Background: Left ventricular diastolic dysfunction that may develop during the early stages of type 2 diabetes mellitus (T2DM) is an important predictor of heart failure and long-term mortality. However, there is limited prospective evidence to demonstrate the molecular mechanisms of diastolic dysfunction in diabetic patients. Nonhuman primates have physiological, metabolic, biochemical and genetic similarity to humans that facilitate the study of diabetes and cardiovascular disease. This study investigated the pathogenesis of left ventricular diastolic dysfunction in cynomolgus monkeys (Macaca fascicularis) with spontaneous T2DM.Methods: Four cynomolgus monkeys with T2DM and left ventricular diastolic dysfunction and two nondiabetic healthy controls were analysed in this study. mRNA, protein and phosphoprotein expression profiles were generated from the isolated left ventricle of each monkey and analysed using a systematic approach integrating transcriptomics, proteomics and phosphoproteomics.Results: Differential expression of 1,404 mRNAs, 528 proteins, and 709 phosphoproteins was observed in the left ventricles of T2DM monkeys compared with controls. Functional analysis of these dysregulated molecules showed that inflammation and immune response and the calcium signalling pathway were prominently altered cellular processes in T2DM monkeys. According to IPA pathway analysis, reduced PP1, SERCA2a, and phosphorylated SERCA2a expression were the main effectors leading to impaired Ca 2+ homeostasis in the cardiac sarcoplasmic reticulum and cytoplasm in T2DM monkeys with left ventricular dysfunction. Targeting the new identified phosphorylated SERCA2a might be a new potential therapy for cardiovascular dysfunction in diabetic patients.>50%) [10], diastolic dysfunction incidence has been underestimated until recently. Diabetic cardiomyopathy pathophysiology is complex and multifactorial: cardiac histopathological analysis has revealed perivascular and interstitial fibrosis, myocardial hypertrophy, increased apoptosis and upregulation of oxidative stress [11]. Specific therapeutic strategies for diabetic cardiomyopathy are currently undefined because the pathological mechanisms are poorly understood. Several underlying mechanisms have been proposed, including autonomic dysfunction, metabolic derangements, Ca 2+ homeostasis abnormalities, and structural protein alterations [12]. In addition, little is known about the mechanisms underlying the transition from a well-compensated cardiomyopathy to heart failure.Cynomolgus monkeys develop spontaneous diabetes and exhibit clinical features, including insulin resistance/hyperinsulinemia, hyperglycaemia, dyslipidaemia, and pancreatic pathology, that are Lei Y (2020) Integrative omics analysis of the mechanisms underlying left ventricular diastolic dysfunction in cynomolgus monkeys with spontaneous type 2 diabetes mellitus