Emerging Actors in Diabetic Cardiomyopathy: Heartbreaker Biomarkers or Therapeutic Targets?

• Published in: Trends in pharmacological sciences (Regular ed.) 2018-05, Vol.39 (5), p.452-467
• Main Authors: Palomer, Xavier, Pizarro-Delgado, Javier, Vázquez-Carrera, Manuel
• Format: Article
• Language: English
• Subjects: diabetic cardiomyopathy; heart failure; inflammation; metabolic dysregulation; myocardial fibrosis
• ISSN: 0165-6147; 1873-3735
• DOI: 10.1016/j.tips.2018.02.010

The diabetic heart is characterized by metabolic disturbances that are often accompanied by local inflammation, oxidative stress, myocardial fibrosis, and cardiomyocyte apoptosis. Overall changes result in contractile dysfunction, concentric left ventricular (LV) hypertrophy, and dilated cardiomyopathy, that together affect cardiac output and eventually lead to heart failure, the foremost cause of death in diabetic patients. There are currently several validated biomarkers for the diagnosis and risk assessment of cardiac diseases, but none is capable of discriminating patients with diabetic cardiomyopathy (DCM). In this review we point to several novel candidate biomarkers from new activated molecular pathways (including microRNAs) with the potential to detect or prevent DCM in its early stages, or even to treat it once established. The prospective use of selected biomarkers that integrate inflammation, oxidative stress, fibrosis, and metabolic dysregulation is widely discussed. DCM is a relatively prevalent disease associated with high rates of morbidity and mortality. The current criteria to diagnose DCM include LV diastolic dysfunction, reduced LV ejection fraction, pathological LV hypertrophy, and interstitial fibrosis. However, it is difficult to identify DCM in its early stages because of its heterogeneity. There are some validated biomarkers for the diagnosis and risk assessment of numerous cardiac diseases, but none of them is able to discriminate patients with DCM. The diabetic heart is characterized by metabolic disturbances that are often accompanied by local inflammation, oxidative stress, myocardial fibrosis, and cardiomyocyte apoptosis. The discovery of selected biomarkers that integrate these processes is of great interest to detect or prevent DCM in its early stages, or even to treat it once established.