Сердечная недостаточность и митохондриальная дисфункция: методы исследования в эксперименте и клинической практике

Сердечная недостаточность (СН) является основной причиной смертности, частых госпитализаций и низкого качества жизни. Фундаментальные механизмы, участвующие в возникновении и прогрессировании СН, в настоящее время точно не  определены. Митохондрии играют ключевую роль в процессах клеточного метаболизма, выполняя множество биологических функций. Функциональная активность митохондрий имеет неразрывную связь с их структурой. При сердечно-сосудистых заболеваниях (ССЗ) в условиях повторяющейся гипоксии/реоксигенации тканей, а также под влиянием процессов субклинического воспаления происходит патологическая перестройка митохондриома кардиомиоцитов (КМЦ). Исследования, проведённые к настоящему времени, позволяют предположить, что митохондрии могут быть ключом к пониманию начала и прогрессирования хронической сердечной недостаточности (ХСН). Анализ литературы демонстрирует, что  изучение митохондрий у  больных ХСН является актуальной темой, а число публикаций в системе PubMed/MEDLINE, касающихся исследований в данной области, прогрессивно увеличивается; в системе eLIBRARY найдено 100 публикаций по данной тематике.

В настоящем обзоре мы рассмотрели современные методы оценки структуры и функции митохондрий в экспериментальных и клинических работах и провели анализ возможности применения данных методов исследования у больных ССЗ. Показано, что, несмотря на достаточно широкий спектр возможностей изучения структурно-функционального состояния митохондрий КМЦ при ХСН, оцениваемые косвенные признаки митохондриальной дисфункции являются суррогатными маркерами, степень информативности которых необходимо изучить в сопоставлении с реальным состоянием ультраструктуры митохондрий КМЦ, клинической картиной заболевания и  прогнозом пациентов. Актуализирована необходимость проведения клинических исследований, направленных на изучение ассоциации прямых ультраструктурных характеристик митохондрий КМЦ с  косвенными признаками митохондриальной дисфункции, с  клиническим течением и  исходами ХСН. Это  позволит получить принципиально новые фундаментальные знания о  механизмах развития и  прогрессирования данного патофизиологического феномена, оценить степень информативности маркеров нарушения митохондриальной функции при ХСН, что послужит основанием для внедрения изучаемых диагностических методов в реальную клиническую практику.

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