Steggall Abbey, Mordi Ify R, Lang Chim C
School of Medicine, Flinders University, Adelaide 5042, Australia.
Division of Molecular and Clinical Medicine, Mailbox 2, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK.
Diseases. 2017 May 10;5(2):14. doi: 10.3390/diseases5020014.
Despite significant improvements in morbidity and mortality with current evidence-based pharmaceutical-based treatment of heart failure (HF) over the previous decades, the burden of HF remains high. An alternative approach is currently being developed, which targets myocardial energy efficiency and the dysfunction of the cardiac mitochondria. Emerging evidence suggests that the insufficient availability of ATP to the failing myocardium can be attributed to abnormalities in the myocardial utilisation of its substrates rather than an overall lack of substrate availability. Therefore, the development of potential metabolic therapeutics has commenced including trimetazidine, ranolazine and perhexiline, as well as specific mitochondrial-targeting pharmaceuticals, such as elamipretide. Large randomised controlled trials are required to confirm the role of metabolic-modulating drugs in the treatment of heart failure, but early studies have been promising in their possible efficacy for the management of heart failure in the future.
尽管在过去几十年中，基于循证药物的心力衰竭（HF）治疗在发病率和死亡率方面取得了显著改善，但HF的负担仍然很高。目前正在开发一种替代方法，该方法针对心肌能量效率和心脏线粒体功能障碍。新出现的证据表明，衰竭心肌中ATP供应不足可归因于心肌对其底物利用的异常，而非底物供应的总体缺乏。因此，已经开始开发潜在的代谢疗法，包括曲美他嗪、雷诺嗪和哌克昔林，以及特定的线粒体靶向药物，如依拉米肽。需要大型随机对照试验来证实代谢调节药物在心力衰竭治疗中的作用，但早期研究对其未来治疗心力衰竭的可能疗效很有前景。
