A Molecular Perspective on the Intricate Interplay Among Exosomes, Bioenergetic Metabolism, and the Pathogenesis of Diabetic Cardiomyopathy.

Diabetic cardiomyopathy (DCM), defined as cardiac impairment resulting from the development of diabetes mellitus, has emerged as a global epidemic. DCM primarily denotes myocardial metabolic impairment induced by elevated glucose levels, with hyperglycemia serving as a separate risk factor for heart disease in a lack of hypertension and coronary atherosclerosis. Exosomes, a category of tiny extracellular vesicles essential for communication between cells, have attracted considerable interest for their prospective use in the investigation and management of DCM. Exosomes harbour bioactive chemicals that indicate specific physiological conditions, modulate bioenergetic metabolism, and facilitate tissue healing. This review elucidates the dynamic progression of exosome research in DCM through bioenergetic disruptions, encompassing different processes such as endothelial dysfunction, mitochondrial impairment, calcium signalling in the endoplasmic reticulum, cell death including apoptosis and ferroptosis, inflammation-related fibrosis, autophagy, and hypertrophy. It emphasizes the necessity for continued research to fully exploit the potential of exosomes in enhancing patient outcomes.