Imagine our body like a big, vibrant and dynamic city, full of busy streets. In this city, blood vessels function like highways and small roads that connect all parts of the city, ensuring that all needs reach their destinations. Now, imagine if many roads in this city were damaged, blocked, or even destroyed — this is what often happens to the bodies of people with diabetes.

In people with diabetes, high blood sugar levels are constantly like heavy traffic and full of pollution. This is like smoke that damages city streets, causing damage to the road surface (blood vessels / vascular) and creating dangerous substances called free radicals, similar to soot or vehicle smoke. These free radicals can damage various parts of the city (body), including the heart, kidneys, and eyes. This condition can cause small blood vessels / microvascular (small roads) and large blood vessels / macrovascular (highways) to become damaged and not smooth, causing various complications such as retinopathy (eye disorders), neuropathy (nerve disorders), to heart disease and stroke.

But your body has little “drivers” called gasotransmitters — special gas molecules that regulate traffic in your body. Gasotransmitters like nitric oxide (NO), carbon monoxide (CO), and hydrogen sulfide (H₂S) are important messengers that help prevent “congestion” in your blood vessels by reducing oxidative stress, improving circulation, and preventing inflammation.

People with diabetes often lack these gasotransmitters, making their “city” roads more vulnerable to damage. Research suggests that these gasotransmitters could be the key to reducing or even preventing diabetes complications by keeping your blood vessels clear and open, much like a driver keeps traffic flowing smoothly.

Benefits of Gasotransmitters to Overcome Microvascular Complications in Diabetes

Gasotransmitters such as NO (nitric oxide), CO (carbon monoxide), and H₂S (hydrogen sulfide) play a complex role in regulating microvascular complications in diabetes. Although gasotransmitters can cause tissue damage when their production or activity is excessive, gasotransmitters have a protective effect on the body when in small or controlled amounts. NO, produced by enzymes such as eNOS and nNOS, plays an important role in maintaining blood vessel health by increasing the production of cGMP (cyclic Guanosine Monophosphate), which helps dilate blood vessels and improve blood flow. This is very important in preventing or slowing the development of microvascular complications, such as diabetic angiopathy (blood vessel damage due to high blood sugar). Although there is a risk of oxidative stress in certain conditions, controlled NO production can improve blood vessel conditions in a very protective way, especially through increased circulation and reduced inflammation.

CO, although known as a toxic gas in high concentrations, has a positive role in maintaining oxidative balance and supporting vascular health in diabetes. CO works by increasing the production of cGMP and reducing the formation of ROS (Reactive Oxygen Species), which can damage blood vessels. In this way, CO acts as a protective agent in vascular disease, helping to maintain the integrity of blood vessels and prevent further damage to tissues.

H₂S has also shown significant benefits, especially in supporting vasodilation or widening of blood vessels, which is essential for improving blood flow in diabetic patients. In addition, H₂S can also improve the condition of blood vessels through angiogenesis, the formation of new blood vessels, which is beneficial in reducing vascular damage as seen in diabetic retinopathy and diabetic neuropathy. By reducing oxidative stress and improving blood circulation, H₂S plays a key role in repairing and protecting tissues damaged by diabetes.

Benefits of Gasotransmitters to Overcome Macrovascular Complications in Diabetes

NO is important for blood vessel dilation and blood flow. In diabetes, especially those suffering from coronary artery disease, the sensitivity of the vessels to NO is reduced, thus worsening the dysfunction of blood vessels. Administration of NO donors such as sodium nitroprusside (SNP) can increase blood vessel dilation in type 1 diabetes, while L-arginine and NOS cofactor (BH4) help improve blood flow in type 2 diabetes. NO deficiency causes thickening of the arterial walls and reduces the ability of the vessels to repair themselves.

CO, although known to be dangerous, has protective benefits against blood vessel disorders in diabetes. Research shows that CO can increase blood vessel dilation. Induction of heme oxygenase-1 (HO-1) which produces CO naturally can improve blood vessel relaxation and reduce oxidative stress. Therapy with CO-releasing compounds has also been shown to reduce the size of cardiac infarcts, making it a potential therapy to reduce heart damage in people with diabetes.

H₂S shows great potential in improving blood vessel dysfunction in diabetes. Administration of H₂S to diabetic mice increased blood vessel relaxation and NO availability, and reduced the production of reactive oxygen species (ROS) that damage blood vessels. H₂S also protected heart function, reduced infarct size, and inhibited inflammation, making it a potential therapy for treating cardiac complications in diabetes.

Conclusion

Overall, gasotransmitters—natural gases produced by our bodies—offer new hope for treating serious complications that often arise in people with diabetes, especially problems with blood vessels. These three gasotransmitters, namely nitric oxide (NO), carbon monoxide (CO), and hydrogen sulfide (H₂S), have great potential in improving blood flow, reducing inflammation, and protecting blood vessels from further damage. More interestingly, these gasotransmitter-based interventions are relatively safe because our bodies already produce them naturally. This makes it a very promising therapeutic approach, providing a glimmer of new hope for people with diabetes to overcome various vascular complications and improve their quality of life.

Article link:

https://diabetesjournals.org/diabetes/article/65/2/331/40153/Gasotransmitters-in-Vascular-Complications-of