Chen Jianning, Xiao Xiao, Zhou Charles, Zhang Yajing, Rhee James, Li Haobo
Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA 02114, USA.
Harvard Medical School, Boston, MA 02114, USA.
Cells. 2025 Aug 16;14(16):1269. doi: 10.3390/cells14161269.
Heart failure with preserved ejection fraction (HFpEF) represents a growing global public health challenge, now accounting for approximately half of all heart failure cases and often linked to a systemic pathophysiological process in older adults with multiple comorbidities. Despite increasing recognition of the vascular contributions to HFpEF, the precise molecular mechanisms, particularly the role of noncoding Ribonucleic Acids (ncRNAs) in mediating vascular aging and subsequent cardiac dysfunction, remain incompletely understood. This review provides a comprehensive overview of the mechanistic link between vascular aging and HFpEF, with a specific focus on the pivotal roles of ncRNAs in this complex interplay. We delineate the classification of vascular aging, its cellular hallmarks, including endothelial senescence, vascular smooth muscle cell phenotypic switching, and extracellular matrix remodeling, and its systemic implications, such as inflammaging, oxidative stress, and reduced nitric oxide bioavailability. We then detail how these vascular alterations, including increased ventricular afterload and impaired myocardial perfusion due to coronary microvascular dysfunction, contribute to HFpEF pathophysiology. The review extensively discusses recent findings on how diverse classes of ncRNAs, notably microRNAs, long noncoding RNAs, and circular RNAs, along with emerging evidence for PIWI-interacting RNAs, small nuclear RNAs, small nucleolar RNAs, and tRNA-derived small RNAs, regulate these vascular aging processes and serve as molecular bridges connecting vascular dysfunction to heart failure. In conclusion, understanding the regulatory landscape of ncRNAs in vascular aging may reveal novel biomarkers and therapeutic avenues, offering new strategies for precision medicine in HFpEF.
射血分数保留的心力衰竭(HFpEF)是一个日益严峻的全球公共卫生挑战,目前约占所有心力衰竭病例的一半,并且常与患有多种合并症的老年人的全身性病理生理过程相关。尽管人们越来越认识到血管因素对HFpEF的影响,但精确的分子机制,特别是非编码核糖核酸(ncRNAs)在介导血管衰老及随后的心脏功能障碍中的作用,仍未完全明确。本综述全面概述了血管衰老与HFpEF之间的机制联系,特别关注ncRNAs在这种复杂相互作用中的关键作用。我们阐述了血管衰老的分类、其细胞特征,包括内皮细胞衰老、血管平滑肌细胞表型转换和细胞外基质重塑,以及其全身性影响,如炎症衰老、氧化应激和一氧化氮生物利用度降低。然后,我们详细介绍了这些血管改变,包括由于冠状动脉微血管功能障碍导致的心室后负荷增加和心肌灌注受损,如何促成HFpEF的病理生理学。本综述广泛讨论了近期关于不同类型的ncRNAs,特别是微小RNA、长链非编码RNA和环状RNA,以及PIWI相互作用RNA、小核RNA、小核仁RNA和tRNA衍生的小RNA的新证据,如何调节这些血管衰老过程并作为连接血管功能障碍与心力衰竭的分子桥梁。总之,了解ncRNAs在血管衰老中的调控格局可能揭示新的生物标志物和治疗途径,为HFpEF的精准医学提供新策略。
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