Furthermore, cardiac fibrosis is an important step in the pathogenesis of diabetic cardiomyopathy, where various stimuli activate the cardiac fibroblasts (CFs) to myofibroblasts (MFs) that release extracellular matrix (ECM) proteins through the intracellular signaling pathway by transforming growth factor β1 (TGF-β1) which activates Smads-dependent signaling causing cardiac fibrosis in the hearts of diabetic mice (56). Here, TGFB1 is linked to diabetic cardiomyopathy.