Autophagy in ALDH2-elicited cardioprotection against ischemic heart disease: slayer or savior?

The mitochondrial isoform of aldehyde dehydrogenase (ALDH2) plays a key role in the metabolism of acetaldehyde and other toxic aldehydes. A recent seminal finding has indicated a potential role of ALDH2 activation in the cardioprotection against ischemic injury. Data from our group unveiled a myocardial protective effect of ALDH2 against ischemia/reperfusion (I/R) injury possibly through detoxification of toxic aldehydes: and a differential regulation of autophagy mediated by AMPK-mTOR and Akt-mTOR signaling cascades during ischemia and reperfusion, respectively. These findings suggest not only the therapeutic potential of ALDH2 against I/R injury but also a pivotal role of the AMPK-Akt-mTOR signaling in the paradoxical autophagic regulation of cardiomyocyte survival.