BioMed Research International

BioMed Research International / 2014 / Article
Special Issue

Endothelium in Diseased States

View this Special Issue

Review Article | Open Access

Volume 2014 |Article ID 193095 |

Alessandra Magenta, Simona Greco, Maurizio C. Capogrossi, Carlo Gaetano, Fabio Martelli, "Nitric Oxide, Oxidative Stress, and Interplay in Diabetic Endothelial Dysfunction", BioMed Research International, vol. 2014, Article ID 193095, 16 pages, 2014.

Nitric Oxide, Oxidative Stress, and Interplay in Diabetic Endothelial Dysfunction

Academic Editor: Silvia M. Arribas
Received18 Nov 2013
Accepted12 Jan 2014
Published05 Mar 2014


Increased oxidative stress and reduced nitric oxide (NO) bioavailability play a causal role in endothelial cell dysfunction occurring in the vasculature of diabetic patients. In this review, we summarized the molecular mechanisms underpinning diabetic endothelial and vascular dysfunction. In particular, we focused our attention on the complex interplay existing among NO, reactive oxygen species (ROS), and one crucial regulator of intracellular ROS production, protein.

1. Introduction

Endothelial cells (ECs) synthesize and release different molecules that orchestrate metabolic, vascular, and cellular responses. Among them, nitric oxide (NO) is a key regulatory molecule of paramount importance for endothelial function and vascular tone relaxation [1, 2]. Notably, reduced endothelial cell nitric oxide synthase (eNOS) expression and/or NO bioavailability are associated with decreased EC survival and with endothelial dysfunction [3]. Indeed, a dysfunctional endothelium is not able to oppose vasoconstrictor stimuli, causing the increase of the arterial tone.

Reactive oxygen species (ROS), which include hydrogen peroxide (H2O2), superoxide anion (), and hydroxyl radicals, also play a pivotal role in endothelial and vascular function as well as in vascular tone constriction [4]. ROS are generated as a consequence of aerobic metabolism and are produced by several cellular sources: plasma membrane NADPH oxidase (NOX), mitochondria, and different enzymes, such as several oxidases, peroxidases, cytochromes, mono- and dioxygenases, and uncoupled NOS.

The amount of ROS within the cell is finely modulated by enzymatic and nonenzymatic antioxidant defenses such as superoxide dismutases (SODs), catalase (CAT), glutathione peroxidase (GPx), and glutathione. Physiological ROS levels play an important role as second messengers within the intracellular signaling. Indeed, ROS can be actively generated and mediate physiological intracellular signalling as second messengers [5]. However, ROS production exacerbation or insufficient scavenging has been demonstrated to impair many biological processes including endothelial function in several pathological contexts.

A strict link exists between NOS activity and ROS production, since NOS uncoupling leads to the production of superoxide anion rather than NO. One of the major determinants of NOS uncoupling is the bioavailability of the cofactor tetrahydrobiopterin (BH4) [6]. ROS as well as peroxynitrite (ONOO), another potent oxidant produced by the reaction of superoxide anion with NO, induce BH4 degradation leading to eNOS uncoupling and to a reduction of the amount of endothelium-derived NO that is required for vascular relaxation and EC survival and proliferation [7].

The cellular pathways induced by ROS increase are known to provoke growth arrest and senescence, as well as cell death, either by apoptosis or by necrosis, according to the level of oxidative stress experienced by the cell, its genotype, and a multitude of epigenetic changes [8, 9]. A pivotal role in ROS-induced apoptosis is played by the p66 isoform of ShcA protein (), a fundamental regulator of mitochondrial ROS production by a variety of different stimuli [10]. Moreover, a fundamental role played by microRNAs is emerging [11, 12], indicating that noncoding RNAs play a major role in the establishment of pathological conditions associated with ROS imbalance, including diabetes mellitus [1315].

In this review, we will focus our attention on the mechanisms regulating the correct balance and the complex interplay among ROS, NO, and that are crucial for EC function. We will also show how the alteration of this network is one of the driving pathogenetic mechanisms underpinning diabetic vasculopathy and endothelial dysfunction.

2. Endothelial Dysfunction in Diabetes Mellitus

2.1. NO Bioavailability Reduction and ROS Increase

The regulation of NO metabolism is particularly important in diabetes mellitus, since the activation of eNOS has been demonstrated to be under the insulin control [1618]. In particular, it has been shown that insulin (INS) binding to its receptor activates the insulin receptor tyrosine kinase activity, resulting in tyrosine phosphorylation of the insulin receptor substrate-1 (IRS1). Phosphorylated IRS1 binds and activates phosphoinositol 3-kinase (PI3 K), leading to activation of serine-kinase phosphoinositide-dependent kinase 1 (PDK1), which phosphorylates and activates v-akt murine thymoma viral oncogene homolog 1 (AKT1). In turn, AKT1 directly phosphorylates eNOS at Ser-1177, leading to increased activity of eNOS and production of NO (Figure 1). Accordingly, IRS-1 mutations in ECs decrease insulin-stimulated eNOS phosphorylation and eNOS gene expression [19] and knockout mice of the endothelial-specific insulin receptor display decreased eNOS expression and endothelial vasodilator function impairment [20]. Moreover, animal models of insulin resistance, including the obese Zucker rat, display defects in the PI3 kinase/AKT1 system and impaired NO bioavailability [21].

Another signaling pathway that is activated by insulin in diabetes is the mitogen-activated protein kinases (MAPK) pathway viathe small GTPase Ras [22]. The Ras/MAPK insulin-signaling pathway generally leads to cellular growth and proliferation. In ECs, activation of this pathway has been linked to the expression of endothelin-1, which is a potent mitogen and vasoconstrictor, and to the expression of proinflammatory adhesion molecules such as ICAM-1 [23]. In diabetes mellitus and insulin resistance, insulin-mediated activation of eNOS viaPI3 kinase/AKT1 is inhibited, while the adverse effects of insulin remain unopposed, which may promote vascular disease [24]. Blood flow and other physiological stimuli activate eNOS viaPI3 kinase/AKT1; therefore, an impairment of this signaling mechanism in diabetes may have broad implications for vascular dysfunction.

NOX is a membrane associated multisubunit complex that generates superoxide anion and is involved in the oxidative burst of inflammatory cells as well as in EC signaling [25]. In pathological conditions, including diabetes mellitus, NOX activity and superoxide production are increased [26, 27]. Increased free fatty acid concentration activates NOX and the proinflammatory transcription factor NFB [28]. Moreover, NOX expression is upregulated by the systemic vasoconstrictor angiotensin II [29] that is increased in type 2 diabetic patients or animal models, along with its generating enzymes and receptors. Moreover, angiotensin II seems to play a role in the regulation of insulin secretion by pancreatic beta-cells and insulin sensitivity by peripheral tissues, which are two critical factors contributing to the development of type 2 diabetes. Accordingly, angiotensin converting enzymes inhibitors show positive vascular effects in diabetes [30, 31].

Finally, diabetes is associated with eNOS uncoupling and decreased BH4 levels and therefore increased ROS production (Figure 2). In keeping with these data, BH4 supplementation improves NO production and endothelial function both in experimental diabetes models [32] and in human subjects with type 2 diabetes mellitus [33, 34].

Interestingly, Thomas et al. reported the effects of H2O2 treatment in ECs on eNOS phosphorylation. It was shown that a short H2O2 treatment with 300 μM H2O2 induced promotion of eNOS activity and modulation of the eNOS phosphorylation status at Ser-1177 in porcine aortic endothelial cells via a calcium- and AKT-dependent pathway [35]. Additionally, another study demonstrated that eNOS mRNA expression was increased in bovine aortic ECs treated with 100 μM H2O2 for 24 hours [36].

Most probably, both these effects might represent adaptive responses of ECs to maintain NO bioactivity under conditions of enhanced oxidative stress. On the other hand, a very interesting report demonstrated that human eNOS phosphorylation of Ser-1177, under conditions of eNOS uncoupling (i.e., in absence of BH4), increases the rate of superoxide anion generation instead of NO [37].

All the above studies demonstrate the intricate interplay existing between ROS and eNOS phosphorylation in Ser-1177 in relationship to BH4 levels (which are reduced under elevated levels of oxidative stress or diabetes; see Figure 2). Therefore, unbalanced red/ox homeostasis, as found in diabetes, will determine an exacerbated production of superoxide anion instead of NO, leading to diabetic-associated vascular dysfunction.

2.2. Oxidative Stress Insulin Resistance and Diabetic Complications

Oxidative stress plays a pivotal role in the development of insulin resistance and in both micro- and macro-vascular diabetic complications [38].

Moreover, diabetic condition is also associated with an impairment of cellular autophagy, a process involved in the degradation of cellular components [39]. Autophagy and oxidative stress are strictly related since autophagy is also responsible for organelles degradation, such as mitochondria, which are the sites of ROS production. Autophagy impairment, in fact, causes an accumulation of dysfunctional mitochondria leading to increased ROS production. Therefore the autophagy impairment associated with diabetes plays a causal role in ROS increase [39]. In diabetic conditions, in fact, there is a mitochondrial superoxide overproduction in ECs of both large and small vessels, as well as in the myocardium. Superoxide production is responsible for the activation of five major pathways involved in the pathogenesis of diabetes complications: polyol pathway flux, increased formation of advanced glycation end products (AGEs), increased expression of the AGE receptor and its activating ligands, activation of protein kinase C isoforms, and overactivity of the hexosamine pathway [38]. Moreover, it directly inactivates two critical antiatherosclerotic enzymes, eNOS (see paragraph above) and prostacyclin synthase. Through these pathways, increased intracellular ROS provokes angiogenesis impairment in response to ischemia, activates a number of proinflammatory pathways, and causes long-lasting epigenetic changes that drive persistent expression of proinflammatory genes after glycemia being normalized (hyperglycemic memory), described below in Section 5. Atherosclerosis and cardiomyopathy in type 2 diabetes are caused in part by pathway-selective insulin resistance, which increases mitochondrial ROS production from free fatty acids and by inactivation of antiatherosclerotic enzymes by ROS [38].Indeed, overexpression of superoxide dismutase in transgenic diabetic mice prevents diabetic retinopathy, nephropathy, and cardiomyopathy [38].

An important role in the establishment of insulin resistance is played by the redox sensitive transcription factor NF-E2-related factor 2 (Nrf2) [40]. Among the different mechanisms used by the cell to counteract sustained oxidative stress, Nrf2 regulates antioxidant response element (ARE/EpRE-) mediated expression of detoxifying and antioxidant enzymes and of the cystine/glutamate transporter involved in glutathione biosynthesis [41]. Nrf2/ARE activity decrease causes oxidative stress increase and mitochondrial dysfunction in the vasculature, leading to endothelial dysfunction, insulin resistance, and abnormal angiogenesis associated with diabetes [42]. Moreover it has been shown that the suppression of Nrf2 activity by the MAPK extracellular-signal-regulated kinase (ERK) is linked to the oxidative stress-induced insulin resistance in mice [43]. Since ERK is known to be a negative regulator of glucose uptake and to be responsible of oxidative stress-induced insulin resistance, a strong link does exist between these phenomena. In addition, Nrf2 expression in the heart has been shown to be first upregulated and then downregulated in late stages of diabetes in the mouse. In this contest, Nrf2 activation has been demonstrated both to suppress oxidative stress-induced ERK activity and to reverse oxidative stress-induced insulin resistance. Finally, antioxidants such as N-acetyl cysteine (NAC) and metallothionein can prevent oxidative stress-induced ERK activation and Nrf2 downregulation [43].

These results demonstrate that Nrf2 plays a critical role in regulating insulin sensitivity in the heart but presumably also in other tissue districts; therefore, targeting Nrf2 might provide a novel therapeutic approach for the treatment of insulin resistance and diabetic cardiomyopathy [43].

2.3. NO Bioavailability and Inflammation

Acute inflammatory states are known to impair endothelium-dependent vasodilatation since inflammatory mediators, such as tumor necrosis factor-α (TNF-α), decrease eNOS expression in ECs [44]. The inflammatory process induces the activation of ECs that is characterized by adhesion molecule expression, eNOS decrease, and consequent loss of NO bioactivity, all mechanisms that are critical for the promotion of the atherogenic phenotype [45]. Diabetes is associated with a systemic inflammatory state that may impair endothelial function and contribute to atherosclerosis [46]. Indeed, in diabetic patients there is an increase of circulating levels of inflammatory markers, including C reactive protein, TNF-α, and intercellular adhesion molecule-1 [4749]. Moreover, higher levels of inflammatory markers are a predictor of increased cardiovascular risk in diabetic patients [50] and, on the other hand, augmented levels of circulating inflammatory markers also relate to the incidence of diabetes mellitus [51].

The nuclear factor B (NFB) transcription factor, a key regulator of inflammatory genes transcription, is also implicated in endothelial activation and is linked to the pathogenesis of insulin resistance [52]. Inflammatory mediators, such as inflammatory cytokines, free fatty acids, and the AGE receptor, activate NFB. They all induce the phosphorylation of the inhibitory subunit IB by the IB kinase (IKK-β), which allows the translocation of the regulatory subunits p50 and p65 to the nucleus, where they promote the expression of inflammatory genes. Indeed, overexpression of IKK-B or TNF-α in skeletal muscles causes insulin resistance [53]. Accordingly, in vitro and in vivo studies confirmed the existence of a link between insulin resistance and NFB activation, inflammation, and NO bioactivity impairment [54]. As a further confirmation, genetic suppression of IKK-β or pharmacological inhibition of IKK-β with a class of drugs named salicylates prevents insulin resistance. Accordingly, a large randomized trial was conducted in type 2 diabetes patients (TINSAL-T2D) testing an anti-inflammatory agent belonging to salicylate group, named salsalate (2-(2-hydroxybenzoyl) oxybenzoic acid). It was found that salsalate lowers hemoglobin A (1c) levels and improves glycemic control, showing the importance of chronic inflammation as pathogenetic mechanism of diabetes.

3. and Intracellular Oxidative Stress

In the oxidative stress-mediated responses, Shc proteins, intracellular adaptors regulating a variety of cellular functions, assume a major role [55]. There are three Shc mammalian genes: ShcA, ShcB, and ShcC. In mammals, ShcA is ubiquitously expressed, while ShcB and ShcC expression are limited to neuronal cells [56, 57].

The ShcA adaptor protein has three isoforms of 46, 52, and 66 kDa (, , and , resp.) all generated from the same transcript, either through RNA splicing or alternative translational initiation [58, 59]. These three isoforms all share a common structure made of the CH2–PTB–CH1–SH2 modular domains [60]; the C terminal SH2 domain is necessary to bind to phosphotyrosine containing sequences; the PTB domain is a second domain capable of interacting with phosphorylated tyrosine residues independently; in particular, the isoform lacks the first 46 amino acids within the PTB domain. The CH1 domain lays between the PTB and SH2 domains and contains tyrosine residues that, upon phosphorylation, activate a specific signaling cascade. Finally, only has an additional domain at the N terminus, the CH2 domain. Of relevance, this domain contains a serine residue at position 36 (Ser-36) that is phosphorylated in response to several stress stimuli, including UV irradiation and H2O2 [61].

and proteins are inductors of the Ras signaling pathway [6264]. In particular, is efficiently phosphorylated by the insulin receptor, causing the activation of the MAPK pathway that leads to cellular growth and proliferationviathe small GTPase Ras [22]. Interestingly, this pathway is not inhibited in diabetes mellitus and insulin resistance; conversely, the insulin-mediated activation of eNOS viaPI3 kinase/AKT1 is inhibited, limiting its vasodilator and prosurvival function and therefore promoting vascular disease [24].

The isoform function is not limited to signal transduction, since it is a redox enzyme implicated in mitochondrial ROS generation and translation of oxidative signals [55].

Under physiological conditions, the phosphorylation of Tyr residues of by growth factors mediates the signal transduction to the nucleus, inhibiting the Ras signaling pathway, while phosphorylation of the Ser-36 site seems to be crucial for oxidative stress response [6567].

modulates ROS production by using three mechanisms restricted in the nucleus, the plasma membrane, and the mitochondria, respectively. The nuclear mechanism involves mediated by forkhead box sub-group O (FOXO) transcription factors inhibition, leading to the decreased expression of ROS-scavenging enzymes CAT and manganese superoxide dismutase (MnSOD) [68]. At the plasma membrane, promotes RAC1 activation and triggers NADPH membrane oxidase-ROS production. A positive feedback loop between RAC1 and exists: RAC1, in fact, induces the phosphorylation-dependent increase of stability [69]. Finally, acts in the mitochondrial intermembrane space. In response to oxidative stress, is serine phosphorylated by protein kinase CβII (PKCβII) and isomerized by the peptidylprolyl cis/trans isomerase PIN-1 [70, 71]; this isomerization allows the dephosphorylation of Ser-36 residue by the serine threonine phosphatase PP2A, inducing the translocation from the cytosol to the mitochondrial intermembrane space, through the TIM/TOM mitochondrial import machinery. In the mitochondrial intermembrane space, binds to cytochrome c, acting as an oxidoreductase and generating ROS. These ROS, in turn, activate the permeability transition pore, triggering organelle dysfunction, massive release of mitochondrial apoptotic factors, and ROS and eventually inducing cell apoptosis [71] (Figure 3).

Indeed, increased content in the mitochondria correlates with alteration of mitochondrial structure, decrease of mitochondrial calcium uptake, and enhanced mitochondrial ROS production, triggering the mitochondrial route of apoptosis [70]. It is worth noting that the mitochondrial H2O2 production induced by further increases intracellular H2O2 levels, maintaining or increasing PKCβII activation in a positive control loop [72, 73].

In keeping with its proapoptotic function, can be also phosphorylated by apoptosis signal-regulating kinase 1 (ASK1) [74] and p38 MAPK [75]. Indeed, p38 MAPK is target of several factors inducing ROS generation, including osmotic and thermic shock, inflammatory cytokines, lipopolysaccharides, ultraviolet light, interleukin 1, and H2O2 [75].

In agreement with these data, increased resistance to oxidative stress has been observed in knockout mice () [61] and characterized by reduced oxidative stress-induced apoptosis, prolonged lifespan, reduced production of intracellular oxidants, and increased resistance to oxidative stress-induced apoptosis, which is restored by overexpression [61]. Consistently, mice show reduced levels of systemic (isoprostane) and tissue (nitrotyrosine, 8-oxo-dG) oxidative stress markers [68, 76, 77] and enhanced resistance to oxidative stress induced by hypercholesterolemia [78], angiotensin II [79], carbon tetrachloride, and ethanol [80]. Indeed, our group demonstrated that deletion increased both skeletal muscle and EC resistance to ischemia [81]. Intriguingly, we also found that not only inhibited cell survival but also differentiation of skeletal muscle progenitors and skeletal muscle regeneration after hindlimb ischemia [82].

These observations seem to be of clinical relevance. Indeed, mRNAs is increased in peripheral blood monocytes of patients with acute coronary syndrome, but not in those who display stable coronary artery disease [83]. In addition, plasma levels of malondialdehyde, an established marker of lipid peroxidation and thus of oxidative stress, correlate positively with expression.

3.1. , ROS and Diabetes Mellitus

Different reports unravel a major role of also in response to hyperglycemia (HG) and diabetes conditions that both upregulate oxidative stress.

There are several studies exploring the interactions between hyperglycemia-associated ROS production and in diabetes animal models. Indeed, streptozotocin (STZ) treated mice, a model of type 1 diabetes, show higher expression of compared to nondiabetic mice. In addition, STZ treated and wild type (wt) mice show a similar increase in blood glucose but significant differences with respect to endothelial dysfunction and oxidative stress production [84]. Peroxynitrites are formed after the reaction between free radicals, such as superoxide and NO, decreasing NO availability and enhancing cellular oxidative stress and eventually leading to endothelial dysfunction [85]. In accordance with the decreased oxidative stress levels observed upon diabetes induction, mice also display reduced peroxynitrite production, and thus contributing to blood vessel relaxation [84].

Increased glucose levels impact directly on . Indeed, HG-mediated ROS production induces phosphorylation of the Ser-36 residue of , leading to the collapse of mitochondrial transmembrane potential [86].

A well-known effect of HG is the formation and accumulation of AGEs, which can further amplify oxidative damage by increasing oxidative stress in cells [87, 88]. Ser-36 phosphorylation mediated through AGE-induced ROS production has been shown to be responsible for FOXO3A inhibition [89].

Additionally,HG-mediated ROS overproduction also activates AKT1/PKB kinase, which phosphorylates and inactivates FOXO3A protein, inducing oxidative stress and depressing the survival phenotype [90]. This is of particular importance for diabetes-associated redox imbalance, since FOXO3A transcription factor is responsible for SOD2 and catalase ROS scavenger synthesis [9193]. -AKT interplay also affects NO production: silencing leads to activation of Ras and AKT kinase, with a corresponding increase in phosphorylation of eNOS at Ser-1177. Accordingly, in rat aortic rings, knockdown of suppresses the vasoconstrictor responses enhancing vasodilatation [94].

Another signaling pathway altered in HG involves NFB and NOX4 (NADPH oxidase 4),that are elevated in wt but not in knockout animals [95].

Finally, is essential also for glucose uptake in skeletal muscle cells. In fact, protein regulates MAPK activity and the actin cytoskeleton turnover [96], which are both required for normal glucose transport regulation. Loss of in rat myoblasts activates MAPK activity, leading to altered cell cytoskeleton and resulting in strong increase in basal glucose transport [97]. Moreover glucose transporter proteins GLUT1 and GLUT3 are induced too. On the other hand, in rat myoblasts overexpressing , basal glucose uptake rate is significantly reduced and the cellular levels of glucose transporters GLUT1 and GLUT3 are decreased. Thus, may represent an effector of glucose transport in skeletal muscle cells and confirm to play an important role in the adaptive responses to environmental factors [97].

Again, these observations appear to be of clinical relevance. Indeed, mRNA level is significantly increased in mononuclear blood cells from type 2 diabetic patients compared to healthy controls and it correlates positively with total plasma isoprostanes, well-known markers of oxidative stress [98].

3.1.1. and Endothelial Progenitor Cells (EPCs) Function in Diabetes Mellitus

EPC levels in diabetic patients are significantly reduced compared with control subjects. EPCs derived from diabetic patients, in fact, produce excessive ROS and show impaired migratory capacity [99]. eNOS uncoupling explains, at least in part, the reduced levels and impaired function of EPCs observed in diabetes contributing to the pathogenesis of vascular disease [99].

Accordingly, mouse bone marrow derived c-kit+ cells of mice are resistant to both apoptosis and oxidative stress induced by high glucose [100]. Upon oxidative stress, the bioavailability of NO is reduced, and consequently endothelial function and differentiation are impaired. HG resistance conferred by deletion is dependent on the activity of NOS and, accordingly, a NO donor is sufficient to rescue bone marrow-derived EPCs deficit induced by HG [100]. In line with in vitro data, the knockout of prevents the diabetic impairment of capillary network formation in a mouse model of angiogenesis [100], strongly indicating that represents a promising therapeutic target for the prevention, the development, and the progression of diabetic vasculopathy.

3.2. Role in Hypercholesterolemia

Hypercholesterolemia increases ROS and reactive nitrogen species production, resulting in oxidation and peroxidation of lipids, proteins, and lipoproteins [101104]. In mice chronically fed with a high-fat diet, the levels of oxidized low-density lipoprotein (LDLs) and of isoprostanes, produced from polyunsaturated fatty acids through radical-catalyzed mechanisms, are reduced as well as the formation of intimal macrophage-derived foam cells in the arterial wall. Thus, loss of expression protects against oxidative stress and early lesion formation [78]. Furthermore, in mice, low atherogenesis and reduced oxidative stress are coupled with reduced apoptosis in aortic lesions [78].

In an interesting study, the relationships among lipids, oxidative stress, and were investigated in peripheral white blood cells and in subcutaneous adipose specimens of patients displaying either high or low LDL plasma levels [105]. It was reported that mRNA levels in WBC and in adipose tissue were directly related to LDL expression, and multiple regression analysis showed that LDL plasma levels were the only variable affecting mRNA expression [105].

3.3. Role in Aging

Aging is an independent risk factor for cardiovascular diseases and senescent vascular cells are present in human atherosclerotic tissues [106], suggesting that vascular cell senescence could be linked to the pathophysiology of age-related vascular diseases. Accordingly, vascular cell senescence has been also shown in diabetic vasculopathy [107, 108]. Indeed, HG-induced endothelial senescence leads to vascular inflammation and thrombosis, exacerbating the diabetic-associated cardiovascular events.

Calorie restriction in mammals decreases the incidence of age-associated disorders including cardiovascular diseases [109]. “Silent mating type information regulation 2 homolog” (sirtuin 1 or SIRT1) is NAD+-dependent class III histone deacetylase (HDAC) found up-regulated under caloric restriction and extending the lifespan of many organisms [110]. A SIRT1 upregulation and/or activation is associated with EC functional preservation; whereas excessive ROS or aging decrease SIRT1 expression, leading to endothelial dysfunction [111]. In fact, SIRT1 activation in ECs ameliorates oxidative stress response, prevents endothelial senescence, and promotes eNOS-derived NO bioavailability and mitochondrial biogenesis [112114].

SIRT1 has been shown to target p53, FOXO3, and eNOS for deacetylation, negatively regulating oxidative stress [114116]. Recently, it has been demonstrated that the endothelium-specific overexpression of SIRT1 is able to inhibit the HG-induced upregulation of the senescence-associated markers, such as the CDK inhibitor (p21), p53, and the plasminogen activator inhibitor-1 (PAI-1) [117]. Furthermore, SIRT1-transgenic diabetic mice exhibited decreased expression of and increased expression of the scavenging enzyme MnSOD [117]. Indeed, SIRT1 has been shown to repress transcription at the chromatin level: SIRT1 overexpression decreased acetylated histone H3 binding to the promoter region; whereas inhibition of SIRT1 increased acetylated histone H3 binding to the same region. Therefore, the decreased levels of attributable to SIRT1 could be the result of a direct inhibitory role of SIRT1 on expression through epigenetic chromatin modifications [112].

Overall, these data suggest that the protective role of SIRT1 against hyperglycemia-induced vascular cell senescence is mediated, at least in part, through the reduction of oxidative stress through a cross-talk with .

The above described role of in endothelial dysfunction associated with different disease conditions is summarized in Table 1.

Disease Phenotype p66Shc+/+

Diabetes Peroxynitrite production +++ +
Lipid peroxidation +++ +
p66Shc expression ++

Aging NO availability + +++
O2 production +++ +
Protein nitration +++ +
iNOS expression +++ +

Hypercholesterolemia Aortic lesions area +++ +
Plasmatic isoprostanes +++ +
Lipid peroxidation +++ +
Vascular apoptosis +++ +

+++: high expression or production; ++: medium expression or production; +: moderate expression or production; −: no expression.

4. MicroRNAs Oxidative Stress and Diabetes

MicroRNAs (miRNAs) are small noncoding RNAs that regulate stability and translational inhibition of target messenger RNAs (mRNAs). miRNAs are involved in most biological processes, including proliferation, differentiation, development, migration, and apoptosis [11, 12]. miRNA dysregulation has been observed in the development of different diseases, including diabetes mellitus [1315]. Specifically, several miRNAs modulated by oxidative stress have been demonstrated to be dysregulated in diabetes and to cause vasculopathy (Table 2).

miRNAs Tissue/organ Source Target Functions References

H2O2 miR-200c, miR-141,
 miR-200a, miR-200b, and
ECs, myoblasts Human ZEB1 Apoptosis, senescence [120]
Diabetes  miR-200c, miR-200b, and
VSMCs Mouse ZEB1 Inflammation [118]
NO  miR-200c, miR-200a,
 miR-200b, and miR-429
mES Mouse ZEB2 Mesendoderm and cardiovascular differentiation [121]
Hypoxia  miR-210 ECs Human EFNA3 Angiogenesis [125]
Diabetes  miR-210 Failing heart Human [127]
Diabetes  miR-125 VSMCs Mouse Suv39h1 Inflammation [122]
Diabetes  miR-27b BMACs Human/mouse Sema6A, p66shc, and TSP-1 ROS production; angiogenesis impairment [124]

BMACs: bone marrow-derived angiogenic cells, ECs: endothelial cells, EFNA3: Ephrin A3, H2O2: hydrogen peroxide, mES: mouse embryonic stem, NO: nitric oxide, p66Shc: p66 isoform of ShcA protein, ROS: reactive oxygen species, Sema6A: semaphorin 6A, Suv39h1: suppressor of variegation 3-9 homolog 1 (Drosophila), TSP-1: thrombospondin-1, VSMCs: vascular smooth muscle cells, ZEB1: zinc finger E-box binding homeobox 1, and ZEB2: zinc finger E-box binding homeobox 2.

Among them, miR-200 family members have been shown to play a causative role in the establishment of vascular diabetic inflammatory phenotype [118]. This miRNA family consists of five members, miR-200c, miR-141, miR-200a, miR-200b, and miR-429 and it has been widely studied for its role in the epithelial to mesenchymal transition of tumor cells [119].

We found that miR-200 family is induced upon H2O2 treatment in ECs and in particular one of its members, miR-200c, is responsible for the induction of apoptosis and senescence [120]. This is likely physiologically relevant since miR-200 family induction is also observed in a mouse model of hindlimb ischemia with an oxidative stress mediated mechanism [81]. Indeed, miR-200c and miR-200b upregulation is markedly inhibited in ischemic mice, which display lower levels of oxidative stress in basal conditions [10] and after ischemia [81], supporting a role of ROS in miR-200 family induction [120].

An upregulation of miR-200 family members has been also reported in VSMCs of diabetic mice (db/db) compared to control db/+ mice [118]. In particular, the authors found that miR-200b, miR-200c, and miR-429 expression levels were increased in VSMCs of diabetic mice, while the protein levels of their common target ZEB1 were decreased. Overexpression of miR-200 mimics the downregulated transcriptional repressor ZEB1, leading to the transcription of the inflammatory genes cyclooxygenase-2 (COX-2) and monocyte chemoattractant protein-1 (MCP-1) that in turn promote monocyte binding to VSMCs, eliciting a proinflammatory response. In accordance with these results, ZEB1 occupancy of inflammatory gene promoters was reduced in db/db VSMCs [118].

Notably, miR-200 family is also induced by NO [121]. NO treatment and miR-200-family overexpression, or ZEB2 knockdown, all elicit the expression of mesendoderm and early cardiovascular precursor markers, including fetal liver kinase 1 (Flk1) and chemokine receptor type 4 (CXCR4), inducing mouse embryonic stem (ES) cells differentiation towards the mesoendoderm and cardiovascular lineage [121].

Another miRNA that is found significantly upregulated in VSMCs of diabetic mice (db/db) compared to control mice db/+ is miR-125b [122] that is also induced by oxidative stress in human keratinocytes HaCaT exposed to H2O2 [123]. miR-125b protein target is the histone H3 lysine-9 methyltransferase Suv39 h1. In diabetic VSMCs, there is a decreased promoter occupancy of Suv39 h1 in inflammatory genes and, consequently, of the associated repressive epigenetic mark histone H3 lysine-9 trimethylation (H3K9me3) [122]. This study supports the idea that epigenetic mechanisms implicated in the upregulation of inflammatory genes in ECs and VSMCs under diabetic conditions, at least in part, pass through oxidative stress-dependent modification of miRNA expression (see section below).

Recently, it has been shown that decreased levels of miR-27b are present in bone marrow-derived angiogenic cells (BMACs) from both type 2 diabetes mellitus patients and type 2 diabetic db/db mice [124]. miR-27b under normoglycemic condition protects BMAC angiogenesis, represses mitochondrial reactive oxygen species, and improves wound healing by targeting the antiangiogenic molecules semaphorin 6A (Sema6A), , and thrombospondin-1 (TSP-1), respectively [124]. In contrast, in diabetes mellitus, miR-27b expression is decreased, which harms BMAC angiogenesis and increases mitochondrial ROS production [124]. Overexpression of miR-27b, in fact, rescues BMAC functions and improves BMAC therapy on diabetic wounds, accelerating wound closure and increasing wound perfusion. These data indicate that miR-27b gene therapy enhances the efficacy of diabetic angiogenic cells for wound angiogenesis and wound repair in diabetic subjects [124].

Another miRNA that plays a major role in EC function is miR-210 [125]. In particular, its upregulation stimulates EC angiogenesis, at least in part, through the downmodulation of Ephrin A3 (EFNA3) [125]. Moreover, miR-210 is involved in mitochondrial ROS production targeting many mitochondrial components [3] and miR-210 blockade decreases EC survival upon ischemia with an oxidative stress mediated mechanism [126]. Interestingly, miR-210 levels are also induced in the failing heart of postischemic type 2 diabetic patients [127]. Thus, while miR-210 levels have not been measured in cardiac endothelium specifically, dysregulation of this miRNA is likely to play a role in diabetic EC dysfunction.

5. Epigenetic Modulations Induced by ROS in Diabetes Mellitus

As previously described, epigenetic modulations elicited under diabetic conditions have been proven to play a pivotal role in the progression of the disease and, importantly, in hyperglycemic memory. The latter likely underpins the failure of intensive glucose control in the improvement of cardiovascular outcomes in diabetic patients [9].

In vitro studies demonstrate that epigenetic mechanisms modulate glucose-induced gene expression of the subunit p65 of NFB. This phenomenon has been assigned to the activation of SET7/9 histone methyltransferase which methylates lysine 4 on histone H3 and promotes gene transcription [128]. The overall process leads to NFB activation and to the expression of proinflammatory molecules such as VCAM-1 and MCP-1.

The emerging concept is that epigenetic modifications are at the basis of high glucose-dependent modifications and may be involved in the onset of hyperglycemic memory. Although this observation still awaits confirmation in humans, it is certainly intriguing and worth of further investigations. A possible problem could be that not all the cells in the body may be equally sensitive to high glucose, resulting in a persistent modification of gene expression and/or cell function. Our knowledge in this direction is still limited and further analyses are required to understand the molecular basis of hyperglycemic/epigenetic memory as well as the potential interventions we may design to correct the problem [129]. Intriguingly, the same proinflammatory genes are induced in models of diabetes-associated atherosclerosis, suggesting that similar mechanistic processes may underlie different physiopathological outcomes associated with the same metabolic alteration [130, 131].

Evidence is emerging that ROS could be key mediators underpinning glucose mediated epigenetic modulations; in particular, mitochondrial ROS have been shown to be implicated in the epigenetic changes that induces NFB activation [129, 132]. Recently, a study shows that. in ECs exposed to high glucose and in aortas of diabetic mice, activation of by PKCβII continues after returning to normoglycemia [133]. This persistent upregulation and mitochondrial translocation is associated with continued ROS production, apoptosis, and reduced NO bioavailability. In particular, gene is epigenetically regulated by its promoter CpG hypomethylation and by GCN 5-induced histone 3 acetylation, causing overexpression [133]. Accordingly, also other oxidative stress inducing stimuli seem to act with a similar mechanism: cholesterol upregulates EC expression via hypomethylation of two CpG dinucleotides and acetylation of histone 3 in its promoter [134].

Furthermore, -derived ROS production induces PKCβII upregulation that, in turn, phosphorylates and inhibits eNOS, leading to a damaging vicious cycle even after restoration of normoglycemia. In vivo and in vitro gene silencing of after glucose normalization restores endothelium-dependent vasorelaxation and, decreasing ROS production, inhibits apoptosis [133].

The above described studies underline the importance of the relationship occurring between , ROS production, eNOS activity, and inflammation that all concur to the establishment of the hyperglycemic memory and of vascular diseases associated with diabetes.

6. Clinical Use of Antioxidants to Improve Endothelial Function

Given the fundamental role of oxidative stress in the onset of diabetes and diabetic complications, several attempts to target redox imbalance pharmacologically have been conducted [135].

A number of interventional trials were conducted between 1996 and 2002, testing vitamin E, β-carotene, and vitamin C, alone or in combination, and at different dosages. Although some studies showed a benefit of vitamin E administration in the secondary prevention of cardiovascular disease [136] and of vitamin E + C supplementation in slowing carotid intima-media thickening in hypercholesterolaemic patients [137], clinical trials gave heterogeneous outcomes. Therefore, in 2004, the American Heart Association Committee for Nutrition, Physical Activity, and Metabolism discouraged the use of antioxidant for cardiovascular disease prevention [138].

The neutral effect of vitamin E + C administration was also confirmed by the results of the 2008 Physicians Health Study that enrolled more than 14000 middle-aged male with low prevalent cardiovascular disease and followed them up for about 10 years [139]. Importantly, questions have been raised about the safety of antioxidant vitamins, since an increased overall mortality associated with β-carotene, vitamin E, and vitamin A supplementation was reported in some of these trials, possibly due to increased cancer mortality [140]. In conclusion, these interventional trials did not confirm that pharmacological correction of the redox status with antioxidant vitamins could be used as a safe and effective therapeutic strategy.

However, another group of antioxidant compounds, polyphenols, comprising about 8000 different molecules, among which flavonoids are the most studied, holds good promise. Polyphenols are abundant in vegetables and particularly in products such as wine, chocolate, and tea. The antioxidant capacity of these compounds is attributable both to the inhibition of enzymatic sources of ROS and to the stimulation of antioxidant mechanisms [141]. Indeed, a meta-analysis of 113 studies testing different food, beverages, or extracts supplementations demonstrated that polyphenols improve endothelial function, both in healthy subjects and in patients with cardiovascular risk factors, reducing blood pressure [142].

One of the most studied polyphenols is resveratrol that is contained in red grapes as well as in other fruits. Animal studies demonstrated that resveratrol displays a strong antidiabetic effect, decreasing blood glucose in hyperglycemic rodents [143]. This effect seems to result from increased intracellular transport of glucose. Moreover, resveratrol was also demonstrated to have effects that may contribute to the protection of β-cells in diabetes. Indeed, in rat pancreatic islets experiments, resveratrol was shown to reduce insulin secretion [143] and this event was confirmed in rats with hyperinsulinemia, in which resveratrol decreased blood insulin levels [144]. Moreover, resveratrol inhibited cytokine action and attenuated the oxidative damage of the pancreatic tissue [145]. Additionally, studies in animal models of insulin resistance indicate that resveratrol increases insulin function (reviewed in [144]). The improvement of insulin action mechanism is complex and involves reduced adiposity and changes in gene expression and in the activities of different enzymes. Finally, resveratrol has been demonstrated to increase Nrf2 activity, supporting its antioxidant effect [146] and to be a potent inducer of SIRT1, a key molecule that regulates energy homeostasis, mitochondrial biogenesis, and insulin sensitivity, as above described [147].

In spite of the encouraging preclinical data, clinical intervention studies performed so far show conflicting effects of resveratrol between trials (reviewed in [148]). Some trials revealed an insulin sensitivity increase and glucose control, whereas others did not report positive effects [148]. Factors that may influence the outcome of the trials are resveratrol doses and the timing of consumption as well as the metabolic status of the subject.

Another approach aimed at modulating oxidative stress in humans takes advantage of drugs directed primarily to other targets. Angiotensin-receptor blockers and ACE inhibitors have been found to exert nonhemodynamic beneficial effects on endothelial function by inhibiting NOX activity, reducing subunits expression and vascular oxidative stress [149]. Similarly, statins reduce NOX-mediated ROS production and activate NOS function [150]. After a short time of treatment with statins, an improvement in the endothelial function of the forearm vasculature was demonstrated, prior to any lipid-reducing effect [151]. In summary, the beneficial effects obtained by a therapy with ACE inhibitors and/or statins seem to be, at least in part, mediated by properties that are independent of the hemodynamic or cholesterol-lowering effects of these drugs.

Another approach to prevent ROS generation is inhibiting the enzyme system xanthine-oxidase, a well-known endothelial and cardiac source of superoxide [152]. Indeed, in one trial, the inhibition of xanthine-oxidase with allopurinol was shown to improve endothelial dysfunction in patients with type 2 diabetes with mild hypertension [153].

Several explanations can be envisioned to explain the largely conflicting results obtained so far in interventional trials testing antioxidant strategies. It must be underlined that ROS play a fundamental role as second messengers in cell physiology and that in low concentrations some ROS, particularly H2O2, are very important for cell growth and angiogenesis; moreover, a crucial role of ROS has also been shown in protective mechanisms such as preconditioning [154]. Therefore, the administration of antioxidants that is based on the concept that these molecules only have damaging effects should be reconsidered since, in certain settings, ROS quenching might have deleterious implications that counterbalance the positive ones. Methodological issues also need to be carefully considered: for instance, dosage, treatment duration, choice of outcome measures, populations under study, and concomitant therapy [155].

Collectively, these considerations provide a sufficient explanation for the failure of antioxidants tested so far. Evidence indicates that we need more hypothesis-driven and rigorous clinical trial designs, guided by a better understanding of the complex physiopathological role of ROS. Future research will have to develop newer antioxidant molecules, more specific, with a better pharmacodynamic profile or ancillary effects or impacting systemic and tissue oxidative stress through different mechanisms.

7. Conclusions

We described in this review how oxidative stress, modulating -NO pathway, impinges in many crucial aspects of diabetic endothelial dysfunction, representing a promising therapeutic objective. So far, however, it is still unclear which pathogenetic mechanism should be targeted and the class of drugs that may be useful. In our vision, a more accurate knowledge of the fundamental disease mechanisms is the only way to the identification of a therapeutic strategy targeting oxidative stress.

Conflict of Interests

The authors declare that there is no conflict of interests regarding the publication of this paper.


This study was supported by Ministero della Salute Grants nos. 2010-2309531 to Alessandra Magenta, RF-2010 2318330 to Maurizio C. Capogrossi, and RC2013 to Fabio Martelli and Simona Greco and by Cariplo Foundation Grant 2013-0887 and AIRC IG11436 to Fabio Martelli.


  1. J. E. Deanfield, J. P. Halcox, and T. J. Rabelink, “Endothelial function and dysfunction: testing and clinical relevance,” Circulation, vol. 115, no. 10, pp. 1285–1295, 2007. View at: Publisher Site | Google Scholar
  2. C. Napoli and L. J. Ignarro, “Nitric oxide and pathogenic mechanisms involved in the development of vascular diseases,” Archives of Pharmacal Research, vol. 32, no. 8, pp. 1103–1108, 2009. View at: Publisher Site | Google Scholar
  3. A. Magenta, S. Greco, C. Gaetano et al., “Oxidative stress and microRNAs in vascular diseases,” International Journal of Molecular Sciences, vol. 14, no. 9, pp. 17319–17346, 2013. View at: Google Scholar
  4. D. D. Gutterman, H. Miura, and Y. Liu, “Redox modulation of vascular tone: focus of potassium channel mechanisms of dilation,” Arteriosclerosis, Thrombosis, and Vascular Biology, vol. 25, no. 4, pp. 671–678, 2005. View at: Publisher Site | Google Scholar
  5. H. Miki and Y. Funato, “Regulation of intracellular signalling through cysteine oxidation by reactive oxygen species,” Journal of Biochemistry, vol. 151, no. 3, pp. 255–261, 2012. View at: Publisher Site | Google Scholar
  6. Y. Yang, A. Huang, G. Kaley, and D. Sun, “eNOS uncoupling and endothelial dysfunction in aged vessels,” American Journal of Physiology—Heart and Circulatory Physiology, vol. 297, no. 5, pp. H1829–H1836, 2009. View at: Publisher Site | Google Scholar
  7. Y. Higashi, K. Noma, M. Yoshizumi, and Y. Kihara, “Endothelial function and oxidative stress in cardiovascular diseases,” Circulation Journal, vol. 73, no. 3, pp. 411–418, 2009. View at: Publisher Site | Google Scholar
  8. P. D. Ray, B. Huang, and Y. Tsuji, “Reactive oxygen species (ROS) homeostasis and redox regulation in cellular signaling,” Cellular Signalling, vol. 24, no. 5, pp. 981–990, 2012. View at: Publisher Site | Google Scholar
  9. M. E. Cooper and A. El-Osta, “Epigenetics: mechanisms and implications for diabetic complications,” Circulation Research, vol. 107, no. 12, pp. 1403–1413, 2010. View at: Publisher Site | Google Scholar
  10. M. Giorgio, M. Trinei, E. Migliaccio, and P. G. Pelicci, “Hydrogen peroxide: a metabolic by-product or a common mediator of ageing signals?” Nature Reviews Molecular Cell Biology, vol. 8, no. 9, pp. 722–728, 2007. View at: Publisher Site | Google Scholar
  11. D. P. Bartel, “MicroRNAs: target recognition and regulatory functions,” Cell, vol. 136, no. 2, pp. 215–233, 2009. View at: Publisher Site | Google Scholar
  12. E. Huntzinger and E. Izaurralde, “Gene silencing by microRNAs: contributions of translational repression and mRNA decay,” Nature Reviews Genetics, vol. 12, no. 2, pp. 99–110, 2011. View at: Publisher Site | Google Scholar
  13. C. Guay, E. Roggli, V. Nesca, C. Jacovetti, and R. Regazzi, “Diabetes mellitus, a microRNA-related disease?” Translational Research, vol. 157, no. 4, pp. 253–264, 2011. View at: Publisher Site | Google Scholar
  14. A. K. Pandey, P. Agarwal, K. Kaur, and M. Datta, “MicroRNAs in diabetes: tiny players in big disease,” Cellular Physiology and Biochemistry, vol. 23, no. 4–6, pp. 221–232, 2009. View at: Publisher Site | Google Scholar
  15. M. van de Bunt, K. J. Gaulton, L. Parts et al., “The miRNA profile of human pancreatic islets and beta-cells and relationship to type 2 diabetes pathogenesis,” PLoS ONE, vol. 8, no. 1, Article ID e55272, 2013. View at: Google Scholar
  16. R. Muniyappa and M. J. Quon, “Insulin action and insulin resistance in vascular endothelium,” Current Opinion in Clinical Nutrition and Metabolic Care, vol. 10, no. 4, pp. 523–530, 2007. View at: Publisher Site | Google Scholar
  17. J. A. Ware, D. D. Heistad, J. Flier, E. Salzman, and P. Weller, “Platelet-endothelium interactions,” The New England Journal of Medicine, vol. 328, no. 9, pp. 628–635, 1993. View at: Publisher Site | Google Scholar
  18. M. A. Vincent, M. Montagnani, and M. J. Quon, “Molecular and physiologic actions of insulin related to production of nitric oxide in vascular endothelium,” Current Diabetes Reports, vol. 3, no. 4, pp. 279–288, 2003. View at: Google Scholar
  19. M. Federici, A. Pandolfi, E. A. de Filippis et al., “G972R IRS-1 variant impairs insulin regulation of endothelial nitric oxide synthase in cultured human endothelial cells,” Circulation, vol. 109, no. 3, pp. 399–405, 2004. View at: Publisher Site | Google Scholar
  20. E. R. Duncan, P. A. Crossey, S. Walker et al., “Effect of endothelium-specific insulin resistance on endothelial function in vivo,” Diabetes, vol. 57, no. 12, pp. 3307–3314, 2008. View at: Google Scholar
  21. Z. Y. Jiang, Y. Lin, A. Clemont et al., “Characterization of selective resistance to insulin signaling in the vasculature of obese Zucker (fa/fa) rats,” The Journal of Clinical Investigation, vol. 104, no. 4, pp. 447–457, 1999. View at: Google Scholar
  22. C. Nacci, M. Tarquinio, and M. Montagnani, “Molecular and clinical aspects of endothelial dysfunction in diabetes,” Internal and Emergency Medicine, vol. 4, no. 2, pp. 107–116, 2009. View at: Publisher Site | Google Scholar
  23. S. B. Wheatcroft, I. L. Williams, A. M. Shah, and M. T. Kearney, “Pathophysiological implications of insulin resistance on vascular endothelial function,” Diabetic Medicine, vol. 20, no. 4, pp. 255–268, 2003. View at: Publisher Site | Google Scholar
  24. M. Montagnani, I. Golovchenko, I. Kim et al., “Inhibition of phosphatidylinositol 3-kinase enhances mitogenic actions of insulin in endothelial cells,” The Journal of Biological Chemistry, vol. 277, no. 3, pp. 1794–1799, 2002. View at: Publisher Site | Google Scholar
  25. R. Stocker and J. F. Keaney Jr., “Role of oxidative modifications in atherosclerosis,” Physiological Reviews, vol. 84, no. 4, pp. 1381–1478, 2004. View at: Publisher Site | Google Scholar
  26. A. San Martín, P. Du, A. Dikalova et al., “Reactive oxygen species-selective regulation of aortic inflammatory gene expression in type 2 diabetes,” American Journal of Physiology—Heart and Circulatory Physiology, vol. 292, no. 5, pp. H2073–H2082, 2007. View at: Publisher Site | Google Scholar
  27. L. Gao and G. E. Mann, “Vascular NAD(P)H oxidase activation in diabetes: a double-edged sword in redox signalling,” Cardiovascular Research, vol. 82, no. 1, pp. 9–20, 2009. View at: Publisher Site | Google Scholar
  28. C. E. Tabit, W. B. Chung, N. M. Hamburg, and J. A. Vita, “Endothelial dysfunction in diabetes mellitus: molecular mechanisms and clinical implications,” Reviews in Endocrine and Metabolic Disorders, vol. 11, no. 1, pp. 61–74, 2010. View at: Publisher Site | Google Scholar
  29. S. Rajagopalan and D. G. Harrison, “Reversing endothelial dysfunction with ACE inhibitors: a new TREND?” Circulation, vol. 94, no. 3, pp. 240–243, 1996. View at: Google Scholar
  30. E. J. Henriksen, “Improvement of insulin sensitivity by antagonism of the renin-angiotensin system,” American Journal of Physiology—Regulatory Integrative and Comparative Physiology, vol. 293, no. 3, pp. R974–R980, 2007. View at: Publisher Site | Google Scholar
  31. J. Oak and H. Cai, “Attenuation of angiotensin II signaling recouples eNOS and inhibits nonendothelial NOX activity in diabetic mice,” Diabetes, vol. 56, no. 1, pp. 118–126, 2007. View at: Publisher Site | Google Scholar
  32. G. M. Pieper, “Acute amelioration of diabetic endothelial dysfunction with a derivative of the nitric oxide synthase cofactor, tetrahydrobiopterin,” Journal of Cardiovascular Pharmacology, vol. 29, no. 1, pp. 8–15, 1997. View at: Publisher Site | Google Scholar
  33. N. J. Alp, S. Mussa, J. Khoo et al., “Tetrahydrobiopterin-dependent preservation of nitric oxide-mediated endothelial function in diabetes by targeted transgenic GTP-cyclohydrolase I overexpression,” The Journal of Clinical Investigation, vol. 112, no. 5, pp. 725–735, 2003. View at: Publisher Site | Google Scholar
  34. D. Tousoulis, N. Papageorgiou, E. Androulakis, K. Paroutoglou, and C. Stefanadis, “Novel therapeutic strategies targeting vascular endothelium in essential hypertension,” Expert Opinion on Investigational Drugs, vol. 19, no. 11, pp. 1395–1412, 2010. View at: Publisher Site | Google Scholar
  35. S. R. Thomas, K. Chen, and J. F. Keaney Jr., “Hydrogen peroxide activates endothelial nitric-oxide synthase through coordinated phosphorylation and dephosphorylation via a phosphoinositide 3-kinase-dependent signaling pathway,” The Journal of Biological Chemistry, vol. 277, no. 8, pp. 6017–6024, 2002. View at: Publisher Site | Google Scholar
  36. G. R. Drummond, H. Cai, M. E. Davis, S. Ramasamy, and D. G. Harrison, “Transcriptional and posttranscriptional regulation of endothelial nitric oxide synthase expression by hydrogen peroxide,” Circulation Research, vol. 86, no. 3, pp. 347–354, 2000. View at: Google Scholar
  37. C. Chen, L. J. Druhan, S. Varadharaj, Y. Chen, and J. L. Zweier, “Phosphorylation of endothelial nitric-oxide synthase regulates superoxide generation from the enzyme,” The Journal of Biological Chemistry, vol. 283, no. 40, pp. 27038–27047, 2008. View at: Publisher Site | Google Scholar
  38. F. Giacco and M. Brownlee, “Oxidative stress and diabetic complications,” Circulation Research, vol. 107, no. 9, pp. 1058–1070, 2010. View at: Publisher Site | Google Scholar
  39. C. D. Gonzalez, M. Lee, P. Marchetti et al., “The emerging role of autophagy in the pathophysiology of diabetes mellitus,” Autophagy, vol. 7, no. 1, pp. 2–11, 2011. View at: Publisher Site | Google Scholar
  40. N. Houstis, E. D. Rosen, and E. S. Lander, “Reactive oxygen species have a causal role in multiple forms of insulin resistance,” Nature, vol. 440, no. 7086, pp. 944–948, 2006. View at: Publisher Site | Google Scholar
  41. J. Li, T. Ichikawa, J. S. Janicki, and T. Cui, “Targeting the Nrf2 pathway against cardiovascular disease,” Expert Opinion on Therapeutic Targets, vol. 13, no. 7, pp. 785–794, 2009. View at: Publisher Site | Google Scholar
  42. X. Cheng, R. C. M. Siow, and G. E. Mann, “Impaired redox signaling and antioxidant gene expression in endothelial cells in diabetes: a role for mitochondria and the nuclear factor-E2-related factor 2-Kelch-like ECH-associated protein 1 defense pathway,” Antioxidants and Redox Signaling, vol. 14, no. 3, pp. 469–487, 2011. View at: Publisher Site | Google Scholar
  43. Y. Tan, T. Ichikawa, J. Li et al., “Diabetic downregulation of Nrf2 activity via ERK contributes to oxidative stress-induced insulin resistance in cardiac cells in vitro and in vivo,” Diabetes, vol. 60, no. 2, pp. 625–633, 2011. View at: Publisher Site | Google Scholar
  44. J. Zhang, J. M. Patel, Y. D. Li, and E. R. Block, “Proinflammatory cytokines downregulate gene expression and activity of constitutive nitric oxide synthase in porcine pulmonary artery endothelial cells,” Research Communications in Molecular Pathology and Pharmacology, vol. 96, no. 1, pp. 71–87, 1997. View at: Google Scholar
  45. P. Libby, P. M. Ridker, and A. Maseri, “Inflammation and atherosclerosis,” Circulation, vol. 105, no. 9, pp. 1135–1143, 2002. View at: Publisher Site | Google Scholar
  46. J. A. Beckman, F. Paneni, F. Cosentino et al., “Diabetes and vascular disease: pathophysiology, clinical consequences, and medical therapy: part II,” European Heart Journal, vol. 34, no. 31, pp. 2444–2452, 2013. View at: Google Scholar
  47. J. F. Keaney Jr., J. M. Massaro, M. G. Larson et al., “Heritability and correlates of intercellular adhesion molecule-1 in the Framingham Offspring study,” Journal of the American College of Cardiology, vol. 44, no. 1, pp. 168–173, 2004. View at: Publisher Site | Google Scholar
  48. A. Festa, R. D'Agostino Jr., G. Howard, L. Mykkänen, R. P. Tracy, and S. M. Haffner, “Chronic subclinical inflammation as part of the insulin resistance syndrome: the insulin resistance atherosclerosis study (IRAS),” Circulation, vol. 102, no. 1, pp. 42–47, 2000. View at: Google Scholar
  49. A. D. Pradhan, J. E. Manson, N. Rifai, J. E. Buring, and P. M. Ridker, “C-reactive protein, interleukin 6, and risk of developing type 2 diabetes mellitus,” Journal of the American Medical Association, vol. 286, no. 3, pp. 327–334, 2001. View at: Google Scholar
  50. M. B. Schulze, E. B. Rimm, T. Li, N. Rifai, M. J. Stampfer, and F. B. Hu, “C-reactive protein and incident cardiovascular events among men with diabetes,” Diabetes Care, vol. 27, no. 4, pp. 889–894, 2004. View at: Publisher Site | Google Scholar
  51. B. B. Duncan, M. I. Schmidt, J. S. Pankow et al., “Low-grade systemic inflammation and the development of type 2 diabetes: the atherosclerosis risk in communities study,” Diabetes, vol. 52, no. 7, pp. 1799–1805, 2003. View at: Google Scholar
  52. M. A. Read, M. Z. Whitley, A. J. Williams, and T. Collins, “NF-κB and IκBα: an inducible regulatory system in endothelial activation,” Journal of Experimental Medicine, vol. 179, no. 2, pp. 503–512, 1994. View at: Google Scholar
  53. C. de Alvaro, T. Teruel, R. Hernandez, and M. Lorenzo, “Tumor necrosis factor alpha produces insulin resistance in skeletal muscle by activation of inhibitor kappaB kinase in a p38 MAPK-dependent manner,” The Journal of Biological Chemistry, vol. 279, no. 17, pp. 17070–17078, 2004. View at: Publisher Site | Google Scholar
  54. F. Kim, M. Pham, E. Maloney et al., “Vascular inflammation, insulin resistance, and reduced nitric oxide production precede the onset of peripheral insulin resistance,” Arteriosclerosis, Thrombosis, and Vascular Biology, vol. 28, no. 11, pp. 1982–1988, 2008. View at: Publisher Site | Google Scholar
  55. L. Bonfini, E. Migliaccio, G. Pelicci, L. Lanfrancone, and P. G. Pelicci, “Not all Shc's roads lead to Ras,” Trends in Biochemical Sciences, vol. 21, no. 7, pp. 257–261, 1996. View at: Publisher Site | Google Scholar
  56. G. Pelicci, L. Dente, A. de Giuseppe et al., “A family of Shc related proteins with conserved PTB, CH1 and SH2 regions,” Oncogene, vol. 13, no. 3, pp. 633–641, 1996. View at: Google Scholar
  57. R. Sakai, J. T. Henderson, J. P. O'Bryan, A. J. Elia, T. M. Saxton, and T. Pawson, “The mammalian ShcB and ShcC phosphotyrosine docking proteins function in the maturation of sensory and sympathetic neurons,” Neuron, vol. 28, no. 3, pp. 819–833, 2000. View at: Publisher Site | Google Scholar
  58. E. Migliaccio, S. Mele, A. E. Salcini et al., “Opposite effects of the p52(shc)/p46(shc) and p66(shc) splicing isoforms on the EGF receptor-MAP kinase-fos signalling pathway,” The EMBO Journal, vol. 16, no. 4, pp. 706–716, 1997. View at: Publisher Site | Google Scholar
  59. G. Pelicci, L. Lanfrancone, F. Grignani et al., “A novel transforming protein (SHC) with an SH2 domain is implicated in mitogenic signal transduction,” Cell, vol. 70, no. 1, pp. 93–104, 1992. View at: Publisher Site | Google Scholar
  60. M. K. Wills and N. Jones, “Teaching an old dogma new tricks: twenty years of Shc adaptor signalling,” Biochemical Journal, vol. 447, no. 1, pp. 1–16, 2012. View at: Google Scholar
  61. E. Migliaccio, M. Giogio, S. Mele et al., “The p66(shc) adaptor protein controls oxidative stress response and life span in mammals,” Nature, vol. 402, no. 6759, pp. 309–313, 1999. View at: Publisher Site | Google Scholar
  62. E. Y. Skolnik, A. Batzer, N. Li et al., “The function of GRB2 in linking the insulin receptor to Ras signaling pathways,” Science, vol. 260, no. 5116, pp. 1953–1955, 1993. View at: Google Scholar
  63. A. Aronheim, D. Engelberg, N. Li, N. Ai-Alawi, J. Schlessinger, and M. Karin, “Membrane targeting of the nucleotide exchange factor Sos is sufficient for activating the Ras signaling pathway,” Cell, vol. 78, no. 6, pp. 949–961, 1994. View at: Publisher Site | Google Scholar
  64. M. Ohmichi, K. Matuoka, T. Takenawa, and A. R. Saltiel, “Growth factors differentially stimulate the phosphorylation of Shc proteins and their association with Grb2 in PC-12 pheochromocytoma cells,” The Journal of Biological Chemistry, vol. 269, no. 2, pp. 1143–1148, 1994. View at: Google Scholar
  65. M. Y. M. El-Shemerly, D. Besser, M. Nagasawa, and Y. Nagamine, “12-O-tetradecanoylphorbol-13-acetate activates the Ras/extracellular signal-regulated kinase (ERK) signaling pathway upstream of SOS involving serine phosphorylation of Shc in NIH3T3 cells,” The Journal of Biological Chemistry, vol. 272, no. 49, pp. 30599–30602, 1997. View at: Publisher Site | Google Scholar
  66. A. W. Kao, S. B. Waters, S. Okada, and J. E. Pessin, “Insulin stimulates the phosphorylation of the 66- and 52-kilodalton Shc isoforms by distinct pathways,” Endocrinology, vol. 138, no. 6, pp. 2474–2480, 1997. View at: Publisher Site | Google Scholar
  67. C. P. Yang and S. B. Horwitz, “Taxol mediates serine phosphorylation of the 66-kDa Shc isoform,” Cancer Research, vol. 60, no. 18, pp. 5171–5178, 2000. View at: Google Scholar
  68. S. Nemoto and T. Finkel, “Redox regulation of forkhead proteins through a p66Shc-dependent signaling pathway,” Science, vol. 295, no. 5564, pp. 2450–2452, 2002. View at: Publisher Site | Google Scholar
  69. F. A. Khanday, T. Yamamori, I. Mattagajasingh et al., “Rac1 leads to phosphorylation-dependent increase in stability of the p66Shc adaptor protein: role in Rac1-induced oxidative stress,” Molecular Biology of the Cell, vol. 17, no. 1, pp. 122–129, 2006. View at: Publisher Site | Google Scholar
  70. P. Pinton, A. Rimessi, S. Marchi et al., “Protein kinase C β and prolyl isomerase 1 regulate mitochondrial effects of the life-span determinant p66Shc,” Science, vol. 315, no. 5812, pp. 659–663, 2007. View at: Publisher Site | Google Scholar
  71. M. Giorgio, E. Migliaccio, F. Orsini et al., “Electron transfer between cytochrome c and p66Shc generates reactive oxygen species that trigger mitochondrial apoptosis,” Cell, vol. 122, no. 2, pp. 221–233, 2005. View at: Publisher Site | Google Scholar
  72. P. Pinton and R. Rizzuto, “P66Shc, oxidative stress and aging: importing a lifespan determinant into mitochondria,” Cell Cycle, vol. 7, no. 3, pp. 304–308, 2008. View at: Google Scholar
  73. A. Rimessi, R. Rizzuto, and P. Pinton, “Differential recruitment of PKC isoforms in HeLa cells during redox stress,” Cell Stress and Chaperones, vol. 12, no. 4, pp. 291–298, 2007. View at: Publisher Site | Google Scholar
  74. M. Li, K. Chiou, and D. A. Kass, “Shear stress inhibition of H2O2 induced p66Shc phosphorylation by ASK1-JNK inactivation in endothelium,” Heart and Vessels, vol. 22, no. 6, pp. 423–427, 2007. View at: Publisher Site | Google Scholar
  75. Y. M. Yannoni, M. Gaestel, and L. Lin, “P66ShcA interacts with MAPKAP kinase 2 and regulates its activity,” FEBS Letters, vol. 564, no. 1-2, pp. 205–211, 2004. View at: Publisher Site | Google Scholar
  76. P. Francia, C. delli Gatti, M. Bachschmid et al., “Deletion of p66Shc gene protects against age-related endothelial dysfunction,” Circulation, vol. 110, no. 18, pp. 2889–2895, 2004. View at: Publisher Site | Google Scholar
  77. M. Trinei, M. Giorgio, A. Cicalese et al., “A p53-p66Shc signalling pathway controls intracellular redox status, levels of oxidation-damaged DNA and oxidative stress-induced apoptosis,” Oncogene, vol. 21, no. 24, pp. 3872–3878, 2002. View at: Publisher Site | Google Scholar
  78. C. Napoli, I. Martin-Padura, F. de Nigris et al., “Deletion of the p66Shc longevity gene reduces systemic and tissue oxidative stress, vascular cell apoptosis, and early atherogenesis in mice fed a high-fat diet,” Proceedings of the National Academy of Sciences of the United States of America, vol. 100, no. 4, pp. 2112–2116, 2003. View at: Publisher Site | Google Scholar
  79. G. Graiani, C. Lagrasta, E. Migliaccio et al., “Genetic deletion of the p66Shc adaptor protein protects from angiotensin II-induced myocardial damage,” Hypertension, vol. 46, no. 2, pp. 433–440, 2005. View at: Publisher Site | Google Scholar
  80. O. R. Koch, S. Fusco, S. C. Ranieri et al., “Role of the life span determinant p66ShcA in ethanol-induced liver damage,” Laboratory Investigation, vol. 88, no. 7, pp. 750–760, 2008. View at: Publisher Site | Google Scholar
  81. G. Zaccagnini, F. Martelli, P. Fasanaro et al., “P66ShcA modulates tissue response to hindlimb ischemia,” Circulation, vol. 109, no. 23, pp. 2917–2923, 2004. View at: Publisher Site | Google Scholar
  82. G. Zaccagnini, F. Martelli, A. Magenta et al., “P66ShcA and oxidative stress modulate myogenic differentiation and skeletal muscle regeneration after hind limb ischemia,” The Journal of Biological Chemistry, vol. 282, no. 43, pp. 31453–31459, 2007. View at: Publisher Site | Google Scholar
  83. F. C. Franzeck, D. Hof, R. D. Spescha et al., “Expression of the aging gene p66Shc is increased in peripheral blood monocytes of patients with acute coronary syndrome but not with stable coronary artery disease,” Atherosclerosis, vol. 220, no. 1, pp. 282–286, 2012. View at: Publisher Site | Google Scholar
  84. G. G. Camici, M. Schiavoni, P. Francia et al., “Genetic deletion of p66Shc adaptor protein prevents hyperglycemia-induced endothelial dysfunction and oxidative stress,” Proceedings of the National Academy of Sciences of the United States of America, vol. 104, no. 12, pp. 5217–5222, 2007. View at: Publisher Site | Google Scholar
  85. G. H. Kim, J. J. Ryan, and S. L. Archer, “The role of redox signaling in epigenetics and cardiovascular disease,” Antioxidants and Redox Signaling, vol. 18, no. 15, pp. 1920–1936, 2013. View at: Google Scholar
  86. A. Malhotra, H. Vashistha, V. S. Yadav et al., “Inhibition of p66ShcA redox activity in cardiac muscle cells attenuates hyperglycemia-induced oxidative stress and apoptosis,” American Journal of Physiology—Heart and Circulatory Physiology, vol. 296, no. 2, pp. H380–H388, 2009. View at: Publisher Site | Google Scholar
  87. N. Ahmed, “Advanced glycation endproducts: role in pathology of diabetic complications,” Diabetes Research and Clinical Practice, vol. 67, no. 1, pp. 3–21, 2005. View at: Publisher Site | Google Scholar
  88. E. Schleicher and U. Friess, “Oxidative stress, AGE, and atherosclerosis,” Kidney International, vol. 72, no. 106, pp. S17–S26, 2007. View at: Publisher Site | Google Scholar
  89. W. Cai, J. C. He, L. Zhu, X. Chen, G. E. Striker, and H. Vlassara, “AGE-receptor-1 counteracts cellular oxidant stress induced by AGEs via negative regulation of p66Shc-dependent FKHRL1 phosphorylation,” American Journal of Physiology—Cell Physiology, vol. 294, no. 1, pp. C145–C152, 2008. View at: Publisher Site | Google Scholar
  90. J. Chintapalli, S. Yang, D. Opawumi et al., “Inhibition of wild-type p66ShcA in mesangial cells prevents glycooxidant-dependent FOXO3a regulation and promotes the survival phenotype,” American Journal of Physiology—Renal Physiology, vol. 292, no. 2, pp. F523–F530, 2007. View at: Publisher Site | Google Scholar
  91. E. W.-F. Lam, R. E. Francis, and M. Petkovic, “FOXO transcription factors: key regulators of cell fate,” Biochemical Society Transactions, vol. 34, no. 5, pp. 722–726, 2006. View at: Publisher Site | Google Scholar
  92. S. Purdom and Q. M. Chen, “Linking oxidative stress and genetics of aging with p66Shc signaling and forkhead transcription factors,” Biogerontology, vol. 4, no. 4, pp. 181–191, 2003. View at: Publisher Site | Google Scholar
  93. G. Pani, O. R. Koch, and T. Galeotti, “The p53-p66Shc-Manganese Superoxide Dismutase (MnSOD) network: a mitochondrial intrigue to generate reactive oxygen species,” International Journal of Biochemistry and Cell Biology, vol. 41, no. 5, pp. 1002–1005, 2009. View at: Publisher Site | Google Scholar
  94. T. Yamamori, A. R. White, I. Mattagajasingh et al., “P66Shc regulates endothelial NO production and endothelium-dependent vasorelaxation: implications for age-associated vascular dysfunction,” Journal of Molecular and Cellular Cardiology, vol. 39, no. 6, pp. 992–995, 2005. View at: Publisher Site | Google Scholar
  95. S. Menini, C. Iacobini, C. Ricci et al., “Ablation of the gene encoding p66Shc protects mice against AGE-induced glomerulopathy by preventing oxidant-dependent tissue injury and further AGE accumulation,” Diabetologia, vol. 50, no. 9, pp. 1997–2007, 2007. View at: Publisher Site | Google Scholar
  96. A. Natalicchio, L. Laviola, C. de Tullio et al., “Role of the p66Shc isoform in insulin-like growth factor I receptor signaling through MEK/Erk and regulation of actin cytoskeleton in rat myoblasts,” The Journal of Biological Chemistry, vol. 279, no. 42, pp. 43900–43909, 2004. View at: Publisher Site | Google Scholar
  97. A. Natalicchio, F. de Stefano, S. Perrini et al., “Involvement of the p66Shc protein in glucose transport regulation in skeletal muscle myoblasts,” American Journal of Physiology—Endocrinology and Metabolism, vol. 296, no. 2, pp. E228–E237, 2009. View at: Publisher Site | Google Scholar
  98. E. Pagnin, G. Fadini, R. de Toni, A. Tiengo, L. Calò, and A. Avogaro, “Diabetes induces p66Shc gene expression in human peripheral blood mononuclear cells: relationship to oxidative,” Journal of Clinical Endocrinology and Metabolism, vol. 90, no. 2, pp. 1130–1136, 2005. View at: Publisher Site | Google Scholar
  99. T. Thum, D. Fraccarollo, M. Schultheiss et al., “Endothelial nitric oxide synthase uncoupling impairs endothelial progenitor cell mobilization and function in diabetes,” Diabetes, vol. 56, no. 3, pp. 666–674, 2007. View at: Publisher Site | Google Scholar
  100. V. Di Stefano, C. Cencioni, G. Zaccagnini, A. Magenta, M. C. Capogrossi, and F. Martelli, “P66ShcA modulates oxidative stress and survival of endothelial progenitor cells in response to high glucose,” Cardiovascular Research, vol. 82, no. 3, pp. 421–429, 2009. View at: Publisher Site | Google Scholar
  101. C. Napoli, J. L. Witztum, F. Calara, F. de Nigris, and W. Palinski, “Maternal hypercholesterolemia enhances atherogenesis in normocholesterolemic rabbits, which is inhibited by antioxidant or lipid-lowering intervention during pregnancy: an experimental model of atherogenic mechanisms in human fetuses,” Circulation Research, vol. 87, no. 10, pp. 946–952, 2000. View at: Google Scholar
  102. C. Napoli, F. de Nigris, and W. Palinski, “Multiple role of reactive oxygen species in the arterial wall,” Journal of Cellular Biochemistry, vol. 82, no. 4, pp. 674–682, 2001. View at: Publisher Site | Google Scholar
  103. C. Napoli, F. de Nigris, J. S. Welch et al., “Maternal hypercholesterolemia during pregnancy promotes early atherogenesis in LDL receptor-deficient mice and alters aortic gene expression determined by microarray,” Circulation, vol. 105, no. 11, pp. 1360–1367, 2002. View at: Publisher Site | Google Scholar
  104. A. Boullier, D. A. Bird, M. Chang et al., “Scavenger receptors, oxidized LDL, and atherosclerosis,” Annals of the New York Academy of Sciences, vol. 947, pp. 214–223, 2001. View at: Google Scholar
  105. A. Bosutti, G. Grassi, M. Zanetti et al., “Relation between the plasma levels of LDL-cholesterol and the expression of the early marker of inflammation long pentraxin PTX3 and the stress response gene p66(ShcA) in pacemaker-implanted patients,” Clinical and Experimental Medicine, vol. 7, no. 1, pp. 16–23, 2007. View at: Publisher Site | Google Scholar
  106. T. Minamino, H. Miyauchi, T. Yoshida, Y. Ishida, H. Yoshida, and I. Komuro, “Endothelial cell senescence in human atherosclerosis: role of telomere in endothelial dysfunction,” Circulation, vol. 105, no. 13, pp. 1541–1544, 2002. View at: Publisher Site | Google Scholar
  107. S. V. Brodsky, O. Gealekman, J. Chen et al., “Prevention and reversal of premature endothelial cell senescence and vasculopathy in obesity-induced diabetes by ebselen,” Circulation Research, vol. 94, no. 3, pp. 377–384, 2004. View at: Publisher Site | Google Scholar
  108. H. Matsui-Hirai, T. Hayashi, S. Yamamoto et al., “Dose-dependent modulatory effects of insulin on glucose-induced endothelial senescence in vitro and in vivo: a relationship between telomeres and nitric oxide,” Journal of Pharmacology and Experimental Therapeutics, vol. 337, no. 3, pp. 591–599, 2011. View at: Publisher Site | Google Scholar
  109. R. J. Colman, R. M. Anderson, S. C. Johnson et al., “Caloric restriction delays disease onset and mortality in rhesus monkeys,” Science, vol. 325, no. 5937, pp. 201–204, 2009. View at: Publisher Site | Google Scholar
  110. B. Rogina and S. L. Helfand, “Sir2 mediates longevity in the fly through a pathway related to calorie restriction,” Proceedings of the National Academy of Sciences of the United States of America, vol. 101, no. 45, pp. 15998–16003, 2004. View at: Publisher Site | Google Scholar
  111. M. Potente and S. Dimmeler, “Emerging roles of SIRT1 in vascular endothelial homeostasis,” Cell Cycle, vol. 7, no. 14, pp. 2117–2122, 2008. View at: Google Scholar
  112. S. Zhou, H. Chen, Y. Wan et al., “Repression of p66Shc expression by SIRT1 contributes to the prevention of hyperglycemia-induced endothelial dysfunction,” Circulation Research, vol. 109, no. 6, pp. 639–648, 2011. View at: Publisher Site | Google Scholar
  113. R. R. Alcendor, S. Gao, P. Zhai et al., “Sirt1 regulates aging and resistance to oxidative stress in the heart,” Circulation Research, vol. 100, no. 10, pp. 1512–1521, 2007. View at: Publisher Site | Google Scholar
  114. I. Mattagajasingh, C. Kim, A. Naqvi et al., “SIRT1 promotes endothelium-dependent vascular relaxation by activating endothelial nitric oxide synthase,” Proceedings of the National Academy of Sciences of the United States of America, vol. 104, no. 37, pp. 14855–14860, 2007. View at: Publisher Site | Google Scholar
  115. A. Brunet, L. B. Sweeney, J. F. Sturgill et al., “Stress-dependent regulation of FOXO transcription factors by the SIRT1 deacetylase,” Science, vol. 303, no. 5666, pp. 2011–2015, 2004. View at: Publisher Site | Google Scholar
  116. J. Luo, A. Y. Nikolaev, S. Imai et al., “Negative control of p53 by Sir2α promotes cell survival under stress,” Cell, vol. 107, no. 2, pp. 137–148, 2001. View at: Publisher Site | Google Scholar
  117. H. Chen, Y. Wan, S. Zhou et al., “Endothelium-specific SIRT1 overexpression inhibits hyperglycemia-induced upregulation of vascular cell senescence,” Science China Life Sciences, vol. 55, no. 6, pp. 467–473, 2012. View at: Google Scholar
  118. M. A. Reddy, W. Jin, L. Villeneuve et al., “Pro-inflammatory role of MicroRNA-200 in vascular smooth muscle cells from diabetic mice,” Arteriosclerosis, Thrombosis, and Vascular Biology, vol. 32, no. 3, pp. 721–729, 2012. View at: Publisher Site | Google Scholar
  119. S. Brabletz and T. Brabletz, “The ZEB/miR-200 feedback loop-a motor of cellular plasticity in development and cancer?” EMBO Reports, vol. 11, no. 9, pp. 670–677, 2010. View at: Publisher Site | Google Scholar
  120. A. Magenta, C. Cencioni, P. Fasanaro et al., “MiR-200c is upregulated by oxidative stress and induces endothelial cell apoptosis and senescence via ZEB1 inhibition,” Cell Death and Differentiation, vol. 18, no. 10, pp. 1628–1639, 2011. View at: Publisher Site | Google Scholar
  121. J. Rosati, F. Spallotta, S. Nanni et al., “Smad-interacting protein-1 and microRNA 200 family define a nitric oxide-dependent molecular circuitry involved in embryonic stem cell mesendoderm differentiation,” Arteriosclerosis, Thrombosis, and Vascular Biology, vol. 31, no. 4, pp. 898–907, 2011. View at: Publisher Site | Google Scholar
  122. L. M. Villeneuve, M. Kato, M. A. Reddy, M. Wang, L. Lanting, and R. Natarajan, “Enhanced levels of microRNA-125b in vascular smooth muscle cells of diabetic db/db mice lead to increased inflammatory gene expression by targeting the histone methyltransferase Suv39h1,” Diabetes, vol. 59, no. 11, pp. 2904–2915, 2010. View at: Publisher Site | Google Scholar
  123. S. Manca, A. Magrelli, S. Cialfi et al., “Oxidative stress activation of miR-125b is part of the molecular switch for Hailey-Hailey disease manifestation,” Experimental Dermatology, vol. 20, no. 11, pp. 932–937, 2011. View at: Publisher Site | Google Scholar
  124. J. M. Wang, J. Tao, D. D. Chen et al., “MicroRNA miR-27b rescues bone Marrow-Derived angiogenic cell function and accelerates wound healing in type 2 diabetes mellitus,” Arteriosclerosis, Thrombosis, and Vascular Biology, vol. 34, no. 1, pp. 99–109, 2014. View at: Google Scholar
  125. P. Fasanaro, Y. D'Alessandra, V. Di Stefano et al., “MicroRNA-210 modulates endothelial cell response to hypoxia and inhibits the receptor tyrosine kinase ligand ephrin-A3,” The Journal of Biological Chemistry, vol. 283, no. 23, pp. 15878–15883, 2008. View at: Publisher Site | Google Scholar
  126. G. Zaccagnini, B. Maimone, V. Di Stefano et al., “Hypoxia-induced miR-210 modulates tissue response to acute peripheral ischemia,” Antioxid Redox Signal, 2013. View at: Publisher Site | Google Scholar
  127. S. Greco, P. Fasanaro, S. Castelvecchio et al., “MicroRNA dysregulation in diabetic ischemic heart failure patients,” Diabetes, vol. 61, no. 6, pp. 1633–1641, 2012. View at: Google Scholar
  128. Y. Li, M. A. Reddy, F. Miao et al., “Role of the histone H3 lysine 4 methyltransferase, SET7/9, in the regulation of NF-κB-dependent inflammatory genes: relevance to diabetes and inflammation,” The Journal of Biological Chemistry, vol. 283, no. 39, pp. 26771–26781, 2008. View at: Publisher Site | Google Scholar
  129. A. El-Osta, D. Brasacchio, D. Yao et al., “Transient high glucose causes persistent epigenetic changes and altered gene expression during subsequent normoglycemia,” Journal of Experimental Medicine, vol. 205, no. 10, pp. 2409–2417, 2008. View at: Google Scholar
  130. R. Candido, K. A. Jandeleit-Dahm, Z. Cao et al., “Prevention of accelerated atherosclerosis by angiotensin-converting enzyme inhibition in diabetic apolipoprotein E-deficient mice,” Circulation, vol. 106, no. 2, pp. 246–253, 2002. View at: Publisher Site | Google Scholar
  131. R. Candido, T. J. Allen, M. Lassila et al., “Irbesartan but not amlodipine suppresses diabetes-associated atherosclerosis,” Circulation, vol. 109, no. 12, pp. 1536–1542, 2004. View at: Publisher Site | Google Scholar
  132. D. S. Kerr, “Treatment of mitochondrial electron transport chain disorders: a review of clinical trials over the past decade,” Molecular Genetics and Metabolism, vol. 99, no. 3, pp. 246–255, 2010. View at: Publisher Site | Google Scholar
  133. F. Paneni, P. Mocharla, A. Akhmedov et al., “Gene silencing of the mitochondrial adaptor p66(Shc) suppresses vascular hyperglycemic memory in diabetes,” Circulation Research, vol. 111, no. 3, pp. 278–289, 2012. View at: Google Scholar
  134. Y. R. Kim, C. S. Kim, A. Naqvi et al., “Epigenetic upregulation of p66Shc mediates low-density lipoprotein cholesterol-induced endothelial cell dysfunction,” American Journal of Physiology—Heart and Circulatory Physiology, vol. 303, no. 2, pp. H189–H196, 2012. View at: Google Scholar
  135. T. Münzel, T. Gori, R. M. Bruno, and S. Taddei, “Is oxidative stress a therapeutic target in cardiovascular disease?” European Heart Journal, vol. 31, no. 22, pp. 2741–2748, 2010. View at: Google Scholar
  136. N. G. Stephens, A. Parsons, P. M. Schofield et al., “Randomised controlled trial of vitamin E in patients with coronary disease: Cambridge Heart Antioxidant Study (CHAOS),” The Lancet, vol. 347, no. 9004, pp. 781–786, 1996. View at: Publisher Site | Google Scholar
  137. R. M. Salonen, K. Nyyssönen, J. Kaikkonen et al., “Six-year effect of combined vitamin C and E supplementation on atherosclerotic progression: the antioxidant supplementation in atherosclerosis prevention (ASAP) study,” Circulation, vol. 107, no. 7, pp. 947–953, 2003. View at: Publisher Site | Google Scholar
  138. P. M. Kris-Etherton, A. H. Lichtenstein, B. V. Howard, D. Steinberg, and J. L. Witztum, “Antioxidant vitamin supplements and cardiovascular disease,” Circulation, vol. 110, no. 5, pp. 637–641, 2004. View at: Publisher Site | Google Scholar
  139. H. D. Sesso, J. E. Buring, W. G. Christen et al., “Vitamins E and C in the prevention of cardiovascular disease in men: the physicians' health study II randomized controlled trial,” Journal of the American Medical Association, vol. 300, no. 18, pp. 2123–2133, 2008. View at: Publisher Site | Google Scholar
  140. G. Bjelakovic, D. Nikolova, L. L. Gluud, R. G. Simonetti, and C. Gluud, “Mortality in randomized trials of antioxidant supplements for primary and secondary prevention: systematic review and meta-analysis,” Journal of the American Medical Association, vol. 297, no. 8, pp. 842–857, 2007. View at: Publisher Site | Google Scholar
  141. J. Stoclet, T. Chataigneau, M. Ndiaye et al., “Vascular protection by dietary polyphenols,” European Journal of Pharmacology, vol. 500, no. 1–3, pp. 299–313, 2004. View at: Publisher Site | Google Scholar
  142. L. Hooper, P. A. Kroon, E. B. Rimm et al., “Flavonoids, flavonoid-rich foods, and cardiovascular risk: a meta-analysis of randomized controlled trials,” American Journal of Clinical Nutrition, vol. 88, no. 1, pp. 38–50, 2008. View at: Google Scholar
  143. T. Szkudelski, “Resveratrol-induced inhibition of insulin secretion from rat pancreatic islets: evidence for pivotal role of metabolic disturbances,” American Journal of Physiology—Endocrinology and Metabolism, vol. 293, no. 4, pp. E901–E907, 2007. View at: Publisher Site | Google Scholar
  144. T. Szkudelski and K. Szkudelska, “Anti-diabetic effects of resveratrol,” Annals of the New York Academy of Sciences, vol. 1215, no. 1, pp. 34–39, 2011. View at: Publisher Site | Google Scholar
  145. P. Palsamy and S. Subramanian, “Ameliorative potential of resveratrol on proinflammatory cytokines, hyperglycemia mediated oxidative stress, and pancreatic β-cell dysfunction in streptozotocin-nicotinamide-induced diabetic rats,” Journal of Cellular Physiology, vol. 224, no. 2, pp. 423–432, 2010. View at: Publisher Site | Google Scholar
  146. H. Ghanim, C. L. Sia, K. Korzeniewski et al., “A resveratrol and polyphenol preparation suppresses oxidative and inflammatory stress response to a high-fat, high-carbohydrate meal,” Journal of Clinical Endocrinology and Metabolism, vol. 96, no. 5, pp. 1409–1414, 2011. View at: Publisher Site | Google Scholar
  147. M. Lagouge, C. Argmann, Z. Gerhart-Hines et al., “Resveratrol improves mitochondrial function and protects against metabolic disease by activating SIRT1 and PGC-1α,” Cell, vol. 127, no. 6, pp. 1109–1122, 2006. View at: Publisher Site | Google Scholar
  148. S. Timmers, M. K. Hesselink, and P. Schrauwen, “Therapeutic potential of resveratrol in obesity and type 2 diabetes: new avenues for health benefits?” Annals of the New York Academy of Sciences, vol. 1290, pp. 83–89, 2013. View at: Google Scholar
  149. H. C. Williams and K. K. Griendling, “NADPH oxidase inhibitors: new antihypertensive agents?” Journal of Cardiovascular Pharmacology, vol. 50, no. 1, pp. 9–16, 2007. View at: Publisher Site | Google Scholar
  150. R. Cangemi, L. Loffredo, R. Carnevale et al., “Early decrease of oxidative stress by atorvastatin in hypercholesterolaemic patients: effect on circulating vitamin E,” European Heart Journal, vol. 29, no. 1, pp. 54–62, 2008. View at: Publisher Site | Google Scholar
  151. S. John, C. Delles, J. Jacobi et al., “Rapid improvement of nitric oxide bioavailability after lipid-lowering therapy with cerivastatin within two weeks,” Journal of the American College of Cardiology, vol. 37, no. 5, pp. 1351–1358, 2001. View at: Google Scholar
  152. H. P. Friedl, D. J. Smith, G. O. Till, P. D. Thomson, D. S. Louis, and P. A. Ward, “Ischemia-reperfusion in humans. Appearance of xanthine oxidase activity,” The American Journal of Pathology, vol. 136, no. 3, pp. 491–495, 1990. View at: Google Scholar
  153. R. Butler, A. D. Morris, J. J. F. Belch, A. Hill, and A. D. Struthers, “Allopurinol normalizes endothelial dysfunction in type 2 diabetics with mild hypertension,” Hypertension, vol. 35, no. 3, pp. 746–751, 2000. View at: Google Scholar
  154. T. Gori and J. D. Parker, “Nitrate-induced toxicity and preconditioning: a rationale for reconsidering the use of these drugs,” Journal of the American College of Cardiology, vol. 52, no. 4, pp. 251–254, 2008. View at: Publisher Site | Google Scholar
  155. S. R. Steinhubl, “Why have antioxidants failed in clinical trials?” American Journal of Cardiology, vol. 101, no. 10, pp. 14D–19D, 2008. View at: Publisher Site | Google Scholar

Copyright © 2014 Alessandra Magenta et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Related articles

No related content is available yet for this article.
 PDF Download Citation Citation
 Download other formatsMore
 Order printed copiesOrder

Related articles

No related content is available yet for this article.

Article of the Year Award: Outstanding research contributions of 2021, as selected by our Chief Editors. Read the winning articles.