New Targets to Treat the Structural Remodeling of the Myocardium

• 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
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2011.06.058

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.