title: AGEs, rather than hyperglycemia, are responsible for microvascular complications in diabetes: a "glycoxidation-centric" point of view.
abstract: OBJECTIVE
  Advanced glycation end products (AGE) excess is one of the most important mechanisms involved in the pathophysiology of chronic diabetic complications. This review first summarizes the role of these compounds in microvascular pathogenesis, particularly in the light of recently proposed biochemical mechanisms for diabetic retinopathy, nephropathy and neuropathy. Then we focus on the relationship between AGE and metabolic memory, trying to clarify the former's role in the missing link between micro- and macrovascular complications.
  
  
  RESULTS
  An excessive AGE formation has been demonstrated in the newly disclosed biochemical pathways involved in the microvascular pathobiology of type 2 diabetes, confirming the central role of AGE in the progression of diabetic neuropathy, retinopathy and nephropathy. As shown by recent studies, AGE seem to be not "actors", but "directors" of processes conducting to these complications, for at least two main reasons: first, AGE have several intra- and extracellular targets, so they can be seen as a "bridge" between intracellular and extracellular damage; secondly, whatever the level of hyperglycemia, AGE-related intracellular glycation of the mitochondrial respiratory chain proteins has been found to produce more reactive oxygen species, triggering a vicious cycle that amplifies AGE formation. This may help to explain the clinical link between micro- and macrovascular disease in diabetes, contributing to clarify the mechanisms behind metabolic memory.
  
  
  CONCLUSIONS
  The pathophysiological cascades triggered by AGE have a dominant, hyperglycemia-independent role in the onset of the microvascular complications of diabetes. An effective approach to prevention and treatment must therefore focus not only on early glycemic control, but also on reducing factors related to oxidative stress, and the dietary intake of exogenous AGE in particular.
authors.affiliation: Department of Medicine, Division of Metabolic Diseases, University of Padova, Via Giustiniani n 2, 35128 Padova, Italy.
authors.forename: N C
authors.initials: NC
authors.lastname: Chilelli
authors.forename: S
authors.initials: S
authors.lastname: Burlina
authors.forename: A
authors.initials: A
authors.lastname: Lapolla
mesh_terms: D000818:Animals; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy; D003925:Diabetic Angiopathies / Q000503:physiopathology*; D003928:Diabetic Nephropathies / Q000378:metabolism / Q000503:physiopathology; D003929:Diabetic Neuropathies / Q000378:metabolism / Q000503:physiopathology; D003930:Diabetic Retinopathy / Q000378:metabolism / Q000503:physiopathology; D017127:Glycation End Products, Advanced / Q000097:blood / Q000378:metabolism*; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control; D055806:Microvessels / Q000378:metabolism / Q000503:physiopathology*; D008954:Models, Biological; D018384:Oxidative Stress
chemical_list: D017127:Glycation End Products, Advanced
keywords: Advanced glycation end products; Diabetes mellitus; Metabolic memory; Microvascular complications; Oxidative stress