Ubiquitination in diabetic cardiomyopathy mechanisms and therapeutic perspectives

Diabetic cardiomyopathy (DCM) involves metabolic dysfunction and adverse myocardial remodeling that can progress to heart failure. Ubiquitination links diabetic stress to changes in protein turnover, signaling-complex assembly, and organellar quality control. This review examines these mechanisms across cardiomyocytes, cardiac fibroblasts, endothelial cells, and immune cells, distinguishing direct DCM evidence from findings in other disease models. We compare E3 ubiquitin ligases and deubiquitinating enzymes that converge on lipid metabolism, mitochondrial function, inflammation, and regulated cell death. Their effects depend on substrate identity, ubiquitin-chain topology, cellular context, and interactions with other post-translational modifications. We also assess pharmacological modulation, cardiac-directed gene delivery, and targeted protein degradation, while identifying limitations in selectivity, safety, and human validation. Substrate-resolved and cell-specific studies are needed to determine which ubiquitination pathways can be targeted without disrupting essential cardiac proteostasis.