Song Ming, Dai Honggang, Zhou Quan, Meng Xiao
State Key Laboratory for Innovation and Transformation of Luobing Theory, Key Laboratory of Cardiovascular Remodeling and Function Research of MOE, NHC, CAMS and Shandong Province, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China.
Front Endocrinol (Lausanne). 2025 Apr 7;16:1542208. doi: 10.3389/fendo.2025.1542208. eCollection 2025.
Diabetic cardiomyopathy is a notable microvascular complication of diabetes, characterized primarily by myocardial fibrosis and functional abnormalities. Long-term hyperglycemia induces excessive activation and recruitment of immune cells and triggers the cascade of inflammatory responses, resulting in systemic and local cardiac inflammation. Emerging evidence highlights the significant roles of immunology in modulating the pathology of diabetic cardiomyopathy. As the primary effectors of inflammatory reactions, immune cells are consistently present in cardiac tissue and can be recruited under pathological hyperglycemia circumstances. A disproportionate favor to proinflammatory types of immune cells and the increased proinflammatory cytokine levels mediate fibroblast proliferation, phenotypic transformation, and collagen synthesis and ultimately rise to cardiac fibrosis and hypertrophy. Meanwhile, the severity of cardiac fibrosis is also strongly associated with the diverse phenotypes and phenotypic alterations of the immune cells, including macrophages, dendritic cells, mast cells, neutrophils, and natural killer cells in innate immunity and CD4 T lymphocytes, CD8 T lymphocytes, and B lymphocytes in adaptive immunity. In this review, we synthesized the current analysis of the critical role played by the immune system and its components in the progression of diabetic cardiomyopathy. Finally, we highlight preclinical and clinical immune targeting strategies and translational implications.
糖尿病性心肌病是糖尿病一种显著的微血管并发症,主要特征为心肌纤维化和功能异常。长期高血糖会导致免疫细胞过度活化和募集,并引发炎症反应级联反应,从而导致全身和局部心脏炎症。新出现的证据突显了免疫学在调节糖尿病性心肌病病理过程中的重要作用。作为炎症反应的主要效应细胞,免疫细胞一直存在于心脏组织中,并且在病理性高血糖情况下会被募集。对促炎型免疫细胞的过度偏向以及促炎细胞因子水平的升高会介导成纤维细胞增殖、表型转化和胶原蛋白合成,并最终导致心脏纤维化和肥大。同时,心脏纤维化的严重程度也与免疫细胞的多种表型及表型改变密切相关,包括固有免疫中的巨噬细胞、树突状细胞、肥大细胞、中性粒细胞和自然杀伤细胞,以及适应性免疫中的CD4 T淋巴细胞、CD8 T淋巴细胞和B淋巴细胞。在本综述中,我们综合了目前对免疫系统及其组成部分在糖尿病性心肌病进展中所起关键作用的分析。最后,我们强调了临床前和临床免疫靶向策略及其转化意义。
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