Diabetes mellitus is an emerging global threat to human health. It is estimated that the total number of people experiencing diabetes mellitus will reach 366 million in 2030. 1 Although hypertension and coronary narrowing are major pathogenic factors of acquired cardiomyopathy, diabetes mellitus has been established as an independent risk factor since 1972.2 Diabetic cardiomyopathy, as a major complication, is the leading cause of morbidity and mortality for diabetic patients. Epidemiological studies have demonstrated that diabetic people have a 2-to 5-fold increase of risk in developing heart failure compared with age-matched healthy subjects after adjusting for age, blood pressure, weight, cholesterol level, and coronary artery disease.
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Editorial see p 771 Clinical Perspective on p 804Rodent models are of particular value in study of diabetic cardiomyopathy because there is minimal confounding involvement of coronary atherosclerosis. It has been demonstrated that diabetic mice and rats fed with high-fat diet display cardiac remodeling and dysfunction. [8][9][10][11] Recently we and others have shown that mice overexpressing Mitsugumin 53 (MG53) Background-Diabetic cardiomyopathy, which contributes to >50% diabetic death, is featured by myocardial lipid accumulation, hypertrophy, fibrosis, and cardiac dysfunction. The mechanism underlying diabetic cardiomyopathy is poorly understood. Recent studies have shown that a striated muscle-specific E3 ligase Mitsugumin 53 (MG53, or TRIM72) constitutes a primary causal factor of systemic insulin resistance and metabolic disorders. Although it is most abundantly expressed in myocardium, the biological and pathological roles of MG53 in triggering cardiac metabolic disorders remain elusive. Methods and Results-Here we show that cardiac-specific transgenic expression of MG53 induces diabetic cardiomyopathy in mice. Specifically, MG53 transgenic mouse develops severe diabetic cardiomyopathy at 20 weeks of age, as manifested by insulin resistance, compromised glucose uptake, increased lipid accumulation, myocardial hypertrophy, fibrosis, and cardiac dysfunction. Overexpression of MG53 leads to insulin resistant via destabilizing insulin receptor and insulin receptor substrate 1. More importantly, we identified a novel role of MG53 in transcriptional upregulation of peroxisome proliferation-activated receptor alpha and its target genes, resulting in lipid accumulation and lipid toxicity, thereby contributing to diabetic cardiomyopathy. Conclusions-Our results suggest that overexpression of myocardial MG53 is sufficient to induce diabetic cardiomyopathy via dual mechanisms involving upregulation of peroxisome proliferation-activated receptor alpha and impairment of insulin signaling. These findings not only reveal a novel function of MG53 in regulating cardiac peroxisome proliferation-activated receptor alpha gene expression and lipid metabolism, but also underscore MG53 as an important therapeutic target for diabetes mellitus and associated cardiomyopathy. develop obes...