Can Metformin Exert as an Active Drug on Endothelial Dysfunction in Diabetic Subjects?
Teresa SalvatorePia Clara PafundiRaffaele GalieroLuca RinaldiAlfredo CaturanoErica VetranoConcetta ApreaGaetana AlbaneseAnna Di MartinoCarmen RicozziSimona ImbrianiFerdinando Carlo SassoPublished in: Biomedicines (2020)
Cardiovascular mortality is a major cause of death among in type 2 diabetes (T2DM). Endothelial dysfunction (ED) is a well-known important risk factor for the development of diabetes cardiovascular complications. Therefore, the prevention of diabetic macroangiopathies by preserving endothelial function represents a major therapeutic concern for all National Health Systems. Several complex mechanisms support ED in diabetic patients, frequently cross-talking each other: uncoupling of eNOS with impaired endothelium-dependent vascular response, increased ROS production, mitochondrial dysfunction, activation of polyol pathway, generation of advanced glycation end-products (AGEs), activation of protein kinase C (PKC), endothelial inflammation, endothelial apoptosis and senescence, and dysregulation of microRNAs (miRNAs). Metformin is a milestone in T2DM treatment. To date, according to most recent EASD/ADA guidelines, it still represents the first-choice drug in these patients. Intriguingly, several extraglycemic effects of metformin have been recently observed, among which large preclinical and clinical evidence support metformin's efficacy against ED in T2DM. Metformin seems effective thanks to its favorable action on all the aforementioned pathophysiological ED mechanisms. AMPK pharmacological activation plays a key role, with metformin inhibiting inflammation and improving ED. Therefore, aim of this review is to assess metformin's beneficial effects on endothelial dysfunction in T2DM, which could preempt development of atherosclerosis.
Keyphrases
- type diabetes
- emergency department
- glycemic control
- oxidative stress
- endothelial cells
- protein kinase
- end stage renal disease
- dna damage
- chronic kidney disease
- nitric oxide
- stem cells
- skeletal muscle
- newly diagnosed
- adipose tissue
- endoplasmic reticulum stress
- metabolic syndrome
- coronary artery disease
- prognostic factors
- cell proliferation
- drug induced
- quality improvement
- pi k akt
- reactive oxygen species