Translation of hemodynamic stress to sterile inflammation in the heart

• Sterile inflammation plays an important role in the genesis of heart failure.
• Mitochondrial DNA that escapes from autophagy leads to inflammation and heart failure.
• The mitochondrial DNA–TLR9 axis is a promising therapeutic target for treating patients with heart failure.
• The inflammasome provides a possible alternative mechanism for sterile inflammation in the heart.

Recently, growing evidence suggests that cardiac inflammation contributes to progression of heart failure (HF). However, the precise mechanism has been elusive. Autophagy is well-known phenomenon which plays essential roles in the maintenance of cardiomyocyte homeostasis by clearing damaged proteins and organelles, and dysfunction of this system evokes HF. Although emerging roles of mitochondria in inflammasome development are highlighted in immune cells, an involvement in the heart has not been defined until recently. This review discusses recent advances in understanding the complex mechanisms underlying cardiac inflammation: these studies have revealed that a combination of mitochondrial autophagy and innate immune responses to mitochondrial DNA during increased hemodynamic stress contribute to cardiac inflammation.