Mitochondrial function in heart failure

Experimental and clinical studies have detected an impaired respiratory function of cardiomyocyte mitochondria in heart failure. Since the reasons for heart failure are manifold, so is mitochondrial involvement. Characteristics of mitochondrial participation in heart failure are as follows: (1) Inherited or acquired mutations of the mitochondrial or nuclear genome cause defects in different mitochondrial components, eventually resulting in cardiomyopathy. (2a) Oxidative stress depresses mitochondrial function. This occurs slowly and inevitably in the 'physiological' process of ageing, but rapidly in pathophysiologic conditions such as post-ischemic reperfusion. (2b) Free radicals damage mitochondrial DNA, proteins, and membrane lipids. Interactions between altered membrane lipids, respiratory chain components, and carrier proteins further enhance mitochondrial dysfunction. (3) Mitochondrial energy transfer via the adenine nucleotide translocator (ANT) and the mitochondrial creatine kinase is disturbed in heart failure. Especially an altered expression and a functional impairment of the ANT seems to be involved in the disturbed energy metabolism of dilated and inflammatory cardiomyopathy. (4) Mitochondria are mainly involved in the initiation and modulation of the process of programmed cell death (apoptosis). (5) Triggered by a variety of conditions during cellular dysfunction mitochondrial membrane permeability suddenly increases, followed by the collapse of the membrane potential, thus abolishing energy production and further aggravating cellular damage. (6a) Increased levels of cytokines, in particular TNF-α, in heart failure and cardiomyopathy modulate mitochondrial function. (6b) Cytokines activate the generation of nitric oxide and heat shock proteins, thus further depressing or preserving mitochondrial activity. These main mechanisms of active and passive participation of mitochondria in heart failure are reviewed in this article. At present, most of them are not completely resolved and some are still hypothetical.