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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">ssmu</journal-id><journal-title-group><journal-title xml:lang="ru">Бюллетень сибирской медицины</journal-title><trans-title-group xml:lang="en"><trans-title>Bulletin of Siberian Medicine</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">1682-0363</issn><issn pub-type="epub">1819-3684</issn><publisher><publisher-name>Siberian State Medical University, the Ministry of Healthcare of the Russian Federation</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.20538/1682-0363-2023-3-98-109</article-id><article-id custom-type="elpub" pub-id-type="custom">ssmu-5315</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>ОБЗОРЫ И ЛЕКЦИИ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>REVIEW AND LECTURES</subject></subj-group></article-categories><title-group><article-title>Роль белков эндосаркомерного скелета в механизмах диастолической дисфункции левого желудочка: фокус на титин</article-title><trans-title-group xml:lang="en"><trans-title>The role of endosarcomeric cytoskeleton proteins in the mechanisms of left ventricular diastolic dysfunction: focus on titin</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-9640-2028</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Калюжин</surname><given-names>В. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Kalyuzhin</surname><given-names>V. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Калюжин Вадим Витальевич, доктор медицинских наук, профессор, заведующий кафедрой госпитальной терапии с курсом реабилитации, физиотерапии и спортивной медицины</p><p>634050, Томск, Московский тракт, 2</p></bio><bio xml:lang="en"><p>2, Moscow Trakt, Tomsk, 634050</p></bio><email xlink:type="simple">kalyuzhinvv@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-0721-0038</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Тепляков</surname><given-names>А. Т.</given-names></name><name name-style="western" xml:lang="en"><surname>Teplyakov</surname><given-names>A. T.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Тепляков Александр Трофимович, доктор медицинских наук, профессор, главный научный сотрудник</p><p>634012, Томск, ул. Киевская, 111а</p></bio><bio xml:lang="en"><p>111а, Kievskaya Str., Tomsk, 634012</p></bio><email xlink:type="simple">Vgelen1970@gmail.com</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-4513-6329</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Беспалова</surname><given-names>И. Д.</given-names></name><name name-style="western" xml:lang="en"><surname>Bespalova</surname><given-names>I. D.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Беспалова Инна Давидовна, доктор медицинских наук, заведующий кафедрой пропедевтики внутренних болезней с курсом терапии</p><p>634050, Томск, Московский тракт, 2</p></bio><bio xml:lang="en"><p>2, Moscow Trakt, Tomsk, 634050</p></bio><email xlink:type="simple">innadave@mail2000.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-7978-5327</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Калюжина</surname><given-names>Е. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Kalyuzhina</surname><given-names>E. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Калюжина Елена Викторовна, доктор медицинских наук, профессор кафедры госпитальной терапии с курсом реабилитации, физиотерапии и спортивной медицины</p><p>634050, Томск, Московский тракт, 2</p></bio><bio xml:lang="en"><p>2, Moscow Trakt, Tomsk, 634050</p></bio><email xlink:type="simple">kalyuzhina.e@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-5780-6660</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Черногорюк</surname><given-names>Г. Э.</given-names></name><name name-style="western" xml:lang="en"><surname>Chernogoryuk</surname><given-names>G. E.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Черногорюк Георгий Эдинович, доктор медицинских наук, профессор кафедры госпитальной терапии с курсом реабилитации, физиотерапии и спортивной медицины</p><p>634050, Томск, Московский тракт, 2</p></bio><bio xml:lang="en"><p>2, Moscow Trakt, Tomsk, 634050</p></bio><email xlink:type="simple">chernogoryuk@yandex.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-0462-3526</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Терентьева</surname><given-names>Н. Н.</given-names></name><name name-style="western" xml:lang="en"><surname>Terentyeva</surname><given-names>N. N.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Терентьева Надежда Николаевна, кандидат медицинских наук, доцент кафедры внутренних болезней</p><p>628412, Сургут, пр. Ленина, 1</p></bio><bio xml:lang="en"><p>1, Lenina Av., Surgut, 628412</p></bio><email xlink:type="simple">nadiater@mail.ru</email><xref ref-type="aff" rid="aff-3"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-4019-3735</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Гракова</surname><given-names>Е. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Grakova</surname><given-names>E. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Гракова Елена Викторовна, доктор медицинских наук, ведущий научный сотрудник отделения патологии миокарда </p><p>634012, Томск, ул. Киевская, 111а</p></bio><bio xml:lang="en"><p>111а, Kievskaya Str., Tomsk, 634012</p></bio><email xlink:type="simple">gev@cardio-tomsk.ru</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-2285-6438</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Копьева</surname><given-names>К. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Kopeva</surname><given-names>K. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Копьева Кристина Васильевна, кандидат медицинских наук, научный сотрудник отделения патологии миокарда </p><p>634012, Томск, ул. Киевская, 111а</p></bio><bio xml:lang="en"><p>111а, Kievskaya Str., Tomsk, 634012</p></bio><email xlink:type="simple">kristin-kop@inbox.ru</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-7978-5514</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Усов</surname><given-names>В. Ю.</given-names></name><name name-style="western" xml:lang="en"><surname>Usov</surname><given-names>V. Yu.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Усов Владимир Юрьевич, доктор медицинских наук, профессор, ведущий научный сотрудник отделения рентгеновских и томографических методов диагностики</p><p>634012, Томск, ул. Киевская, 111а</p></bio><bio xml:lang="en"><p>111а, Kievskaya Str., Tomsk, 634012</p></bio><email xlink:type="simple">ussov1962@yandex.ru</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-7353-7154</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Гарганеева</surname><given-names>Н. П.</given-names></name><name name-style="western" xml:lang="en"><surname>Garganeeva</surname><given-names>N. P.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Гарганеева Наталья Петровна, доктор медицинских наук, профессор кафедры общей врачебной практики и поликлинической терапии</p><p>634050, Томск, Московский тракт, 2</p></bio><bio xml:lang="en"><p>2, Moscow Trakt, Tomsk, 634050</p></bio><email xlink:type="simple">garganeeva@gmail.com</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-2357-6910</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Лившиц</surname><given-names>И. К.</given-names></name><name name-style="western" xml:lang="en"><surname>Livshits</surname><given-names>I. K.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Лившиц Инна Климентьевна, кандидат медицинских наук, доцент кафедры госпитальной терапии с курсом реабилитации, физиотерапии и спортивной медицины</p><p>634050, Томск, Московский тракт, 2</p></bio><bio xml:lang="en"><p>2, Moscow Trakt, Tomsk, 634050</p></bio><email xlink:type="simple">lik78.78@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-9034-4226</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Петрова</surname><given-names>И. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Petrova</surname><given-names>I. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Петрова Ирина Викторовна, доктор биологических наук, профессор кафедры биофизики и функциональной диагностики</p><p>634050, Томск, Московский тракт, 2</p></bio><bio xml:lang="en"><p>2, Moscow Trakt, Tomsk, 634050</p></bio><email xlink:type="simple">ivpetrova57@yandex.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-3274-6010</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Ласукова</surname><given-names>Т. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Lasukova</surname><given-names>T. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Ласукова Татьяна Викторовна, доктор биологических наук, профессор кафедры нормальной физиологии</p><p>634050, Томск, Московский тракт, 2</p></bio><bio xml:lang="en"><p>2, Moscow Trakt, Tomsk, 634050</p></bio><email xlink:type="simple">tlasukova@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>Сибирский государственный медицинский университет (СибГМУ)</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Siberian State Medical University</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>Научно-исследовательский институт (НИИ) кардиологии, Томский национальный исследовательский медицинский центр (НИМЦ) Российской академии наук</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Cardiology Research Institute, Tomsk National Research Medical Center (NRMC) of the Russian Academy of Sciences</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-3"><aff xml:lang="ru"><institution>Сургутский государственный университет (СурГУ)</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Surgut State University</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2023</year></pub-date><pub-date pub-type="epub"><day>18</day><month>10</month><year>2023</year></pub-date><volume>22</volume><issue>3</issue><fpage>98</fpage><lpage>109</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Калюжин В.В., Тепляков А.Т., Беспалова И.Д., Калюжина Е.В., Черногорюк Г.Э., Терентьева Н.Н., Гракова Е.В., Копьева К.В., Усов В.Ю., Гарганеева Н.П., Лившиц И.К., Петрова И.В., Ласукова Т.В., 2023</copyright-statement><copyright-year>2023</copyright-year><copyright-holder xml:lang="ru">Калюжин В.В., Тепляков А.Т., Беспалова И.Д., Калюжина Е.В., Черногорюк Г.Э., Терентьева Н.Н., Гракова Е.В., Копьева К.В., Усов В.Ю., Гарганеева Н.П., Лившиц И.К., Петрова И.В., Ласукова Т.В.</copyright-holder><copyright-holder xml:lang="en">Kalyuzhin V.V., Teplyakov A.T., Bespalova I.D., Kalyuzhina E.V., Chernogoryuk G.E., Terentyeva N.N., Grakova E.V., Kopeva K.V., Usov V.Y., Garganeeva N.P., Livshits I.K., Petrova I.V., Lasukova T.V.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://bulletin.ssmu.ru/jour/article/view/5315">https://bulletin.ssmu.ru/jour/article/view/5315</self-uri><abstract><p>Признание того, что изолированная диастолическая дисфункция (ДД) левого желудочка (ЛЖ) лежит в основе примерно 50% всех случаев сердечной недостаточности, требует глубокого понимания ее основных механизмов, чтобы можно было разработать эффективные диагностические и терапевтические стратегии. Несмотря на то, что в настоящее время достаточно много известно о механизмах, лежащих в основе ДД, немало важных вопросов, касающихся патофизиологии диастолы, еще ожидают своего решения. В частности, нуждается в уточнении роль патологии эндосаркомерного скелета в ухудшении так называемых активных (релаксация миокарда ЛЖ и тесно связанный с ней в здоровом сердце атриовентрикулярный градиент давления в начале диастолы) и пассивных (миокардиальная жесткость) характеристик диастолы.</p><p>В лекции кратко рассматривается сложная иерархия механизмов ДД (от саркомера до целого сердца) и обсуждается участие в последних гигантского белка титина, который является основной детерминантой внутриклеточной жесткости. Лежащие в основе ДД нарушение активного расслабления миокарда и ухудшение податливости его стенки при широком спектре патологических состояний (перегрузка давлением, ишемия, воспаление, кардиотоксические воздействия, окислительный стресс и др.) могут объясняться смещением экспрессии титина в сторону его более жесткой N2B-изоформы, гипофосфорилированием протеинкиназами А и G или дефосфорилированием серин/треонин фосфатазой 5 ее молекулы в сегменте растяжимой части белка, содержащим уникальную N2B последовательность, гиперфосфорилированием PEVK элементов титина протеинкиназой С, а также нарушением Ca2+-зависимого титин-актинового взаимодействия.</p><p>Результаты расшифровки этих механизмов могут стать инструментом для разработки новых подходов к направленной коррекции не имеющей эффективного лечения диастолической сердечной недостаточности, с одной стороны, и ключем для понимания саногенных эффектов препаратов, уже применяемых для терапии хронической сердечной недостаточности с сохраненной фракцией выброса ЛЖ – с другой.</p><p> </p></abstract><trans-abstract xml:lang="en"><p>Recognizing the fact that isolated left ventricular (LV) diastolic dysfunction (DD) underlies approximately 50% of all heart failure cases requires a deep understanding of its principal mechanisms so that effective diagnostic and treatment strategies can be developed. Despite abundance of knowledge about the mechanisms underlying DD, many important questions regarding the pathophysiology of diastole remain unresolved. In particular, the role of endosarcomeric cytoskeleton pathology in the deterioration of the so-called active (relaxation of the LV myocardium and the atrioventricular pressure gradient at the beginning of diastole, closely related to it in a healthy heart) and passive (myocardial stiffness) characteristics of diastole needs to be clarified.</p><p>The lecture briefly discusses the complex hierarchy of DD mechanisms (from the sarcomere to the whole heart) and covers the role of the giant protein titin in the latter, which is the main determinant of intracellular stiffness. Impairment of myocardial relaxation and deterioration of its wall compliance under a wide range of pathological conditions (pressure overload, ischemia, inflammation, cardiotoxic effects, oxidative stress, etc.) underlying DD can be explained by a shift in titin expression toward its more rigid N2B isoform, hypophosphorylation by protein kinases A and G or dephosphorylation by serine / threonine phosphatase 5 of its molecule in the extensible protein segment containing a unique N2B sequence, hyperphosphorylation of PEVK regions of titin by protein kinase C, as well as inhibition of the Ca2+-dependent titin – actin interaction.</p><p>The results of deciphering these mechanisms can become a tool for developing new approaches to targeted therapy for diastolic heart failure that currently does not have effective treatment, on the one hand, and the key to understanding the therapeutic effects of drugs already used to treat chronic heart failure with preserved LV ejection fraction, on the other hand.</p></trans-abstract><kwd-group xml:lang="ru"><kwd>сердечная недостаточность с сохраненной фракцией выброса</kwd><kwd>диастолическая сердечная недостаточность</kwd><kwd>левый желудочек</kwd><kwd>диастолическая дисфункция</kwd><kwd>механизмы</kwd><kwd>эндосаркомерный скелет</kwd><kwd>титин</kwd><kwd>альтернативный сплайсинг</kwd><kwd>посттрансляционная модификация</kwd></kwd-group><kwd-group xml:lang="en"><kwd>heart failure with preserved ejection fraction</kwd><kwd>diastolic heart failure</kwd><kwd>left ventricle</kwd><kwd>diastolic dysfunction</kwd><kwd>mechanisms</kwd><kwd>endosarcomeric cytoskeleton</kwd><kwd>titin</kwd><kwd>alternative splicing</kwd><kwd>post-translational modification</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Nazário Leão R., Marques da Silva P. 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