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. 2019 Jun 11;20(11):2833. doi: 10.3390/ijms20112833

Figure 4.

Figure 4

Role of the RAS and the hexosamine biosynthetic pathways in DCM. High intracellular glucose levels promote the activation of the hexosamine biosynthetic pathway, leading to the O-GlcNAcylation of key proteins related to the cardiac contractile function or involved in calcium homeostasis. In addition, high glucose levels directly stimulate the production of angiotensinogen II, leading to the activation of RAS in cardiomyocytes and cell death. AGEs and ROS promote the synthesis of the ATR1, further enhancing RAS activation.