Figure 7: Schematic of mechanisms of decorin-mediated signaling in high glucose-impaired angiogenesis.

In endothelial cells, decorin overexpression activates IGF1R and promotes the phosphorylation of AKT and AP-1, which is inhibited by high glucose or hyperglycemia. The activation of AP-1 will upregulate the expression of VEGF, which increases proliferation, decreases apoptosis, and promotes migration and tube formation of the cells. Finally, all of these processes contribute to the promotion of angiogenesis and ameliorate DCM.