bims-hafaim Biomed News
on Heart failure metabolism
Issue of 2026–06–21
seven papers selected by
Kyle McCommis, Saint Louis University



  1. Circ Heart Fail. 2026 Jun 17. e013766
      Altered cardiac and systemic metabolism is a hallmark of heart failure (HF). In the failing heart, cardiomyocytes develop alterations in substrate preference, mitochondrial oxidative metabolism, and the shuttling of high-energy phosphates from mitochondria to the cytosol that compromise energetic efficiency and contribute to disease progression. At the systemic level, neurohormonal activation plays a dominant role in HF with reduced ejection fraction, whereas HF with preserved ejection fraction is shaped by the clustering of multiple comorbidities, such as diabetes, obesity and hypertension, which disrupt the physiological crosstalk between the heart and metabolically active organs. This review provides a perspective on cardiac metabolism in HF. We delineate the specific alterations in substrate metabolism that characterize HF with reduced ejection fraction versus HF with preserved ejection fraction, examine the impact of interorgan communication on myocardial function, and highlight how the benefits of emerging HF therapies, including sodium-glucose cotransporter 2 inhibitors and GLP-1 receptor agonists, may be mediated, at least in part, through the restoration of metabolic homeostasis.
    Keywords:  cytosol; glucose; heart failure; obesity; sodium
    DOI:  https://doi.org/10.1161/CIRCHEARTFAILURE.125.013766
  2. Circ Res. 2026 Jun 16.
       BACKGROUND: Pathological cardiac remodeling and afterload-induced increases in energy demand together contribute to heart failure (HF). Lysosome-assisted processes, such as autophagy, coupled with alterations in mitochondrial oxidative capacity, play important roles in cardiac remodeling and HF. Furthermore, the lysosome is a hub for multiple signaling pathways governing hypertrophic growth. The TFEB (transcription factor EB) has emerged as a key regulator of lysosomal genes and mitochondrial function in multiple tissues, especially in response to external stress.
    METHODS: Leveraging a cardiomyocyte-specific TFEB knockout mouse (CTKO), pressure overload was induced by transverse aortic constriction (TAC) to elucidate the role of TFEB under hypertrophic stress conditions. Echocardiography was employed to assess cardiac function, and hearts were subsequently harvested for transcriptomic, proteomic, and metabolomic analyses. To glean further insight into the molecular mechanisms involved, we studied neonatal rat ventricular myocytes exposed to phenylephrine, an in vitro model of cardiomyocyte hypertrophy.
    RESULTS: We report that TFEB is rapidly activated and translocates to the nucleus in cardiomyocytes exposed to hypertrophic stress conditions, triggering a lysosomal gene program independent of autophagy gene changes. At baseline, contractile function measured by echocardiography appeared normal in these mice compared with their Cre-negative littermates. However, in pressure-overload stress induced by TAC, CTKO mice manifested an amplified hypertrophic response, leading rapidly to HF. Unlike WT hearts, CTKO hearts failed to increase lysosomal capacity after TAC. They manifested an increase in the steady-state levels of autophagosome-associated proteins, such as LC3II and p62, as well as accumulation of ubiquitinated proteins, suggesting a defect in protein turnover. Interestingly, CTKO mice harbored altered mitochondrial structure, reduced oxidative capacity, and reduced abundance of peroxisome PGC-1α-b (proliferator-activated receptor-1 alpha-b). Furthermore, CTKO hearts manifested reduced expression of key enzymes within metabolic pathways essential for normal myocardial metabolism, including fatty acid metabolism, carbon metabolism, and branched-chain amino acid metabolism. Surprisingly, AMPK (AMP-activated protein kinase) signaling, while normal at baseline, was significantly decreased in CTKO hearts after TAC. This reliance on TFEB for growth trigger-induced AMPK signaling was also observed in vitro in cells exposed to phenylephrine, as were the antihypertrophic effects of TFEB activation, supporting a direct role of TFEB in this process. Finally, we report that exogenous activation of AMPK in the absence of TFEB can completely rescue the exacerbated hypertrophic response both in vitro and in vivo, independent of lysosomal function. Notably, blunting of the hypertrophic response did not impact the decreased contractile function observed in TAC-treated CTKO mice, highlighting the importance of TFEB in regulating mitochondrial function in response to stress.
    CONCLUSIONS: Our findings demonstrate that TFEB antagonizes pathological hypertrophic cardiac remodeling through upregulation of lysosomal capacity, maintaining mitochondrial energetic function, and promoting AMPK signaling.
    Keywords:  autophagy; heart failure; hypertrophy; lysosomes; proteomics
    DOI:  https://doi.org/10.1161/CIRCRESAHA.125.328083
  3. Nat Commun. 2026 Jun 17.
      Heart failure (HF) is a growing global health burden characterized by impaired cardiac contractility and progressive remodeling, driven in part by disrupted Ca2+ handling and mitochondrial dysfunction. However, the molecular mechanisms coordinating these processes remain incompletely understood. Here we showed that OPA3 was decreased in both human and murine HF. Cardiomyocyte-specific deletion of Opa3 in male mice led to the progressive dilated cardiomyopathy (DCM), accompanied by impaired myocardial function, calcium cycling and mitochondria function. Mechanistically, OPA3 forms multimers that are required for its interaction with phospholamban (PLN), thereby maintaining sarcoplasmic reticulum (SR) Ca2+-ATPase (SERCA2a) activity and Ca2+ handling. OPA3 is localized to the mitochondrial outer membrane, and its absence impaired mitochondrial function. Cardiomyocyte-specific overexpression of Opa3 improved cardiac dysfunction in both pressure overload- and doxorubicin-induced HF models. Our data define a critical role of OPA3-PLN-SERCA2a axis that regulates both mitochondria and SR function, representing a potential therapeutic target for HF.
    DOI:  https://doi.org/10.1038/s41467-026-73991-4
  4. Exp Physiol. 2026 Jun 19.
      Type 2 diabetes (T2D) greatly alters cardiac fuel handling, yet how mitochondrial function adapts to the diabetic substrate environment remains unclear. This study investigated substrate-specific cardiac mitochondrial bioenergetics from a T2D rat model induced by a high-fat diet and low-dose streptozotocin. High-resolution respirometry and fluorimetry were used to measure mitochondrial O2 flux, ATP flux, reactive oxygen species production rate and mitochondrial membrane potential in cardiac tissue homogenates in two key substrate conditions: carbohydrate and fatty acid. Liquid chromatography-mass spectrometry was used to analyse the abundance of metabolites involved in the Krebs cycle and in various fatty acid metabolic pathways. Carbohydrate-supported mitochondrial respiration, ATP flux, reactive oxygen species production and mitochondrial membrane potential were preserved in T2D myocardium. In contrast, fatty acid-supported mitochondrial respiration and ATP flux in oxidative phosphorylation were significantly decreased despite increased myocardial abundance of several fatty acid species, including palmitoleic acid, cis-8-heptadecenoic acid and linoleic acid. Metabolite intermediates of the Krebs cycle were largely unchanged. These findings reveal a substrate-specific energetic defect in the diabetic heart, in which excess fatty acid supply is not matched by mitochondrial oxidative capacity, leading to metabolic inflexibility and impaired ATP generation. This work provides mechanistic insight into how nutrient overload contributes to mitochondrial inefficiency in T2D and establishes a foundation for future studies targeting lipid-mitochondria interactions.
    Keywords:  adenosine triphosphate; cardiac mitochondria; metabolite; mitochondrial respiration; reactive oxygen species; type 2 diabetes
    DOI:  https://doi.org/10.1113/EP094055
  5. Front Pharmacol. 2026 ;17 1781866
       Background: Heart failure with preserved ejection fraction (HFpEF) accounts for more than half of heart failure cases and is associated with substantial morbidity and mortality. Although sodium-glucose cotransporter-2 inhibitors (SGLT2is) have shown efficacy in reducing HFpEF hospitalizations, the disease's multi-pathway pathogenesis often limits the effectiveness of single-target interventions. This study examines whether the cardiovascular benefits of empagliflozin (EMPA) can be synergistically enhanced by co-administration with the targeted anti-fibrotic agent pirfenidone (PFD).
    Aims: We hypothesized that simultaneous modulation of metabolic stress and pro-fibrotic signaling would lead to synergistic structural and functional recovery in a severe HFpEF phenotype.
    Methods: HFpEF was induced in Sprague-Dawley rats (n = 16/group) using a two-hit model [NG-nitro-L-arginine methyl ester (L-NAME) and a high-fat diet (HFD)] over 5 weeks. The rats subsequently received daily oral EMPA (0.35 g/kg/d), PFD (0.3 g/kg/d), or combination therapy (EMPA + PFD) for 4 weeks. Treatment efficacy was evaluated via echocardiography, histopathology, and exercise tolerance testing. Further insights into the underlying transcriptional mechanisms were gained through RNA sequencing and semi-quantitative Western blotting. Bliss independence analysis was used to analyze pharmacological synergy.
    Results: Co-treatment with EMPA + PFD significantly enhanced diastolic indices, left ventricular ejection fraction (LVEF), fractional shortening (FS), and cardiac output (CO) compared with controls and monotherapy groups (p < 0.05). Histological analysis revealed reduced cardiomyocyte hypertrophy and lower collagen deposition, particularly in the endocardium. Although additive improvement in systemic hemodynamics was observed, EMPA + PFD co-treatment exerted compartmentalized synergy within the myocardium. The combination reversed cellular hypertrophy and deep fibrosis, restoring diastolic and systolic function (p < 0.05). Transcriptomic profiling revealed that local myocardial rescue was mediated by gene networks linked to protein kinase C-activating G-protein-coupled receptor signaling, which blocked the downstream PKC/NF-κB inflammatory pathway and transforming growth factor-beta (TGF-β)-driven fibrosis, thereby explaining the molecular basis of functional improvement.
    Conclusion: Dual therapy with EMPA and PFD achieves compartmentalized synergy, effectively eliminating cellular hypertrophy and deep fibrosis, thereby restoring cardiac mechanics. These findings provide mechanistic proof of concept that multi-axis metabolic and antifibrotic combinations can disrupt the complex pathological cycle of HFpEF.
    Keywords:  cardiac fibrosis; compartmentalized synergy; dual therapy; empagliflozin; heart failure with preserved ejection fraction; pirfenidone; sodium–glucose co-transporter-2 inhibitor
    DOI:  https://doi.org/10.3389/fphar.2026.1781866
  6. Redox Biol. 2026 Jun 17. pii: S2213-2317(26)00264-8. [Epub ahead of print]95 104265
       AIMS: Impaired branched-chain amino acid (BCAA) catabolism has been implicated in obesity cardiomyopathy (OCM), and systemic inhibition of branched-chain ketoacid dehydrogenase kinase (BCKDK), a key negative regulator of BCAA oxidation, improves cardiac function. However, whether cardiomyocyte-specific manipulation of BCAA catabolism is sufficient to confer cardioprotection remains unknown.
    METHODS AND RESULTS: Cardiomyocyte-specific BCKDK knockout and overexpression mouse models were generated and subjected to high-fat diet feeding, followed by echocardiography, transcriptomic, metabolomic, and molecular analyses. The mechanistic findings were further validated using in vitro experiments. Despite reduced myocardial BCAA levels, cardiomyocyte-specific BCKDK deletion unexpectedly exacerbated cardiac dysfunction and ventricular remodelling in OCM. Consistently, cardiac BCKDK expression was reduced in OCM. In contrast, cardiomyocyte-specific BCKDK overexpression improved cardiac function and remodelling, accompanied by a further reduction in myocardial BCAA levels, attenuation of mitochondrial oxidative stress, and suppression of MAPK-driven inflammatory signalling. Mechanistically, BCKDK reprogrammed mitochondrial metabolism to restrain oxidative stress. Moreover, mitochondrial ROS scavenging with MitoTEMPO alleviated mitochondrial dysfunction, and reversed the MAPK activation induced by BCKDK deficiency in vitro.
    CONCLUSION: These findings reveal an unexpected BCAA-independent role of BCKDK in preserving cardiomyocyte mitochondrial function and restraining inflammatory signalling in OCM. Our study identifies cardiomyocyte-intrinsic BCKDK as a potential therapeutic target, while cautioning against overestimating the cardioprotective effects of systemic BCKDK inhibition, which may be driven primarily by extracardiac mechanisms.
    Keywords:  BCAA; BCKDK; Mitochondrial dysfunction; Obesity cardiomyopathy; Oxidative stress
    DOI:  https://doi.org/10.1016/j.redox.2026.104265
  7. Circ Heart Fail. 2026 Jun 15. e014397
       BACKGROUND: Exercise intolerance, promoted by skeletal muscle- and mitochondrial dysfunction, has been identified as a therapeutic target in heart failure with preserved ejection fraction (HFpEF). In the context of mitochondrial dysfunction, altered cardiolipin integrity has been reported in the myocardium of HFpEF, suggesting Elamipretide, a cardiolipin stabilizing agent, as potential therapeutic approach. The present study investigated cardiolipin dysregulation in the skeletal muscle of HFpEF rats and analyzed the effect of Elamipretide treatment.
    METHODS: Female zucker fatty spontaneously hypertensive heart failure F1 hybrid lean (n=10, control) and obese rats (n=24, HFpEF) were included. At 20 weeks of age, HFpEF rats were randomized into 2 groups receiving NaCl (n=12) or Elamipretide (n=12) for 12 weeks. Skeletal muscle tissue was collected for whole-muscle force, single-fiber mechanics, mitochondrial respiration, histology and molecular analyses.
    RESULTS: HFpEF rats exhibited reduced cardiolipin levels (-6.8%, P=0.007) and maturation (shown via tafazzin expression), contractile dysfunction, titin hyperphosphorylation, fiber atrophy and increased oxidative stress markers. Elamipretide improved whole muscle (soleus: +8.2%, P=0.041, extensor digitorum longus: +10.9%, P=0.016) and single-fiber (soleus: +173.2%, P<0.001, extensor digitorum longus: +66.0%, P=ns) contractile function and titin phosphorylation (soleus: -35.4%, P<0.001, extensor digitorum longus: -40.2%, P<0.001), while preventing atrophy development (soleus: +49%, P=0.001, extensor digitorum longus: +54.8%, P<0.001). Improved mitochondrial function, presumably through cardiolipin-mediated improvements in oxidative phosphorylation, could be associated with muscle force and cardiolipin integrity.
    CONCLUSIONS: Our data highlight cardiolipin stabilization as a key modulator of mitochondrial and contractile function in HFpEF, identifying Elamipretide as a promising therapeutic approach for skeletal muscle dysfunction.
    Keywords:  animals; heart failure; mitochondria; obesity; stroke volume
    DOI:  https://doi.org/10.1161/CIRCHEARTFAILURE.126.014397