Oxidative Stress and Stress-Activated Signaling Pathways: A Unifying Hypothesis of Type 2 Diabetes
Joseph L. Evans,
Ira D. Goldfine,
Betty A. Maddux and
Gerold M. Grodsky
University of California at San Francisco (I.D.G., B.A.M. G.M.G.), San Francisco, California 94143; and Medical Research Institute (J.L.E.), San Bruno, California 94066
Correspondence: Address all correspondence and requests for reprints to: Joseph L. Evans, Ph.D., Medical Research Institute, 1001 Bayhill Drive, Suite 208, San Bruno, California 94066. E-mail: jevansphd{at}earthlink.net
In both type 1 and type 2 diabetes, the late diabetic complicationsin nerve, vascular endothelium, and kidney arise from chronicelevations of glucose and possibly other metabolites includingfree fatty acids (FFA). Recent evidence suggests that commonstress-activated signaling pathways such as nuclear factor-B,p38 MAPK, and NH2-terminal Jun kinases/stress-activated proteinkinases underlie the development of these late diabetic complications.In addition, in type 2 diabetes, there is evidence that theactivation of these same stress pathways by glucose and possiblyFFA leads to both insulin resistance and impaired insulin secretion.Thus, we propose a unifying hypothesis whereby hyperglycemiaand FFA-induced activation of the nuclear factor-B, p38 MAPK,and NH2-terminal Jun kinases/stress-activated protein kinasesstress pathways, along with the activation of the advanced glycosylationend-products/receptor for advanced glycosylation end-products,protein kinase C, and sorbitol stress pathways, plays a keyrole in causing late complications in type 1 and type 2 diabetes,along with insulin resistance and impaired insulin secretionin type 2 diabetes. Studies with antioxidants such as vitaminE, -lipoic acid, and N-acetylcysteine suggest that new strategiesmay become available to treat these conditions.
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