Reactive oxygen species: sources, consequences and targeted therapy in type 2 diabetes
Abstract
Oxidative stress has been considered as a central mediator in the progression of diabetic complication. The intracellular reactive oxygen species (ROS) leads to oxidative stress and it is raised from the mitochondria as well as by activation of five major pathways: increased polyol pathway flux, activation of protein kinase C (PKC) pathway, increased formation of advanced glycation end products (AGEs), over activity of hexosamine pathway and increased production of angiotensin II. The increased ROS through these pathways leads to β-cell dysfunction and insulin resistance, responsible for cell damage and death. This review not only highlights the sources of ROS production and their involvement in the progression of diabetes, but also emphasizes on pharmacological interventions and targeting of ROS in type 2 diabetes. This review summarizes the ROS as potential therapeutic targets, based on a putative mechanism in the progression of the diabetes. It also summarizes current knowledge of ROS activation in type 2 diabetes as well as ROS as a possible target for its treatment. Eventually, it would be a promising target for various strategies and drugs to modulate ROS levels in diabetes.
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ROS is capable to directly damage β cells, promoting apoptosis, or it can indirectly regulate insulin signaling pathway to inhibit the function of β cells.
“Therefore, ROS is capable to directly damage β cells, promoting apoptosis, or it can indirectly regulate insulin signaling pathway to inhibit the function of β cells (82, 83).”
From Diabetes and Sarcopenic Obesity: Pathogenesis, Diagnosis, and Treatments (2020) · cites this paper as [83]
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The Role of Reactive Oxygen Species in Insulin Signaling in the Vasculature
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Astilbin Attenuates Hyperuricemia and Ameliorates Nephropathy in Fructose-Induced Hyperuricemic Rats
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Chemistry and pharmacology of an ethanol extract of Bumelia sartorum
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Polyol accumulation in muscle and liver in a mouse model of type 2 diabetes
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SIRT1 and SIRT6 Signaling Pathways in Cardiovascular Disease Protection
D’Onofrio, N., Servillo, L., & Balestrieri, M. L. (2017) · Antioxidants and Redox Signaling · doi:10.1089/ars.2017.7178 · Cited by 389 · see citing works
“The metabolic milieu in diabetes, including hyperglycemia, dyslipidemia, insulin resistance, and hyperinsulinemia, induces a vicious circle of events in the vascular wall and causes overactivation of several biochemical pathways, contributing to increased oxidative stress, apoptosis and vascular permeability, and a lo…”
BackgroundThe Role of Oxidative Stress in Pancreatic β Cell Dysfunction in Diabetes
Eguchi, N., Vaziri, N. D., Dafoe, D. C., & Ichii, H. (2021) · International Journal of Molecular Sciences · doi:10.3390/ijms22041509 · Cited by 354 · see citing works
Oxidative stress: Roles in skeletal muscle atrophy
Zhang, H., Qi, G., Wang, K., Yang, J., Shen, Y., Yang, X., Chen, X., Yao, X., Gu, X., Qi, L., et al. (2023) · Biochemical Pharmacology · doi:10.1016/j.bcp.2023.115664 · Cited by 319 · see citing works
Redox Signaling in Diabetic Wound Healing Regulates Extracellular Matrix Deposition
Kunkemoeller, B. H., & Kyriakides, T. R. (2017) · Antioxidants and Redox Signaling · doi:10.1089/ars.2017.7263 · Cited by 236 · see citing works
“PKC phosphorylates the p47 phox subunit of Nox, which induces its translocation to the cell membrane and assembly of the functional Nox complex (133).”
InfluentialDiabetes and Sarcopenic Obesity: Pathogenesis, Diagnosis, and Treatments
Wang, M., Tan, Y., Shi, Y., Wang, X., Liao, Z., & Wei, P. (2020) · Frontiers in Endocrinology · doi:10.3389/fendo.2020.00568 · Cited by 231 · see citing works
Antidiabetic phytoconstituents and their mode of action on metabolic pathways
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Self-citationNrf2: The Master and Captain of Beta Cell Fate
Baumel-Alterzon, S., Katz, L. S., Brill, G., Garcı́a-Ocaña, A., & Scott, D. K. (2020) · Trends in Endocrinology and Metabolism · doi:10.1016/j.tem.2020.11.002 · Cited by 105 · see citing works
Diabetic Muscular Atrophy: Molecular Mechanisms and Promising Therapies
Shen, Y., Li, M., Wang, K., Qi, G., Liu, H., Wang, W., Ji, Y., Chang, M., Deng, C., Xu, F., et al. (2022) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.917113 · Cited by 103 · see citing works
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“Existing experimental studies have shown that antioxidant supplementationmay improve insulin sensitivity and decrease GDM complications [48].”
RetractedRedox imbalance and mitochondrial abnormalities in the diabetic lung
Wu, J., Jin, Z. H., & Yan, L. (2016) · Redox Biology · doi:10.1016/j.redox.2016.11.003 · Cited by 88 · see citing works
Targeting type II diabetes with plant terpenes: the new and promising antidiabetic therapeutics
Panigrahy, S. K., Bhatt, R., & Kumar, A. (2020) · Biologia · doi:10.2478/s11756-020-00575-y · Cited by 86 · see citing works
Self-citationKim, M., & Jeon, J. (2022) · International Journal of Molecular Sciences · doi:10.3390/ijms23052846 · Cited by 79 · see citing works
“A major factor contributing to pancreatic β-cell dysfunction is oxidative stress-mediated mitochondrial damage [205].”
BackgroundTargeting oxidative stress through antioxidants in diabetes mellitus
Thakur, P., Kumar, A., & Kumar, A. (2017) · Journal of drug targeting · doi:10.1080/1061186x.2017.1419478 · Cited by 79 · see citing works
Self-citationA Review on Cellular and Molecular Mechanisms Linked to the Development of Diabetes Complications
Babel, R. A., & Dandekar, M. P. (2020) · Current Diabetes Reviews · doi:10.2174/1573399816666201103143818 · Cited by 76 · see citing works
Research progress on the mechanism of beta-cell apoptosis in type 2 diabetes mellitus
You, S., Zheng, J., Chen, Y., & Huang, H. (2022) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.976465 · Cited by 68 · see citing works
Ghanemi, A., Melouane, A., Yoshioka, M., & St‐Amand, J. (2019) · The International Journal of Biochemistry & Cell Biology · doi:10.1016/j.biocel.2019.105627 · Cited by 57 · see citing works
Recent progress in bone-repair strategies in diabetic conditions
Sheng, N., Xing, F., Wang, J., Zhang, Q., Nie, R., Li‐Ling, J., Duan, X., & Xie, H. (2023) · Materials Today Bio · doi:10.1016/j.mtbio.2023.100835 · Cited by 52 · see citing works
“…of ROS is associated with hyperactivation of multiple molecular pathways resulting from hyperglycemia, including the mitochondrial pathway, polyol pathway, protein kinase C (PKC) pathway, hexosamine pathway, in addition to AGE formation and increased production of angiotensin II [99 – 101].”
BackgroundWen, W., Lin, Y., & Ti, Z. (2019) · Frontiers in Endocrinology · doi:10.3389/fendo.2019.00716 · Cited by 52 · see citing works
Arginase: Biological and Therapeutic Implications in Diabetes Mellitus and Its Complications
Ren, Y., Li, Z., Li, W., Fan, X., Han, F., Huang, Y., Yu, Y., Lü, Q., & Xiong, Y. (2022) · Oxidative Medicine and Cellular Longevity · doi:10.1155/2022/2419412 · Cited by 50 · see citing works
“Reactive oxygen species (ROS) is thought to be one of the culprits to the induction and progression of DM and its complications, owing to an excess of ROS that causes oxidative stress, which promotes β-cell dysfunction, IR, and vascular dysfunction by activating multiple cellular stress-sensitive signaling pathways [6…”
Pereira, C. G., Barreira, L. A., Bijttebier, S., Pieters, L. A. C., Marques, C. F., Santos, T., Rodrigues, M. J., Varela, J. C. S., & Custódio, L. M. B. (2018) · Scientific Reports · doi:10.1038/s41598-018-23038-6 · Cited by 45 · see citing works
Effects of reactive oxygen species and antioxidant strategies on wound healing in diabetes
Yu, Q., Zheng, Z., Zhang, H., Xie, E., Chen, L., Jiang, Z., Gao, Y., Ma, J., & Yang, L. (2025) · Interdisciplinary medicine · doi:10.1002/inmd.20240062 · Cited by 44 · see citing works
Ergothioneine products derived by superoxide oxidation in endothelial cells exposed to high-glucose
Servillo, L., D’Onofrio, N., Casale, R., Cautela, D., Giovane, A., Castaldo, D., & Balestrieri, M. L. (2017) · Free Radical Biology and Medicine · doi:10.1016/j.freeradbiomed.2017.03.009 · Cited by 42 · see citing works
Sreejaya, M. M., Pillai, V. M., Ayesha, A., Baby, M., Bera, M., & Gangopadhyay, M. (2024) · Journal of Materials Chemistry B · doi:10.1039/d3tb02697c · Cited by 41 · see citing works
Vitamin D deficiency causes insulin resistance by provoking oxidative stress in hepatocytes
Tao, S., Yuan, Q., Mao, L., Chen, F., Ji, F., & Cui, Z. (2017) · Oncotarget · doi:10.18632/oncotarget.18754 · Cited by 41 · see citing works
Molecular Genetics of Abnormal Redox Homeostasis in Type 2 Diabetes Mellitus
Azarova, I. E., Polonikov, A., & Klyosova, E. Y. (2023) · International Journal of Molecular Sciences · doi:10.3390/ijms24054738 · Cited by 37 · see citing works
Zhang, H., Chen, G., Yang, J., Yang, C., & Guo, M. (2021) · Phytochemical Analysis · doi:10.1002/pca.3086 · Cited by 29 · see citing works
Almogbel, E. S. (2017) · JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH · doi:10.7860/jcdr/2017/23789.9417 · Cited by 29 · see citing works
Fathi, F. E. Z. M., Sadek, K. M., Khafaga, A. F., Alsenosy, A. A., Ghoniem, H. A., Fayez, S., & Zeweil, M. F. (2022) · Environmental Science and Pollution Research · doi:10.1007/s11356-022-22064-2 · Cited by 28 · see citing works
“Panigrahy et al. (2017) reported that hyperglycemia disrupts electron transfer and activation in the mitochondria and causes an excessive production of reactive oxygen species (ROS) via the polyol pathway.”
RetractedPereira, C. G., Locatelli, M., Innosa, D., Cacciagrano, F., Polesna, L., Santos, T., Rodrigues, M. J., & Custódio, L. M. B. (2018) · South African Journal of Botany · doi:10.1016/j.sajb.2018.06.013 · Cited by 26 · see citing works
Serum free thiols in type 2 diabetes mellitus: A prospective study
Schillern, E. E. M., Pasch, A., Feelisch, M., Waanders, F., Hendriks, S. H., Mencke, R., Harms, G., Groenier, K. H., Bilo, H. J. G., Hillebrands, J., et al. (2019) · Journal of Clinical & Translational Endocrinology · doi:10.1016/j.jcte.2019.100182 · Cited by 25 · see citing works
“Given the antioxidant properties of R-SH and the possibility of supplementation affecting circulating thiol concentrations, this may have implications for future therapeutic interventions [16].”
BackgroundReactive Oxygen Species, Glucose Metabolism, and Lipid Metabolism
Yang, Y., Wu, Y., Sun, X., & Zhang, Y. (2021) · Springer eBooks · doi:10.1007/978-981-16-0522-2_9 · Cited by 25 · see citing works
Алтуніна, Н. В., Lizogub, V. G., & Bondarchuk, O. M. (2020) · Journal of Medicine and Life · doi:10.25122/jml-2020-0018 · Cited by 22 · see citing works
“Activation of the polyol pathway leads to enhanced formation of reactive oxygen species, triggering oxidative stress (OS), which plays a key role in inducing smooth muscle cell apoptosis and cardiac remodeling [5-7].”
BackgroundRecent Progress in Fluorescent Probes for Diabetes Visualization and Drug Therapy
Jia, T.-T., Li, Y., & Niu, H. (2022) · Chemosensors · doi:10.3390/chemosensors10070280 · Cited by 21 · see citing works
Zhou, K., Xiao, S., Cao, S., Zhao, C., Zhang, M., & Ying-hua, F. (2024) · Food Chemistry X · doi:10.1016/j.fochx.2024.101630 · Cited by 21 · see citing works
“Oxidative stress is considered as a primary contributor to the development of IR (Panigrahy et al., 2017).”
Tomato ( Solanum lycopersicum L.) and type 2 diabetes
Banihani, S. A. (2018) · International Journal of Food Properties · doi:10.1080/10942912.2018.1439959 · Cited by 20 · see citing works
“The nonenzymatic glycosylation of proteins (glycation reaction), which occurs more rapidly in diabetic conditions, generates reactive oxygen species, such as superoxide ions, leading to cellular oxidative stress.([25,26]) This state may occur in the pancreas, resulting in β-cell destruction and shifting the progress o…”
BackgroundDIABETES MELLITUS: THE MODERN STATE OF THE ISSUE (PART 1)
Sharofova, M. U., Самаровна, С. Ш., & Yusufi, S. J. (2019) · Avicenna Bulletin · doi:10.25005/2074-0581-2019-21-3-502-512 · Cited by 19 · see citing works
“Повышенный уровень окислительного стресса [59], высокое содержание циркулирующих свободных жирных кислот и нарушение метаболизма липидов вызывают повреждения структуры сердца, что также может привести к диабетической кардиомиопатии [63].”
Venkateswaran, M. R., Vadivel, T. E., Jayabal, S., Murugesan, S., Rajasekaran, S., & Periyasamy, S. (2021) · Environmental Research · doi:10.1016/j.envres.2021.111656 · Cited by 18 · see citing works
RetractedLiu, J., Guo, S., Li, H., & Liu, X.-Y. (2022) · Pakistan Journal of Medical Sciences · doi:10.12669/pjms.38.5.4719 · Cited by 20 · see citing works
Fluorescence Imaging of Mitochondrial Redox State to Assess Diabetic Wounds
Mehrvar, S., Rymut, K. T., Foomani, F. H., Mostaghimi, S., Eells, J. T., Ranji, M., & Gopalakrishnan, S. (2019) · IEEE Journal of Translational Engineering in Health and Medicine · doi:10.1109/jtehm.2019.2945323 · Cited by 17 · see citing works
“oxidative stress [20], [21].”
Wang, Y., Li, Y., Yang, Z., Wang, Z., Chang, J., Zhang, T., Chi, Y., Han, N., & Zhao, K. (2019) · Medical Science Monitor · doi:10.12659/msm.914799 · Cited by 15 · see citing works
“Oxidative stress caused by overproduction of mitochondrial ROS is often deemed to be of importance to diabetic complications [30], which closely related to mitochondrial energy generation.”
BackgroundResistance of nepetin and its analogs on the fibril formation of human islet amyloid polypeptide
Xu, J., Zheng, T., Zhao, C., Huang, X., & Du, W. (2020) · International Journal of Biological Macromolecules · doi:10.1016/j.ijbiomac.2020.10.202 · Cited by 14 · see citing works
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Ying-hua, F., Li, Z., Xiao, S., Zhao, C., Zhou, K., & Cao, S. (2022) · Food & Function · doi:10.1039/d2fo00753c · Cited by 13 · see citing works
Ulusu, N. N., Gök, M., Şakul, A., Arı, N., Štefek, M., & Karasu, Ç. (2017) · Interdisciplinary Toxicology · doi:10.1515/intox-2017-0021 · Cited by 13 · see citing works
“A decrease in endogenous antioxidant mechanisms with aging or diabetes increases the vulnerability of the tissues to oxidative damage (Shakeel, 2015; Panigrahy et al., 2017).”
Busa, P., Kuthati, Y., Huang, N.-C., & Wong, C. (2022) · Frontiers in Pharmacology · doi:10.3389/fphar.2022.864088 · Cited by 13 · see citing works
“retinopathy and neuropathic complications in DM (Rolo & Palmeira, 2006; Kizub, Klymenko, & Soloviev, 2014; Karunakaran et al., 2015; Panigrahy et al., 2017).”
BackgroundInsulin resistance in vitamin D-deficient mice is alleviated by n-acetylcysteine
Cui, Z., Yuan, Q., Mao, L., Chen, F., Ji, F., & Tao, S. (2017) · Oncotarget · doi:10.18632/oncotarget.18793 · Cited by 12 · see citing works
Tang, K. S. (2020) · Current Diabetes Reviews · doi:10.2174/1573399816999201012201111 · Cited by 12 · see citing works
Zhan, X., Chen, W., Chen, J., Lei, C., & Wei, L. (2021) · Chemical Research in Toxicology · doi:10.1021/acs.chemrestox.1c00159 · Cited by 12 · see citing works
Mirnić, J., Djuric, M., Veljović, T., Gušić, I., Katanić, J., Vukoje, K., Ramić, B. D., Tadić, A., & Brkic, S. V. (2022) · Biomedicines · doi:10.3390/biomedicines10123147 · Cited by 11 · see citing works
“Moreover, extant research shows that interactions between AGEs and their receptors on inflammatory cells result in increased proinflammatory cytokine production, leading to enhanced oxidative stress and accelerated tissue damage [33,34], as shown in experimental animal studies involving diabetic rats [35,36].”
BackgroundElnagar, A., El-Dawy, K., El‐Belbasi, H. I., Rehan, I. F., Embark, H. M., Al‐Amgad, Z., Shanab, O., Mickdam, E., Batiha, G. E., Alamery, S. F., et al. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.777129 · Cited by 11 · see citing works
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Biopolymeric nanocarrier: an auspicious system for oral delivery of insulin
Panigrahy, S. K., & Kumar, A. (2022) · Journal of Biomaterials Science Polymer Edition · doi:10.1080/09205063.2022.2096527 · Cited by 10 · see citing works
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“Although he proposed a speculative mechanism based on the development of diabetes, he did not summarize ROS as a potential therapeutic target [3].”
BackgroundRetractedSestrin2 in diabetes and diabetic complications
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Phytochemical activators of Nrf2: a review of therapeutic strategy in diabetes
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“…damage, including the activation of protein kinase C (PKC) isoforms via denovosynthesis of the lipid second messenger DAG, increased hexosamine pathway flux, increased advanced glycation end product (AGE) formation, increased polyol pathway flux, and increased production of angiotensin [13].”
Molecular docking and ADMET-based mining of terpenoids against targets of type-II diabetes
Panigrahy, S. K., Jha, A., Bhatt, R., & Kumar, A. (2020) · Network Modeling Analysis in Health Informatics and Bioinformatics · doi:10.1007/s13721-020-00229-8 · Cited by 9 · see citing works
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Chronic Antihyperglycemic Effect Exerted by Traditional Extracts of Three Mexican Medicinal Plants
Espinoza-Hernández, F. A., & Adolfo Andrade-cetto, A. (2022) · Evidence-based Complementary and Alternative Medicine · doi:10.1155/2022/5970358 · Cited by 7 · see citing works
“noncanonical pathways, such as polyols, that initially cause osmotic stress and fnally damage cells by oxidative stress and abnormal stimulation of protein kinase C [5, 6].”
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“According to several studies, DM has been linked to an increase in the formation of ROS or RNS as well as a decrease in anti-oxidant potential (7).”
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Probiotic therapy as a promising strategy for gestational diabetes mellitus management
Lemos, D. E. D. A., Alves, J. L. D. B., & de Souza, E. L. (2024) · Expert Opinion on Biological Therapy · doi:10.1080/14712598.2024.2409880 · Cited by 7 · see citing works
“…receptor; GLP-1 - glucagon-like peptide-1; ROS – reactive oxygen species; PPAR-γ - peroxisome proliferator-activated receptor gamma; VLDL – very low-density lipoprotein; TC – total cholesterol; TG – triglycerides. be a strategy to reduce oxidative stress and cellular damage in pregnancy [128–130].”
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Aging: An evolutionary competition between host cells and mitochondria
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Panigrahy, S. K., Nandha, A., & Kumar, A. (2025) · Microchemical Journal · doi:10.1016/j.microc.2025.114475 · Cited by 5 · see citing works
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“, superoxide) (Panigrahy et al., 2017), or advanced glycation end products (Vlassara & Uribarri, 2014) attenuated NO bioavailability that promotes a pathologic milieu.”
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Oxidative Stress and Antioxidant Interventions in Type 2 Diabetes
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“Antioxidants have been proven to prevent the destruction of β-cells by inhibiting peroxidation chain reactions so that they can provide protection against the development of diabetes (Volpe et al., 2018; Panigrahy et al., 2017).”
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“Both conditions trigger excessive reactive oxygen species (ROS) production leading to tissue damage in important organs (Takayanagi et al. 2010; Panigrahy et al. 2017) Glucagon-like peptide-1 (GLP-1) is an incretin hormone, secreted postprandially by intestinal enteroendocrine L-cells which…”
Recent Developments in Triazole Derivatives as α-Glucoside Inhibitors for the Treatment of Diabetes
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“ROS increase insulin resistance and decrease intracellular glucose levels, leading to reduction of HBP activation and O-GlcNAcylation [17].”
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- Authors
- Panigrahy, S. K., Bhatt, R., & Kumar, A.
- Affiliations
- Guru Ghasidas Vishwavidyalaya (IN)
- National Institute of Technology Raipur (IN)
- Corresponding author
- Bhatt, Renu
- Kumar, Awanish
- Venue
- Journal of Drug Targeting
- Publisher
- Informa UK Limited
- Published
- 2016-07-19
- Volume
- 25
- Issue
- 2
- Pages
- 93-101
- ISSN
- 1026-7158 (ISSN-L)
- 1061-186X
- 1029-2330
- OpenAlex
- W2468238510
- Cited by
- 103
- References
- 142
- Citations by year
- 2026: 3 · 2025: 10 · 2024: 12 · 2023: 10 · 2022: 20 · 2021: 11 · 2020: 11 · 2019: 8 · 2018: 6 · 2017: 11 · 2016: 1
- FWCI
- 0.89
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of drug targeting (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Advanced Glycation End Products research
- Health Sciences › Medicine › Physiology › Nitric Oxide and Endothelin Effects
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Redox biology and oxidative stress
- Keywords
- reactive oxygen species, oxidative stress, type 2 diabetes, polyol pathway, protein kinase C, advanced glycation end products, hexosamine biosynthetic pathway, angiotensin II, beta-cell dysfunction, insulin resistance, diabetes complications, antioxidant therapy
- MeSH terms
- Diabetes Mellitus, Type 2, Humans, Insulin Resistance, Reactive Oxygen Species
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