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ME1 and ME3 require NADP + and ME2 utilizes either NAD + or NADP + for their catalytic activities, thus NADPH can be produced by ME both directly and indirectly through the activity of the NNT that catalyzes the transfer of hydride ions from NADH to NADP + and produces NADPH in mitochondria

TGF- is a major player in myocardial fibrosis by upregulating collagen synthesis and inhibiting collagen degradation, while the production of TGF- is stimulated by high blood glucose levels and insulin resistance which are the main characteristics of diabetes which also promote the manifestation of DCM

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These peptides exert their effects by binding to melanocortin receptors located throughout the brain and nervous system