Role of bariatric surgery in improving diabetic cardiomyopathy: Molecular mechanisms and therapeutic perspectives (Review)

Figures

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  Figure 1.. Possible mechanisms by which bariatric surgery improves DCM. Bariatric surgery may improve DCM by maintaining calcium homeostasis, regulating the gut-heart axis, reducing myocardial fatty acid formation, reducing myocardial mitochondrial autophagy, improving myocardial glucose uptake, inhibiting inflammasome activation and reducing endoplasmic reticulum stress. DCM, diabetic cardiomyopathy; RYGB, Roux-en-Y gastric bypass; SG, sleeve gastrectomy.

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  Figure 2.. Possible mechanisms of DJB and SG in improving DCM. DJB promotes GLUT-4 translocation and restores MGU by activating the PI3K/AKT signaling pathway and downstream substrates. SG improves diabetes-induced myocardial hypertrophy by inhibiting the MAPK signaling pathway. DJB, duodenal-jejunal bypass; SG, sleeve gastrectomy; DCM, diabetic cardiomyopathy; GLUT-4, glucose transporter 4; PI3K, phosphatidylinositol 3-kinase; Akt, protein kinase B; MGU, myocardial glucose uptake; P, phosphorylated; JNK, c-Jun N-terminal kinase; ERK1/2, extracellular signal-regulated kinase 1/2; TBC1D1, TBC1 domain family member 1.

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  Figure 3.. Possible mechanisms by which bariatric surgery improves ER stress in cardiomyocytes. SG and DJB improve ER stress in cardiomyocytes by decreasing signaling molecules related to apoptosis and ER stress in cardiomyocytes such as GRP78, PERK, P-PERK, CHOP and caspase 12. DJB, duodenal-jejunal bypass; SG, sleeve gastrectomy; PERK, protein kinase R-like endoplasmic reticulum kinase; CHOP, C/EBP homologous protein, ER endoplasmic reticulum; P, phosphorylated.

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  Figure 4.. Schematic representation of the formation of autophagy inhibition/activation. Obesity or diabetic cardiomyopathy leads to over inhibition/activation of myocardial autophagy, which can be ameliorated by bariatric surgery. SG, sleeve gastrectomy; DJB, duodenal-jejunal bypass; RYGB, Roux-en-Y gastric bypass; ROS, reactive oxygen species; DCM, diabetic cardiomyopathy; GLP-1, glucagon-like peptide-1.