Protective Factors and the Pathogenesis of Complications in Diabetes.

IF 22 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Endocrine reviews Pub Date : 2024-03-04 DOI:10.1210/endrev/bnad030
Marc Gregory Yu, Daniel Gordin, Jialin Fu, Kyoungmin Park, Qian Li, George Liang King
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Abstract

Chronic complications of diabetes are due to myriad disorders of numerous metabolic pathways that are responsible for most of the morbidity and mortality associated with the disease. Traditionally, diabetes complications are divided into those of microvascular and macrovascular origin. We suggest revising this antiquated classification into diabetes complications of vascular, parenchymal, and hybrid (both vascular and parenchymal) tissue origin, since the profile of diabetes complications ranges from those involving only vascular tissues to those involving mostly parenchymal organs. A major paradigm shift has occurred in recent years regarding the pathogenesis of diabetes complications, in which the focus has shifted from studies on risks to those on the interplay between risk and protective factors. While risk factors are clearly important for the development of chronic complications in diabetes, recent studies have established that protective factors are equally significant in modulating the development and severity of diabetes complications. These protective responses may help explain the differential severity of complications, and even the lack of pathologies, in some tissues. Nevertheless, despite the growing number of studies on this field, comprehensive reviews on protective factors and their mechanisms of action are not available. This review thus focused on the clinical, biochemical, and molecular mechanisms that support the idea of endogenous protective factors, and their roles in the initiation and progression of chronic complications in diabetes. In addition, this review also aimed to identify the main needs of this field for future studies.

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糖尿病并发症的保护因素和发病机制。
糖尿病的慢性并发症是由于多种代谢途径的紊乱造成的,而这些紊乱是导致糖尿病发病和死亡的主要原因。传统上,糖尿病并发症分为微血管并发症和大血管并发症。我们建议将这一过时的分类法修订为血管、实质和混合(血管和实质)组织来源的糖尿病并发症,因为糖尿病并发症的特征从仅涉及血管组织到主要涉及实质器官不等。近年来,关于糖尿病并发症发病机制的研究模式发生了重大转变,研究重点从对风险的研究转向对风险因素和保护因素之间相互作用的研究。虽然风险因素对于糖尿病慢性并发症的发生显然很重要,但最近的研究已经证实,保护性因素在调节糖尿病并发症的发生和严重程度方面同样重要。这些保护性反应可能有助于解释并发症的不同严重程度,甚至某些组织没有病变的原因。然而,尽管这一领域的研究越来越多,但关于保护性因子及其作用机制的全面综述却并不多见。因此,本综述侧重于支持内源性保护因子观点的临床、生化和分子机制,以及它们在糖尿病慢性并发症的发生和发展中的作用。此外,本综述还旨在确定该领域未来研究的主要需求。
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来源期刊
Endocrine reviews
Endocrine reviews 医学-内分泌学与代谢
CiteScore
42.00
自引率
1.00%
发文量
29
期刊介绍: Endocrine Reviews, published bimonthly, features concise timely reviews updating key mechanistic and clinical concepts, alongside comprehensive, authoritative articles covering both experimental and clinical endocrinology themes. The journal considers topics informing clinical practice based on emerging and established evidence from clinical research. It also reviews advances in endocrine science stemming from studies in cell biology, immunology, pharmacology, genetics, molecular biology, neuroscience, reproductive medicine, and pediatric endocrinology.
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