Badania kliniczne i doświadczalne w chorobach serca, płuc i naczyń
Advanced glycation end products (AGE) in the pathogenesis of ischaemic cardiomyopathy in diabetic patients – preliminary report

Background:
Glycaemic disorders occurring in diabetes type 2 lead to non-enzymatic coupling of glucose to proteins, nucleic acids and lipids, thereby resulting in advanced glycation end products (AGE) which disturb myocardial mechanics.

Aim:
The aim of the work was morphological evaluation of AGE in the left ventricle of the heart in patients with diabetes type 2, and establishing whether, and in what way, AGE play a role in ischaemic cardiomyopathy in diabetic patients.

Material and methods:
The diabetes group encompassed
9 hearts explanted in patients with diabetes type 2 undergoing orthotopic heart transplant. The control group comprised 9 fragments of the left ventricular muscle with no clinical features of diabetes; the specimens originated from hearts designated for homogenic valve harvesting. The localization of AGE was detected immunohistochemically, and intensity was marked with a semi-quantitative scale.

Results:
The positive reaction in cardiomyocytes was of a cytoplasmatic character, predominantly granular, whilst in the diabetic group it was mixed, diffuse-granular. Tiny blood vessels and stromal fibroblasts displayed AGE expression. The diabetic group was characterized by a significantly stronger reaction in cardiomyocytes, stromal fibroblasts and in the walls of arterioles, as compared with the control group. The intensity of reaction did not correlate with patient age in either group; however, a significant correlation was found between reaction intensity and the duration of diabetes.

Conclusions:
Intensified AGE presence in left ventricular structures in diabetic patients indicates a likelihood of AGE in the pathogenesis of cardiac failure.