The Role of Oxidative Stress in Pathogenesis of Diabetic Neuropathy: Erythrocyte Superoxide Dismutase, Catalase and Glutathione Peroxidase Level in Relation to....
155In hyperglicemia there is enhanced metabolism of glucose through the polyol (sorbitol) pathway, which also results in inhanced productions of O 2 -. Glucose is a poor substrate for aldose reductase, but at high concentrations this enzyme converts glucose to sorbitole, initiating the polyol pathway of glucose conversion to fructose. This pathway of glucose metabolism implies the participation of aldosoreductase enzyme, which using the NADPH cofactor, catalyzes the reduction of glucose into sorbitol, which can be further transformed into fructose. Aldosoreductase is widespread in the mammalian tissues such as peripheral nerves, retina, renal glomeruli, eye lenses. Stimulation of this pathway in hyperglycemic conditions is one of the pathogenetic mechanisms responsible for the development of diabetic neuropathy, nephropathy, and cataract. Activation of this pathway leads to structural changes in the tissues via several mechanisms, out of which most significant are increased osmotic pressure in the cell, depletion of myoinositol, and disordered redox potential of the cell due to reduced NADPH concentration, on the account of which the activity of NADPH dependent enzymes (including glutathione reductase and NO synthase) is diminished. Reduced production of NO leads to vasoconstriction, and impossibility of reduced glutathione regeneration in the so called glutathione redox cycle leads to depletion of reduced glutathione, since it is regenerated by the action of NADPHdependent glutathione reductase (Garlberg & Mannervik, 1975), ultimately producing a permanent oxidative stress. Change of redox status of the cell, as determined by the cellular content of thiol compounds, glutathione above all, is a significant factor in the regulation of signal transduction to appropriate genes. This signal transduction pathway is effectuated via so called redox sensors which react to any change of concentration of intracellular thiols responsible for upkeeping of the cellular redox status. Numerous regulatory transcription factors supress transcription if bound in reduced state to regulatory sequences of certain genes. In the absence of GSH in the cell and in the state of intensified polyol metabolic pathway, the oxidized form of regulatory nuclear transcription factors loses the affinity for regulatory gene sequence, which results in increased transcription and synthesis of appropriate functional and structural proteins responsible for complications in diabetes and dysregulation of glucose metabolism homeostasis. Disturbed redox potential initiates the activation of stress-signaling cascade, resulting in direct activation of other kinases and transcription factors and/or indirect modulation (oxidation) of cysteine-rich redox-sensitive proteins, such as thioredoxin and glutathione S-transferase (Adler et al., 1999).
Modulation of cell signal transductionResults of recent...