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Characteristics of heart failure: Charité gains new Collaborative Research Center

The new SFB under the managementt of the Charité researches heart failure with preserved ejection fraction - a certain form of heart failure - as a systemic, heterogeneous clinical picture. © Charité l Renate Möller

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In patients with heart failure, the heart can no longer pump a sufficient volume of blood around the body. Treatment options for a specific type of heart failure – known as ‘heart failure with preserved ejection fraction’ (HFpEF) – remain extremely limited, mainly because much remains unknown about the condition. A new Collaborative Research Center (SFB) led by Charité – Universitätsmedizin Berlin will aim to address this shortfall by studying the underlying mechanisms of HFpEF and developing targeted treatments. The German Research Foundation (DFG) will provide initial funding of € 12 million for four years.

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When the heart cannot supply the body with sufficient volumes of blood – and hence oxygen and nutrients – this is known as heart failure. Common symptoms of heart failure include shortness of breath, fatigue upon exertion, chest tightness and swollen legs. The condition, which currently affects approximately four million people in Germany, is one of the most common reasons for the hospital admission. Heart failure bears a poor prognosis, and up to 50 per cent of patients will die from the disease within five years.

There are still hardly any effective therapies for about half of heart failure patients

Heart failure is currently subdivided into two different types, regardless of the condition’s underlying cause. When the heart muscle is no longer strong enough to pump sufficient volumes of blood, the patient develops what is known as ‘Heart Failure with reduced Ejection Fraction’ (HFrEF). This contrasts with ‘Heart Failure with preserved Ejection Fraction’ (HFpEF), a condition in which the heart contracts typically, but its ventricles are too stiff to fill with a sufficient blood volume. Approximately half of all individuals with heart failure have HFpEF. This latter type of heart failure is the focus of the new Collaborative Research Center. In this Charité collaborates with the Max Delbrück Center for Molecular Medicine (MDC), Freie Universität Berlin (FU), the German Heart Center Berlin (DHZB) and Hannover Medical School (MHH). 

Given current trends in population demographics, we are likely to see an increase in cases over time.

The most important underlying causes responsible for HFpEF development and progression are common risk factors and comorbidities such as high blood pressure and diabetes. Other causes include factors usually associated with these diseases, such as overweight, deconditioning and a sedentary lifestyle. This condition mainly affects the elderly and more women than men. Given current trends in population demographics, we are likely to see an increase in cases over time. In contrast to patients with HFrEF, patients with HFpEF have had very little access to effective treatment until now.

Scientists want to re-measure the disease

“Heart failure with preserved ejection fraction is a systemic disorder – that is, it affects the entire body. Sadly, our knowledge of the disease’s basic mechanisms and cardiovascular changes remains extremely limited. This means we are still not in a position to offer specific treatments to the large group of patients with HFpEF,” explains the new SFB’s spokesperson, Prof. Dr. Burkert Pieske, Head of the Department of Internal Medicine and Cardiology on Charité’s Campus Virchow-Klinikum.

“We would like our new research endeavour to remedy that. We aim to produce a comprehensive description and classification of a systemic and heterogeneous condition to improve our understanding of HFpEF and our ability to treat it. We will do this on multiple levels. In addition to looking at the body as a whole and individual organs, we will research both the molecular and cellular levels,” explains Prof. Pieske.

Conducted by an interdisciplinary team of experts from basic, translational, and clinical research, including computational modelling, this endeavour will follow a multilevel approach. Believing that the disruption of specific signalling pathways is responsible for developing distinct molecular HFpEF phenotypes with different characteristics, the researchers will study the mechanical, metabolic, inflammatory, and immunological factors accountable for disease development and progression. In each case, they will also explore the downstream signalling pathways and the specific effects on the cardiovascular system.

The researchers will draw on their expertise in translational cardiology, functional genomics, cell and molecular biology, systems medicine, bioinformatics, and artificial intelligence. They will be using ‘omic’ technologies (which are particularly suited to multiple-component analyses in the field of molecular biology), as well as state-of-the-art imaging technologies, phenotype analysis and computer-based modelling. Summarizing the aims of their research, Prof. Pieske says: “We want to develop a classification system for patients with heart failure with preserved ejection fraction which will enable us to use both molecular and clinical features to produce clear case definitions and diagnoses. We hope that this will one day enable us to offer patients a more personalized and targeted approach to treatment.”

Source: Press Release Charite