New Targets to Treat the Structural Remodeling of the Myocardium

Classical therapy of heart failure is based on treatment of its pre-disposing/triggering factors and of the neurohumoral activation secondary to the deterioration of cardiac function. A new view is emerging that proposes the direct intervention on the pathological structural remodeling of the myocar...

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Bibliographic Details
Published in:Journal of the American College of Cardiology 2011-10, Vol.58 (18), p.1833-1843
Main Authors: González, Arantxa, PhD, Ravassa, Susana, PhD, Beaumont, Javier, PhD, López, Begoña, PhD, Díez, Javier, MD, PhD
Format: Article
Language:English
Subjects:
Apoptosis
Biological and medical sciences
Cardiology
Cardiology. Vascular system
cardiomyocyte death
Cardiomyocytes
Cardiomyopathy
Cardiovascular
Cardiovascular disease
Cell Death - physiology
Collagen
Collagen - metabolism
Cytokines
Drug therapy
Enzymes
fibrosis
Gene expression
Heart attacks
Heart failure
Heart Failure - drug therapy
Heart Failure - metabolism
Heart Failure - physiopathology
Heart Failure - therapy
Humans
inflammation
Inflammation - pathology
Inflammation Mediators - physiology
Insulin-like growth factors
Internal Medicine
Kinases
Matrix Metalloproteinases - metabolism
Medical sciences
Myocardial Infarction - physiopathology
myocardial remodeling
Myocytes, Cardiac - pathology
Myofibroblasts - physiology
NF-kappa B - physiology
Oxidative Stress - physiology
Proteins
Signal transduction
Ventricular Remodeling - drug effects
Ventricular Remodeling - physiology
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Summary:Classical therapy of heart failure is based on treatment of its pre-disposing/triggering factors and of the neurohumoral activation secondary to the deterioration of cardiac function. A new view is emerging that proposes the direct intervention on the pathological structural remodeling of the myocardium as part of heart failure therapy. In fact, in conditions of chronic injury, the cardiomyocytic and the noncardiomyocytic components of the myocardium undergo a series of structural lesions (i.e., cardiomyocyte growth and death, inflammation, alterations of collagen matrix, and microvascular rarefaction) that are governed by a complex interplay of mechanisms. Our increasing knowledge of the role of these mechanisms in remodeling enables us not only to better understand how our more successful therapies work but also to explore novel therapies for the future. In this paper, we will examine recent insights from experimental and pilot clinical studies that have provided new targets for interventions to prevent or reverse inflammation, alterations of collagen matrix, and cardiomyocyte death.
ISSN:0735-1097
1558-3597
DOI:10.1016/j.jacc.2011.06.058