“…, hypoxia and immunologic stimuli) [48,49,50] and the loss of antioxidant defense system that includes enzymes (e.g., SOD, CAT and GSH-Px) and small molecular antioxidant scavengers (e.g., vitamin E, N -acetylcysteine and α-lipoic acid) [51,52]. The oxidative stress or ROS causes cellular damage by reacting with and/or denaturing cellular macromolecules including lipid, protein and nucleic acids, and/or even mediating or activating intracellular death signaling pathways [53], which plays an important role in the pathogenesis and progression of diabetes, fatty liver disease and their associated CKD including DN [52,54,55,56]. Grape products are rich in antioxidant chemicals, such as phenolic, flavonoid, and anthocyanidin [57,58,59], and exhibit anti-oxidative activities in both humans and animals [37,60,61].…”