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Diabetes, Vol 48, Issue 1 1-9, Copyright © 1999 by American Diabetes Association
Role of oxidative stress in diabetic complications: a new perspective on an old paradigm
JW Baynes and SR Thorpe
Department of Chemistry and Biochemistry, University of South Carolina, Columbia 29208, USA. baynes@psc.sc.edu
Oxidative stress and oxidative damage to tissues are common end points of
chronic diseases, such as atherosclerosis, diabetes, and rheumatoid
arthritis. The question addressed in this review is whether increased
oxidative stress has a primary role in the pathogenesis of diabetic
complications or whether it is a secondary indicator of end-stage tissue
damage in diabetes. The increase in glycoxidation and lipoxidation products
in plasma and tissue proteins suggests that oxidative stress is increased
in diabetes. However, some of these products, such as 3-deoxyglucosone
adducts to lysine and arginine residues, are formed independent of
oxidation chemistry. Elevated levels of oxidizable substrates may also
explain the increase in glycoxidation and lipoxidation products in tissue
proteins, without the necessity of invoking an increase in oxidative
stress. Further, age-adjusted levels of oxidized amino acids, a more direct
indicator of oxidative stress, are not increased in skin collagen in
diabetes. We propose that the increased chemical modification of proteins
by carbohydrates and lipids in diabetes is the result of overload on
metabolic pathways involved in detoxification of reactive carbonyl species,
leading to a general increase in steady-state levels of reactive carbonyl
compounds formed by both oxidative and nonoxidative reactions. The increase
in glycoxidation and lipoxidation of tissue proteins in diabetes may
therefore be viewed as the result of increased carbonyl stress. The
distinction between oxidative and carbonyl stress is discussed along with
the therapeutic implications of this difference.

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