心力衰竭中的线粒体功能障碍:从病理生理机制到治疗机遇
Mitochondrial Dysfunction in Heart Failure: From Pathophysiological Mechanisms to Therapeutic Opportunities.
作者信息
Gallo Giovanna, Rubattu Speranza, Volpe Massimo
机构信息
Department of Clinical and Molecular Medicine, Sapienza University of Rome, Via di Grottarossa 1035-1039, 00189 Rome, RM, Italy.
IRCCS Neuromed, 86077 Pozzilli, IS, Italy.
出版信息
Int J Mol Sci. 2024 Feb 25;25(5):2667. doi: 10.3390/ijms25052667.
Mitochondrial dysfunction, a feature of heart failure, leads to a progressive decline in bioenergetic reserve capacity, consisting in a shift of energy production from mitochondrial fatty acid oxidation to glycolytic pathways. This adaptive process of cardiomyocytes does not represent an effective strategy to increase the energy supply and to restore the energy homeostasis in heart failure, thus contributing to a vicious circle and to disease progression. The increased oxidative stress causes cardiomyocyte apoptosis, dysregulation of calcium homeostasis, damage of proteins and lipids, leakage of mitochondrial DNA, and inflammatory responses, finally stimulating different signaling pathways which lead to cardiac remodeling and failure. Furthermore, the parallel neurohormonal dysregulation with angiotensin II, endothelin-1, and sympatho-adrenergic overactivation, which occurs in heart failure, stimulates ventricular cardiomyocyte hypertrophy and aggravates the cellular damage. In this review, we will discuss the pathophysiological mechanisms related to mitochondrial dysfunction, which are mainly dependent on increased oxidative stress and perturbation of the dynamics of membrane potential and are associated with heart failure development and progression. We will also provide an overview of the potential implication of mitochondria as an attractive therapeutic target in the management and recovery process in heart failure.
线粒体功能障碍是心力衰竭的一个特征,会导致生物能量储备能力逐渐下降,其表现为能量产生从线粒体脂肪酸氧化向糖酵解途径的转变。心肌细胞的这种适应性过程并非增加能量供应和恢复心力衰竭时能量稳态的有效策略,从而导致恶性循环和疾病进展。氧化应激增加会导致心肌细胞凋亡、钙稳态失调、蛋白质和脂质损伤、线粒体DNA泄漏以及炎症反应,最终刺激不同的信号通路,导致心脏重塑和衰竭。此外,心力衰竭时发生的与血管紧张素II、内皮素-1和交感-肾上腺素能过度激活并行的神经激素失调,会刺激心室心肌细胞肥大并加重细胞损伤。在本综述中,我们将讨论与线粒体功能障碍相关的病理生理机制,其主要依赖于氧化应激增加和膜电位动态的扰动,并与心力衰竭的发生和进展相关。我们还将概述线粒体作为心力衰竭管理和恢复过程中一个有吸引力的治疗靶点的潜在意义。