Metabolomics-Driven Precision Prevention and Treatment of Heart Failure with Traditional Chinese Medicine: From Mechanistic Insights to Metabolic Network Regulation.

摘要

Heart failure (HF), as the terminal clinical stage of diverse cardiovascular diseases, involves complex pathological mechanisms. Conventional Western medicines, which typically target individual molecules or pathways, may have limitations in comprehensively halting disease progression and can be associated with adverse effects. In contrast, Traditional Chinese Medicine (TCM) employs a holistic treatment strategy based on a "multi-component, multi-target, multi-pathway" principle (eg, Shenfu Injection, Linggui Zhugan Decoction), which may align more closely with the multifaceted pathophysiology of HF. However, the specific mechanisms underlying the therapeutic benefits of TCM have remained largely unclear, and most existing evidence is correlative rather than causal. Metabolomics, with its inherent strengths for holistic and dynamic analysis, offers a methodological framework for investigating the comprehensive effects and potential mechanisms of TCM interventions in HF. This review outlines the evolution of metabolomics technology platforms and their complementary applications in tackling the chemical complexity of TCM formulations, interpreting in vivo metabolic responses, and revealing spatial metabolic heterogeneity. The convergence of these technologies provides a foundation for a research paradigm centered on "problem orientation, technology matching, data integration, and hypothesis generation for mechanism elucidation". Furthermore, this paradigm has suggested potential synergistic mechanisms through which TCM regulates cardiac metabolism across multiple levels-from single active compounds and individual herbs to complex formulae. Collectively, these advances offer a useful reference for future research aimed at improving the precision and broader applicability of TCM in HF management, although most metabolomic findings remain associative and require validation through flux analysis, intervention studies, or clinical endpoint trials.