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Diabetes activates cytosolic MMP-9 and MMP-2, and activated MMPs damage the mitochondria. ROS production is increased and mtDNA is damaged resulting in cell loss and the development of diabetic retinopathy. To make the bad situation worse, due to damaged mtDNA, transcription of mtDNA-encoded proteins of the electron transport chain (ETC) is impaired further exacerbating ROS production and cell loss.
