Besides DAG, hyperglycemia may also activate PKC indirectly through increased flux of sorbitol pathway, increased flux of hexosamine pathway (Figure 2), and activated renin-angiotensin-aldosterone system, all of which result in the accumulation of pro-inflammatory cytokines and ROS in DCM (6, 34). This evidence concerns the gene PRRT2 and familial dilated cardiomyopathy.