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2014 ; 164
(4
): 323-35
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gab.com Text
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Obesity, metabolic dysfunction, and cardiac fibrosis: pathophysiological
pathways, molecular mechanisms, and therapeutic opportunities
#MMPMID24880146
Cavalera M
; Wang J
; Frangogiannis NG
Transl Res
2014[Oct]; 164
(4
): 323-35
PMID24880146
show ga
Cardiac fibrosis is strongly associated with obesity and metabolic dysfunction
and may contribute to the increased incidence of heart failure, atrial
arrhythmias, and sudden cardiac death in obese subjects. This review discusses
the evidence linking obesity and myocardial fibrosis in animal models and human
patients, focusing on the fundamental pathophysiological alterations that may
trigger fibrogenic signaling, the cellular effectors of fibrosis, and the
molecular signals that may regulate the fibrotic response. Obesity is associated
with a wide range of pathophysiological alterations (such as pressure and volume
overload, metabolic dysregulation, neurohumoral activation, and systemic
inflammation); their relative role in mediating cardiac fibrosis is poorly
defined. Activation of fibroblasts likely plays a major role in
obesity-associated fibrosis; however, inflammatory cells, cardiomyocytes, and
vascular cells may also contribute to fibrogenic signaling. Several molecular
processes have been implicated in regulation of the fibrotic response in obesity.
Activation of the renin-angiotensin-aldosterone system, induction of transforming
growth factor ?, oxidative stress, advanced glycation end-products, endothelin 1,
Rho-kinase signaling, leptin-mediated actions, and upregulation of matricellular
proteins (such as thrombospondin 1) may play a role in the development of
fibrosis in models of obesity and metabolic dysfunction. Moreover, experimental
evidence suggests that obesity and insulin resistance profoundly affect the
fibrotic and remodeling response after cardiac injury. Understanding the pathways
implicated in obesity-associated fibrosis may lead to the development of novel
therapies to prevent heart failure and attenuate postinfarction cardiac
remodeling in patients with obesity.