Inked to defects in cardiac energy metabolism and contractile function [17,18]; however, impaired calcium homeostasis may not explain the contractile deficit in DCM [9,10]. Altered myocellular [K+]IC and [Na+]IC may also contribute to the impaired cardiac function and energy-inefficient metabolism in DCM [19,20]. Both copper deficiency [21,22] and copper excess states [23] can cause elevated oxidative stress and impaired antioxidant defenses [24,25]. Copper deficiency can cause neurodegeneration [26], and hematological and cardiovascular disorders [22], whereas copper overload may be accompanied by hepatic and neurological diseases [27,28]. Copper homeostasis is coordinated by several regulatory protein chaperones, through which it is delivered to specific subcellular compartments and/or copper-requiring proteins without releasing free copper atoms that couldotherwise damage cells and tissues [29,30]: examples include the copper chaperone for superoxide dismutase (CCS) for SOD1, and the antioxidant 1 copper chaperone (ATOX1) for ATP7A and ATP7B. Disturbances in copper homeostasis have pronounced deleterious effects on many bodily functions, such as those observed in Menkes’ or Wilson’s diseases, which are caused by mutations in the genes encoding ATP7A and ATP7B respectively [27,31]. In addition, copper is a key cofactor for many important enzymes such as Cu/Zn-SOD (SOD1) [32], EC-SOD (SOD3) [33], cytochrome c oxidase (COX) [34], and ceruloplasmin/ferroxidase [35], whereof deficient N-hexanoic-Try-Ile-(6)-amino hexanoic amide chemical information activities have been implicated in the causation of several disease states [36-38]. It has also been shown that localized myocardial copper deficiency, caused by the heart-specific knockout of Ctr1 in mice, causes severe cardiomyopathy [39], as do genetically-mediated defects in humans and get ML390 rodents of the SCO2 gene, which encodes a chaperone protein necessary for copper metalation of the CuA site on the COII subunit of COX [40,41]. These observations provide key evidence linking myocardial copper deficiency and impaired copper metalation to the causation of cardiomyopathy. Copper deficiency causes cardiomyopathy in several animal species [42,43], wherein its pathobiology closely resembles that of DCM [24,42,43]. However, indexes of systemic copper regulation differ markedly between the two conditions. Animals with cardiomyopathy caused by insufficient copper intake exhibit clear signs of systemic copper deficiency, including hypocupremia, hypoceruloplasminemia, anemia and neutropenia, and deficient hepatic copper levels [44], all of which can be alleviated by copper replacement. By contrast, diabetic animals and patients with DCM show signs of systemic copper excess with elevations in urinary copper and copper balance, normal or elevated plasma copper and ceruloplasmin levels [8,16,45,46], and markedly elevated hepatic and renal copper levels PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/27321907 [46,47]. These observations indicate that impaired copper metabolism occurs in diabetes, and that defective copper regulation could play specific roles in the pathogenesis and progression of the diabetic complications. It has previously been shown that Cu (II) chelation with triethylenetetramine (TETA) restores indexes of systemicZhang et al. Cardiovascular Diabetology 2014, 13:100 http://www.cardiab.com/content/13/1/Page 3 ofcopper homeostasis and LV mass in diabetic patients with LV hypertrophy [48], and improves cardiac structure and function in rat models of diabetes [8,10,49,50]. The current study was designed to in.Inked to defects in cardiac energy metabolism and contractile function [17,18]; however, impaired calcium homeostasis may not explain the contractile deficit in DCM [9,10]. Altered myocellular [K+]IC and [Na+]IC may also contribute to the impaired cardiac function and energy-inefficient metabolism in DCM [19,20]. Both copper deficiency [21,22] and copper excess states [23] can cause elevated oxidative stress and impaired antioxidant defenses [24,25]. Copper deficiency can cause neurodegeneration [26], and hematological and cardiovascular disorders [22], whereas copper overload may be accompanied by hepatic and neurological diseases [27,28]. Copper homeostasis is coordinated by several regulatory protein chaperones, through which it is delivered to specific subcellular compartments and/or copper-requiring proteins without releasing free copper atoms that couldotherwise damage cells and tissues [29,30]: examples include the copper chaperone for superoxide dismutase (CCS) for SOD1, and the antioxidant 1 copper chaperone (ATOX1) for ATP7A and ATP7B. Disturbances in copper homeostasis have pronounced deleterious effects on many bodily functions, such as those observed in Menkes’ or Wilson’s diseases, which are caused by mutations in the genes encoding ATP7A and ATP7B respectively [27,31]. In addition, copper is a key cofactor for many important enzymes such as Cu/Zn-SOD (SOD1) [32], EC-SOD (SOD3) [33], cytochrome c oxidase (COX) [34], and ceruloplasmin/ferroxidase [35], whereof deficient activities have been implicated in the causation of several disease states [36-38]. It has also been shown that localized myocardial copper deficiency, caused by the heart-specific knockout of Ctr1 in mice, causes severe cardiomyopathy [39], as do genetically-mediated defects in humans and rodents of the SCO2 gene, which encodes a chaperone protein necessary for copper metalation of the CuA site on the COII subunit of COX [40,41]. These observations provide key evidence linking myocardial copper deficiency and impaired copper metalation to the causation of cardiomyopathy. Copper deficiency causes cardiomyopathy in several animal species [42,43], wherein its pathobiology closely resembles that of DCM [24,42,43]. However, indexes of systemic copper regulation differ markedly between the two conditions. Animals with cardiomyopathy caused by insufficient copper intake exhibit clear signs of systemic copper deficiency, including hypocupremia, hypoceruloplasminemia, anemia and neutropenia, and deficient hepatic copper levels [44], all of which can be alleviated by copper replacement. By contrast, diabetic animals and patients with DCM show signs of systemic copper excess with elevations in urinary copper and copper balance, normal or elevated plasma copper and ceruloplasmin levels [8,16,45,46], and markedly elevated hepatic and renal copper levels PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/27321907 [46,47]. These observations indicate that impaired copper metabolism occurs in diabetes, and that defective copper regulation could play specific roles in the pathogenesis and progression of the diabetic complications. It has previously been shown that Cu (II) chelation with triethylenetetramine (TETA) restores indexes of systemicZhang et al. Cardiovascular Diabetology 2014, 13:100 http://www.cardiab.com/content/13/1/Page 3 ofcopper homeostasis and LV mass in diabetic patients with LV hypertrophy [48], and improves cardiac structure and function in rat models of diabetes [8,10,49,50]. The current study was designed to in.