“…In diabetes, increases in oxidative stress disrupt EC homeostasis (Kimura et al, 2017). In response to high glucose levels, proton gradients in the mitochondrial electron transport chain (ETC) are elevated, which initiate oxidative stress and the overproduction of superoxides (Blecha et al, 2017). Oxidative stress changes cellular transcriptional machinery leading to increased production of vasoactive factors (endothelin-1 [ET-1] and vascular endothelial growth factor [VEGF]), growth factors, and cytokines that ultimately cause alterations of organ hemodynamics, increased production of extracellular matrix (ECM) proteins (i.e., fibronectin; FN) (Abd El-Kader & Saiem Al-Dahr, 2016;Iwona, 2016;Ohshiro et al, 2006;Xu, Chiu, Feng, Chen, & Chakrabarti, 2008), structural alterations (i.e., endothelial-to-mesenchymal transition), and neovascularization.…”