Endothelial dysfunction in the pathogenesis of complications of diabetes mellitus

Abstract

Vascular complications are common manifestations of diabetes mellitus (DM). The pathogenesis of these conditions has not been fully understood. Endothelial dysfunction (ED) is considered as an important pathogenetic mechanism for the formation of macro- and microvascular complications in DM. The main links in the pathogenesis of ED in diabetic complications include chronic hyperglycemia, oxidative stress, apoptosis, autophagy, endoplasmic reticulum stress and inflammatory reactions. These conditions cause damage to endothelial cells, often acting by a synergistic mechanism. These pathological processes lead to a decrease in vasodilation and impaired vascular homeostasis, which causes vasculopathy against the background of type 1 and type 2 diabetes. The pathogenesis of ED involves a violation of a large number of signaling pathways, the production of free radicals, the adhesion of leukocytes to the vascular wall, a decrease in the synthesis of vasodilating mediators and the activation of proinflammatory cytokines. A better understanding of the pathogenesis of ED will reduce the risk of vascular diabetic complications due to timely pharmacological effects on the main pathogenetic processes.