Gut microbiota dysbiosis and diabetic cardiomyopathy

Dysregulation of gut microbiota and its metabolites contributes to diabetic cardiomyopathy (DCM) primarily through inflammation, oxidative stress, energy metabolism disturbances, insulin resistance, apoptosis and autophagy. Gut microbiota dysbiosis disrupts intestinal barrier function, triggering inflammation and oxidative stress, which exacerbate myocardial inflammation and damage. Additionally, gut microbiota modulates bile acid metabolism, influencing the activation of Takeda G protein-coupled receptor 5(TGR5), thereby affecting glucose and lipid metabolism as well as cardiac function. Metabolites such as trimethylamine N-oxide (TMAO) may activate inflammatory pathways and impair insulin signaling, reducing insulin sensitivity and exacerbating glucose metabolism disorders, further aggravating DCM. Targeting the gut microbiota composition and restoring the homeostasis of its metabolites may be potential strategy for the prevention and treatment of DCM.