Li Xinyi, Qu Shunlin
Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China.
Pathophysiology Department, Institute of Cardiovascular Disease, Key Laboratory for Arteriosclerology of Hunan Province, Hunan International Scientific and Technological Cooperation Base of Arteriosclerotic Disease, University of South China, Hongxiang Street, Hengyang, 421001, Hunan, China.
Mol Cell Biochem. 2025 Jun;480(6):3535-3551. doi: 10.1007/s11010-024-05196-6. Epub 2025 Feb 10.
Diabetic cardiomyopathy (DCM) is a cardiac complication specific to individuals with diabetes. It is defined as abnormalities of myocardial structure and function in diabetic patients who do not exhibit any obvious coronary artery disease, hypertensive heart disease, valvular heart disease, or inherited cardiomyopathy. A significant cardiovascular protective factor identified recently is angiotensin-converting enzyme 2 (ACE2), which is a rising star in the renin angiotensin system (RAS) and is responsible for the onset and progression of DCM. Nonetheless, there is not a comprehensive review outlining ACE2's effect on DCM. From the perspective of the pathogenesis of DCM, this review summarizes the myocardial protective role of ACE2 in the aspects of alleviating myocardial structure and dysfunction, correcting energy metabolism disorders, and restoring vascular function. Concurrently, we propose the connections between ACE2 and underlying signaling pathways, including ADAM17, Apelin/APJ, and Nrf2. Additionally, we highlight ACE2-related pharmaceutical treatment options and clinical application prospects for preventing and managing DCM. Further and underlying research is extensively required to completely comprehend the principal pathophysiological mechanism of DCM and the distinctive function of ACE2, switching experimental findings into clinical practice and identifying efficient therapeutic approaches.
糖尿病性心肌病（DCM）是糖尿病患者特有的一种心脏并发症。它被定义为在没有表现出任何明显冠状动脉疾病、高血压性心脏病、瓣膜性心脏病或遗传性心肌病的糖尿病患者中出现的心肌结构和功能异常。最近确定的一个重要心血管保护因子是血管紧张素转换酶2（ACE2），它是肾素血管紧张素系统（RAS）中的一颗冉冉升起的新星，与DCM的发生和发展有关。然而，目前尚无全面综述概述ACE2对DCM的影响。从DCM的发病机制角度出发，本综述总结了ACE2在减轻心肌结构和功能障碍、纠正能量代谢紊乱以及恢复血管功能等方面的心肌保护作用。同时，我们提出了ACE2与潜在信号通路之间的联系，包括ADAM17、Apelin/APJ和Nrf2。此外，我们强调了与ACE2相关的药物治疗选择以及预防和管理DCM的临床应用前景。需要进行更深入的基础研究，以全面理解DCM的主要病理生理机制和ACE2的独特作用，将实验结果转化为临床实践并确定有效的治疗方法。
