Trace elements in diabetic cardiomyopathy: An electrophysiological overview

Abstract

There is a growing body of evidence that Diabetes Mellitus leads to a specific cardiomyopathy apart from vascular disease and bring about high morbidity and mortality throughout the world. Recent clinical and experimental studies have extensively demonstrated that this cardiomyopathy causes impaired cardiac performance manifested by early diastolic and late systolic dysfunction. This impaired cardiac performance most probably have emerged upon the expression and activity of regulatory proteins such as Na⁺/Ca²⁺ exchanger, sarcoplasmic reticulum Ca²⁺-ATPase, ryanodine receptor and phospholamban. Over years many therapeutic strategies have been recommended for treatment of diabetic cardiomyopathy. Lately, inorganic elements have been suggested to have anti-diabetic effects due to their suggested ability to regulate glucose homeostasis, reduce oxidative stress or suppress phosphatases. Recent findings have shown that trace elements exert many biological effects including insulin-mimetic or antioxidant activity and in this manner they have been recommended as potential candidates for treatment of diabetes-induced cardiac complications, an effect based on their modes of action. Some of these trace elements are known to play an essential role as component of enzymes and thus modulate the organ function in physiological and pathological conditions. Besides, they can also manipulate redox state of the channels via antioxidant properties and thus contribute to the regulation of [Ca²⁺]_i homeostasis and cardiac ion channels. On account of little information about some trace elements, we discussed the effect of vanadium, selenium, zinc and tungstate on diabetic heart complications.

Keywords: Diabetic cardiomyopathy; Electrophysiology; Trace elements; Insulin-mimetic; Antioxidant

Core tip: Diabetic cardiomyopathy is one of the major causes of mortality in diabetic patients. Common cellular defects underlying the progressive cardiac complications of diabetes are reduction in the rate of contraction, low myosin ATPase activity, dysregulation of [Ca²⁺]_i homeostasis and altered ionic currents. Accordingly, it is of critical importance to develop therapeutic strategies that will effectively inhibit diabetes induced fatal complications. In last decade, several trace elements have been suggested to improve performance of diabetic heart based due to their potential anti-diabetic and/or antioxidant activity. In this article the effects of trace elements on electrophysiological alterations of diabetic heart were discussed in detail.