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Alterations in cellular metabolism are fundamental to the development and progression of DKD, although the underlying mechanisms are not always easy to explain

In brief, the first and rate-limiting step is the abstraction of a hydrogen atom by non-heme ferric iron (Fe(III)), involving a proton-coupled electron transfer in which the electron is transferred directly to the iron and the proton is acquired simultaneously by the hydroxide ligand in a concerted mechanism to give a substrate radical, while the iron atom is reduced to the ferrous state (Fe(II))

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Zinc also inhibits the phosphatase and tensin homolog (PTEN), which normally dephosphorylates PIP 3 , thereby suppressing the activation of Akt