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subsarcolemmal mitochondria had reduced respiration rates and ETC activity, whereas interfibrillar mitochondria did not.42 Elevated ROS levels are highly implicated in cardiac dysfunction, as they can cause mitochondrial DNA and cellular damage, either via the oxidation of proteins or the generation of toxic lipid peroxidation products.43 Evidence also suggests that mitochondrial permeability transition pores of diabetic cardiac mitochondria have increased propensity to open, allowing release of matrix metalloproteases (MMPs), which can induce apoptosis and increase susceptibility to cardiomyocyte injury.44 ROS may also activate MMPs directly, stimulating myocyte hypertrophy, apoptosis and interstitial cardiac fibrosis.45 In diabetes, baseline oxygen consumption is high due to the dominance of FA utilisation and mitochondrial uncoupling.46 Normally, ATP production is directly coupled with oxygen consumption

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FIGURE 3 2.2 Transcription factor EB Transcription factor EB (TFEB), a basic helix-loop-helix-leucine-zipper transcription factor, belongs to the MiT family (Napolitano and Ballabio, 2016)

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