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Figure 5. Overview of cytokine changes in myocardium and skeletal muscle during Heart Failure (HF). HF can drive a wide breadth of inflammatory changes. Some of these include elevated pro-inflammatory hormonal signaling, gut edema allowing bacterial translocation, and exposure of damage-associate molecular patterns (DAMPs), leading to the release of cytokines including tumor necrosis factor (TNF) and interleukins (IL) 1 and 6. TNF can cause apoptosis, elevated reactive oxygen species (ROS), and mitochondrial DNA (mtDNA) damage in the musculature, leading to muscle damage and degradation. Transcription factors, including the Forkhead box O (FOXO) nuclear factor κB (NF-κB) families, are activated by cytokines, leading to altered proteostasis and activation of the ubiquitin-protease system (UPS).