Lipid Research Group, School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia.
Rural Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
Heart Fail Rev. 2023 Jan;28(1):261-272. doi: 10.1007/s10741-022-10268-0. Epub 2022 Aug 27.
Fibroblast growth factor 21 (FGF21) is a peptide hormone involved in energy homeostasis that protects against the development of obesity and diabetes in animal models. Its level is elevated in atherosclerotic cardiovascular diseases (CVD) in humans. However, little is known about the role of FGF21 in heart failure (HF). HF is a major global health problem with a prevalence that is predicted to rise, especially in ageing populations. Despite improved therapies, mortality due to HF remains high, and given its insidious onset, prediction of its development is challenging for physicians. The emergence of cardiac biomarkers to improve prediction, diagnosis, and prognosis of HF has received much attention over the past decade. Recent studies have suggested FGF21 is a promising biomarker candidate for HF. Preclinical research has shown that FGF21 is involved in the pathophysiology of HF through the prevention of oxidative stress, cardiac hypertrophy, and inflammation in cardiomyocytes. However, in the available clinical literature, FGF21 levels appear to be paradoxically raised in HF, potentially implying a FGF21 resistant state as occurs in obesity. Several potential confounding variables complicate the verdict on whether FGF21 is of clinical value as a biomarker. Further research is thus needed to evaluate whether FGF21 has a causal role in HF, and whether circulating FGF21 can be used as a biomarker to improve the prediction, diagnosis, and prognosis of HF. This review draws from preclinical and clinical studies to explore the role of FGF21 in HF.
成纤维细胞生长因子 21（FGF21）是一种参与能量稳态的肽类激素，可预防动物模型中肥胖和糖尿病的发生。在人类动脉粥样硬化心血管疾病（CVD）中，其水平升高。然而，关于 FGF21 在心力衰竭（HF）中的作用知之甚少。HF 是一个主要的全球健康问题，预计其患病率会上升，尤其是在老龄化人口中。尽管治疗方法有所改善，但 HF 导致的死亡率仍然很高，而且由于其隐匿性发病，医生预测其发展具有挑战性。过去十年，心脏生物标志物的出现引起了人们对改善 HF 的预测、诊断和预后的极大关注。最近的研究表明，FGF21 是 HF 的一种很有前途的生物标志物候选物。临床前研究表明，FGF21 通过预防心肌细胞中的氧化应激、心肌肥大和炎症参与 HF 的病理生理学。然而，在现有的临床文献中，HF 中 FGF21 水平似乎反常升高，这可能意味着肥胖时发生的 FGF21 抵抗状态。一些潜在的混杂变量使关于 FGF21 是否作为生物标志物具有临床价值的结论变得复杂。因此，需要进一步研究来评估 FGF21 是否在 HF 中具有因果关系，以及循环 FGF21 是否可用于改善 HF 的预测、诊断和预后。本综述借鉴了临床前和临床研究，探讨了 FGF21 在 HF 中的作用。
