Division of Cardiac Surgery, St. Michael's Hospital, Toronto, ON, Canada.
Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
Rev Endocr Metab Disord. 2021 Dec;22(4):1171-1188. doi: 10.1007/s11154-021-09669-7. Epub 2021 Jul 6.
Type 2 diabetes (T2D) and obesity represent entangled pandemics that accelerate the development of cardiovascular disease (CVD). Given the immense burden of CVD in society, non-invasive prevention and treatment strategies to promote cardiovascular health are desperately needed. During T2D and obesity, chronic dysglycemia and abnormal adiposity result in systemic oxidative stress and inflammation that deplete the vascular regenerative cell reservoir in the bone marrow that impairs blood vessel repair and exacerbates the penetrance of CVD co-morbidities. This novel translational paradigm, termed 'regenerative cell exhaustion' (RCE), can be detected as the depletion and dysfunction of hematopoietic and endothelial progenitor cell lineages in the peripheral blood of individuals with established T2D and/or obesity. The reversal of vascular RCE has been observed after administration of the sodium-glucose cotransporter-2 inhibitor (SGLT2i), empagliflozin, or after bariatric surgery for severe obesity. In this review, we explore emerging evidence that links improved dysglycemia to a reduction in systemic oxidative stress and recovery of circulating pro-vascular progenitor cell content required for blood vessel repair. Given that bariatric surgery consistently increases systemic glucagon-like-peptide 1 (GLP-1) release, we also focus on evidence that the use of GLP-1 receptor agonists (GLP-1RA) during obesity may act to inhibit the progression of systemic dysglycemia and adiposity, and indirectly reduce inflammation and oxidative stress, thereby limiting the impact of RCE. Therefore, therapeutic intervention with currently-available GLP-1RA may provide a less-invasive modality to reverse RCE, bolster vascular repair mechanisms, and improve cardiometabolic risk in individuals living with T2D and obesity.
2 型糖尿病(T2D)和肥胖症代表着相互交织的流行病,它们加速了心血管疾病(CVD)的发展。鉴于 CVD 在社会中带来的巨大负担,急需寻找非侵入性的预防和治疗策略来促进心血管健康。在 T2D 和肥胖症期间,慢性高血糖和异常脂肪堆积会导致全身氧化应激和炎症,从而耗尽骨髓中的血管再生细胞储备,损害血管修复,并加剧 CVD 合并症的发生率。这种新的转化范式,称为“再生细胞衰竭”(RCE),可以通过检测个体外周血中造血和内皮祖细胞谱系的耗竭和功能障碍来检测。在接受钠-葡萄糖共转运蛋白 2 抑制剂(SGLT2i)依帕列净或严重肥胖症行减肥手术后,观察到血管 RCE 的逆转。在这篇综述中,我们探讨了一些新的证据,这些证据将改善的高血糖与全身氧化应激减少和血管修复所需的循环促血管前体细胞含量的恢复联系起来。鉴于减肥手术会持续增加全身胰高血糖素样肽 1(GLP-1)的释放,我们还关注了在肥胖症期间使用 GLP-1 受体激动剂(GLP-1RA)的证据,这些证据表明它可能会抑制全身高血糖和肥胖症的进展,并间接减少炎症和氧化应激,从而限制 RCE 的影响。因此,目前可用的 GLP-1RA 治疗干预可能提供一种侵入性较小的方法来逆转 RCE,增强血管修复机制,并改善患有 T2D 和肥胖症个体的心血管代谢风险。