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Review
. 2021 Feb 12;10(4):721.
doi: 10.3390/jcm10040721.

Cardiometabolism as an Interlocking Puzzle between the Healthy and Diseased Heart: New Frontiers in Therapeutic Applications

Teresa Pasqua  1 , Carmine Rocca  2 , Anita Giglio  3 , Tommaso Angelone  2   4
Affiliations
Review

Cardiometabolism as an Interlocking Puzzle between the Healthy and Diseased Heart: New Frontiers in Therapeutic Applications

Teresa Pasqua et al. J Clin Med. .

Abstract

Cardiac metabolism represents a crucial and essential connecting bridge between the healthy and diseased heart. The cardiac muscle, which may be considered an omnivore organ with regard to the energy substrate utilization, under physiological conditions mainly draws energy by fatty acids oxidation. Within cardiomyocytes and their mitochondria, through well-concerted enzymatic reactions, substrates converge on the production of ATP, the basic chemical energy that cardiac muscle converts into mechanical energy, i.e., contraction. When a perturbation of homeostasis occurs, such as an ischemic event, the heart is forced to switch its fatty acid-based metabolism to the carbohydrate utilization as a protective mechanism that allows the maintenance of its key role within the whole organism. Consequently, the flexibility of the cardiac metabolic networks deeply influences the ability of the heart to respond, by adapting to pathophysiological changes. The aim of the present review is to summarize the main metabolic changes detectable in the heart under acute and chronic cardiac pathologies, analyzing possible therapeutic targets to be used. On this basis, cardiometabolism can be described as a crucial mechanism in keeping the physiological structure and function of the heart; furthermore, it can be considered a promising goal for future pharmacological agents able to appropriately modulate the rate-limiting steps of heart metabolic pathways.

Keywords: cardiac physiology; cardiometabolism; heart failure; ischemia; therapeutic targets.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Metabolic substrate used by the healthy heart. BCAAs, branched-chain amino acids.
Figure 2
Figure 2
Cardiometabolism of glucose. GLUT 1/4: Glucose Transporter; HBP: Hexosamine biosynthetic pathway; UDP-GlcNAc: uridine diphosphate-N-acetylglucosamine; PPP: Pentose phosphate pathway.
Figure 3
Figure 3
Cardiometabolism of fatty acids and ketones. CD36/FAT: Fatty Acid Transport proteins; MCT 1/2: Monocarboxylate Transporter; β-HB: β-hydroxybutyrate.
See this image and copyright information in PMC

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