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Endothelial dysfunction in patients with type 2 diabetes: the truth is in the blood
Sarah Costantino, Shafeeq A. Mohammed, Francesco Paneni
Sarah Costantino, Shafeeq A. Mohammed, Francesco Paneni
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Commentary

Endothelial dysfunction in patients with type 2 diabetes: the truth is in the blood

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Abstract

Endothelial dysfunction remains a cornerstone of diabetic vascular complications. RBCs emerge as pivotal players in endothelial dysfunction, yet the underlying mechanisms remain elusive. In this issue of the JCI, Collado et al. show that the detrimental action of RBCs on the endothelium is mediated by extracellular vesicles (EVs). EVs derived from RBCs (RBC-EVs) of patients with diabetes were taken up by the endothelium and were able to impair endothelium-dependent relaxation via an EV-mediated transfer of the prooxidant enzyme arginase-1 (Arg1) from RBCs to endothelial cells. These findings reveal events implicated in vascular oxidative stress and set the stage for personalized approaches preventing RBC-EVs’ uptake by the endothelium.

Authors

Sarah Costantino, Shafeeq A. Mohammed, Francesco Paneni

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Figure 1

RBC-derived EVs cause endothelial dysfunction in diabetes.

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RBC-derived EVs cause endothelial dysfunction in diabetes.
EVs derived f...
EVs derived from RBCs of patients with T2D are taken up by the endothelium and impair endothelium-dependent relaxation via an EV-mediated transfer of the prooxidant enzyme Arg1. Proteoglycan remodeling is a main event fostering EV uptake and may provide targets that could serve as disease biomarkers and/or personalized therapies for blocking EV uptake. RBC-EVs are also implicated in diabetes-related comorbidities, namely hypercoagulability, myocardial infarction, and vascular dementia. Blood transfusion from patients with cardiovascular risk factors represents a potential issue given the transfer of RBC-EVs and subsequent endothelial dysfunction in the recipient patient.

Copyright © 2025 American Society for Clinical Investigation
ISSN: 0021-9738 (print), 1558-8238 (online)

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