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The intrinsic metabolic environment of diabetes markedly exacerbates oxidative stress, and the accumulated polyunsaturated fatty acids within cardiomyocytes are highly susceptible to lipid peroxidation, leading to the excessive generation of 4-hydroxy-2-nonenal (4-HNE)

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The phosphorylation of p38 activates MITF expression, which up-regulates melanogenesis-related proteins and stimulates melanin synthesis [37,38]

& Reichel, C