothelial cells of large and small vessels as well as the myocardium. The unifying pathophysiological mechanism that underlies diabetic complications could be explained by increased production of reactive oxygen species (ROS) via: (1) the polyol pathway flux, (2) increased formation of advanced glycation end products (AGEs), (3) increased expression of the receptor for AGEs, (4) activation of protein kinase C isoforms, and (5) overactivity of the hexosamine pathway. Furthermore, the effects of oxidative stress in individuals with type 2 diabetes are compounded by the inactivation of two critical anti-atherosclerotic enzymes: endothelial nitric oxide synthase and prostacyclin synthase. Of interest, the results of clinical trials in patients with type 2 diabetes in whom intensive management of all the components of the metabolic syndrome (hyperglycemia, hypercholesterolemia, and essential hypertension) was attempted (with agents that exert a beneficial effect on serum glucose, serum lipid concentrations, and blood pressure, respectively) showed a decrease in adverse cardiovascular end points. The purpose of this review is (1) to examine the mechanisms that link oxidative stress to micro-and macrovascular complications in subjects with type 2 diabetes and (2) to consider the therapeutic opportunities that are presented by currently used therapeutic agents which possess antioxidant properties as well as new potential antioxidant substances.

Original languageEnglish
Pages (from-to)313-324
Number of pages12
JournalCurrent Diabetes Reviews
Volume7
Issue number5
Publication statusPublished - Sep 2011

Fingerprint

Type 2 Diabetes Mellitus
Oxidative Stress
Diabetes Complications
Hyperglycemia
Antioxidants
Hexosamines
Advanced Glycosylation End Products
Nitric Oxide Synthase Type III
Hyperinsulinism
Therapeutics
Dyslipidemias
Hypercholesterolemia
Serum
Superoxides
Protein Kinase C
Insulin Resistance
Reactive Oxygen Species
Myocardium
Protein Isoforms
Endothelial Cells

Keywords

  • Macrovascular complications
  • Metabolic
  • Microvascular complications
  • Oxidative stress
  • Type 2 diabetes mellitus

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

The role of oxidative stress in the pathogenesis of type 2 diabetes mellitus micro-and macrovascular complications : Avenues for a mechanistic-based therapeutic approach. / Folli, Franco; Corradi, Domenico; Fanti, Paolo; Davalli, Alberto; Paez, Ana; Giaccari, Andrea; Perego, Carla; Muscogiuri, Giovanna.

In: Current Diabetes Reviews, Vol. 7, No. 5, 09.2011, p. 313-324.

Research output: Contribution to journalArticle

Folli, F, Corradi, D, Fanti, P, Davalli, A, Paez, A, Giaccari, A, Perego, C & Muscogiuri, G 2011, 'The role of oxidative stress in the pathogenesis of type 2 diabetes mellitus micro-and macrovascular complications: Avenues for a mechanistic-based therapeutic approach', Current Diabetes Reviews, vol. 7, no. 5, pp. 313-324.
Folli, Franco ; Corradi, Domenico ; Fanti, Paolo ; Davalli, Alberto ; Paez, Ana ; Giaccari, Andrea ; Perego, Carla ; Muscogiuri, Giovanna. / The role of oxidative stress in the pathogenesis of type 2 diabetes mellitus micro-and macrovascular complications : Avenues for a mechanistic-based therapeutic approach. In: Current Diabetes Reviews. 2011 ; Vol. 7, No. 5. pp. 313-324.
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