Statins play an important role in the treatment of diabetic nephropathy. Increasing attention has been given to the relationship between statins and insulin resistance, but many randomized controlled trials confirm that the therapeutic effects of statins on diabetic nephropathy are more beneficial than harmful. However, further confirmation of whether the beneficial effects of chronic statin administration on diabetic nephropathy outweigh the detrimental effects is urgently needed. Here, we find that long-term statin administration may increase insulin resistance, interfere with lipid metabolism, leads to inflammation and fibrosis, and ultimately fuel diabetic nephropathy progression in diabetic mice. Mechanistically, activation of insulin-regulated phosphatidylinositol 3-kinase/protein kinase B/mammalian target of rapamycin signaling pathway leads to increased fatty acid synthesis. Furthermore, statins administration increases lipid uptake and inhibits fatty acid oxidation, leading to lipid deposition. Here we show that long-term statins administration exacerbates diabetic nephropathy via ectopic fat deposition in diabetic mice.
Diabetic cardiomyopathy is a primary myocardial injury induced by diabetes with complex pathogenesis. In this study, we identify disordered cardiac retinol metabolism in type 2 diabetic male mice and patients characterized by retinol overload, all-trans retinoic acid deficiency. By supplementing type 2 diabetic male mice with retinol or all-trans retinoic acid, we demonstrate that both cardiac retinol overload and all-trans retinoic acid deficiency promote diabetic cardiomyopathy. Mechanistically, by constructing cardiomyocyte-specific conditional retinol dehydrogenase 10-knockout male mice and overexpressing retinol dehydrogenase 10 in male type 2 diabetic mice via adeno-associated virus, we verify that the reduction in cardiac retinol dehydrogenase 10 is the initiating factor for cardiac retinol metabolism disorder and results in diabetic cardiomyopathy through lipotoxicity and ferroptosis. Therefore, we suggest that the reduction of cardiac retinol dehydrogenase 10 and its mediated disorder of cardiac retinol metabolism is a new mechanism underlying diabetic cardiomyopathy.
Aims:
Lack of cardiac regeneration with robust fibrosis response to the acute myocardial injury is the main obstacle to clinical treatment of cardiovascular diseases in humans. Stimulating the proliferation of endogenous cardiomyocytes (CMs) and replacing the scarred tissue with new functional CMs is a potential therapeutic strategy to the patients with heart failure. Heart rate reduction (HRR) is regarded as an effective clinical treatment for myocardial infarction. However, the mechanism of HRR promoting the recovery of cardiac function after injury still remains controversial, and whether there is any endogenous CM proliferation induced by HRR is undefined.
Methods and results:
The beating of CMs was reduced
in vitro
and heart rate (HR) of adult mice and different animal models of myocardial injury were modulated by six antiarrhythmic drugs to determine the role of HR in CM proliferation and cardiac repair. RNA-seq, extracellular flux analysis, metabolic flux analysis, and metabonomics were used to study the CM metabolism after HR modulation. We verified that reducing the beating can induce CM proliferation both
in vitro
and
in vivo
physiologically, and HRR also promoted cardiac regenerative repair after myocardial injury as well, reversely, increasing HR showed the opposite effect. Mechanistically, HRR reduced energy metabolism requirements and total ATP production of CMs but switched energy metabolic mode that the proportion of ATP production from aerobic glycolysis was increased, while from fatty acid oxidation was decreased. The switching of energy metabolic mode in CMs occurred in synchrony with the changes of glycolytic enzymes activities, these enzymes, including PFKFB3, PKM2, GAPDH, induced G1/S transition for cell cycle re-entry of CMs by upregulating the expression of cyclin D and CDK4/6 and facilitate substrates into the biomass needed to produce a new cell by biosynthesis. This coordinating function of glycolytic enzymes contributed to CM proliferation.
Conclusion:
Together, these results demonstrate that reduction of heart rate promotes CM proliferation by switching the energy metabolic mode, and highlight the potential therapeutic role of HRR in regenerative medicine.
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