Cardiology Research and Practice / 2012 / Article / Fig 4

Review Article

The Diabetic Heart: Too Sweet for Its Own Good?

Figure 4

Why is the diabetic heart harder to protect with conditioning strategies? The diabetic heart has been suggested to have a raised threshold for cardioprotection [55], this is caused by the downregulation of prosurvival kinase pathways [55, 88], resulting in dysregulation of mitochondrial permeability transition pore (mPTP), increased receptor activities for pharmacological agents [78], increased calcineurin activity [81] and evidence suggests a dysfunctional KATP channel in the mitochondria [76]. In diabetes, endoplasmic reticulum (ER) stress also causes alterations in kinase pathways leading to dysregulation of the mPTP [85]. Interestingly, some evidence suggests that the diabetic heart is in a paradoxical protective state therefore conditioning potential is lower [89].