title: Molecular pathogenesis of myocardial remodeling and new potential therapeutic targets in chronic heart failure.
abstract: It is well known that the natural history of chronic heart failure (CHF),regardless of age and aetiology,is characterized by progressive cardiac dysfunction refractory to conventional cardiokinetic, diuretic and peripheral vasodilator therapy. Several previous studies, both in animals and humans, showed that the key pathogenetic element of CHF negative clinical evolution is constituted by myocardial remodeling. This is a complex pathologic process of ultrastructural rearrangement of the heart induced by various neuro-humoral factors released by cardiac fibrocells in response to biomechanical stress connected to chronic haemodynamic overload. Typical features of myocardial remodeling are represented by cardiomyocytes hypertrophy and apoptosis, extracellular matrix alterations, mesenchymal fibrotic and phlogistic processes and by cardiac gene expression modifications with fetal genetic program reactivation. In the last years, increasing knowledge of subtle molecular and cellular mechanisms involved in myocardial remodeling has led to the discovery of some new potential therapeutic targets capable of inducing its regression. In this paper our attention is focused on the possible use of antiapoptotic and antifibrotic agents, and on the fascinating perspectives offered by the development of myocardial gene therapy and, in particular, by myocardial regenerative therapy.
authors.affiliation: Department of Pediatrics, Pediatric Cardiology Service, University of Catania, Via S Sofia 78, Catania, 95123, Italy. distef@unict.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Distefano
authors.forename: Pietro
authors.initials: P
authors.lastname: Sciacca
mesh_terms: D000818:Animals; D017209:Apoptosis / Q000187:drug effects; D002908:Chronic Disease; D018450:Disease Progression; D005109:Extracellular Matrix / Q000187:drug effects / Q000473:pathology; D005355:Fibrosis / Q000473:pathology; D015870:Gene Expression; D015316:Genetic Therapy / Q000379:methods*; D006333:Heart Failure / Q000473:pathology* / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D009200:Myocardial Contraction; D009206:Myocardium / Q000473:pathology*; D032383:Myocytes, Cardiac / Q000473:pathology; D015398:Signal Transduction; D033581:Stem Cell Transplantation; D020257:Ventricular Remodeling