Role of Imbalance of "Metabolic Flexibility" in Diabetic Cardiomyopathy： Based on Theory of “Blood-Qi Disharmony”
10.13422/j.cnki.syfjx.20221729
- VernacularTitle:从“血气不和”理论探讨“代谢灵活性”失衡在糖尿病心肌病的作用
- Author:
Hongqin WANG
1
;
Fengqin XU
1
;
Qingbing ZHOU
1
;
Xiaolin LIU
1
;
Li LIU
1
;
Ying ZHANG
1
Author Information
1. Xiyuan Hospital，China Academy of Chinese Medical Sciences，Beijing 100091，China
- Publication Type:Journal Article
- Keywords:
''blood-Qi'' disharmony;
metabolic flexibility;
energy metabolism;
diabetic cardiomyopathy;
heart failure
- From:
Chinese Journal of Experimental Traditional Medical Formulae
2023;29(1):194-201
- CountryChina
- Language:Chinese
-
Abstract:
Diabetic cardiomyopathy refers to dysfunction of cardiac muscle in patients with diabetes that cannot be directly ascribed to hypertension， coronary heart disease or other defined cardiac abnormalities. Imbalance in metabolic flexibility is the underlying cause of diabetic cardiomyopathy， which is manifested as distorted nutrient sensing， slow substrate switching， and impaired energy homeostasis. In the case of diabetes/insulin resistance， cardiac fatty acid oxidation increases while glucose oxidation decreases， resulting in the imbalance in cardiac metabolic flexibility. Thus， the heart fails to switch substrates depending on the changes （taking food/fasting， rest/exercise） and the energy production in cardiomyocytes reduced， causing cardiac dysfunction. Moreover， the excessive cardiac fatty acid fails to be degraded by the mitochondrial β oxidation， triggering cardiac lipid accumulation and reduction in glucose oxidation. Therefore， the glucose in the pentose phosphate （PPP） and the hexosamine biosynthetic pathway （HBP） increases and the production of advanced glycation end products rises， inducing glycolipotoxicity. The intermediates of abnormal substrate metabolism cause oxidative stress， inflammation， mitochondrial dysfunction and further result in impaired myocardial function. Qi and blood are the main functional substances for the normal functioning of the body. Qi and blood harmonize and work together to defend against external pathogen， while disharmony of blood and Qi will induce the production of various pathological products that lead to the occurrence of diseases. The function and regulation of Qi-Blood movement are similar to those of metabolism. Qi deficiency and blood stasis， Qi stagnation and blood stasis， and other "blood-Qi disharmony" types run through the whole process of diabetic cardiomyopathy， and "blood-Qi disharmony" will affect systemic substrate metabolism and lead to impaired energy metabolism. By systematically explaining the relationship between "blood-Qi disharmony" and "metabolic flexibility" in diabetic cardiomyopathy， we provide scientific research and clinical formulation ideas for targeting "metabolic flexibility" in the prevention of diabetic cardiomyopathy with Qi-replenishing and Blood-activating medicinals.
