Background: Cardiomyopathies contribute substantially to heart failure, arrhythmias, and sudden cardiac death. Innate immune activation-particularly via Toll-like receptors (TLRs)-is increasingly recognized as a driver of pathological cardiac remodeling.
Objective: To evaluate how TLR expression and downstream signaling pathways (MyD88 and TRIF) shape distinct cardiomyopathy phenotypes and to assess therapeutic strategies targeting these mechanisms.
Methods: Evidence from studies of ischemic, viral, septic, diabetic, drug-induced, hypertrophic, and obesity-associated cardiomyopathies was surveyed to determine the roles of TLR subtypes and the impact of modulating their signaling pathways.
Results: Activation of TLR2, TLR3, TLR4, TLR7, and TLR9 consistently amplifies myocardial inflammation, fibrosis, and functional decline. However, context-dependent protective effects in certain settings highlight the complexity of uniformly suppressing TLR activity. Preclinical investigations demonstrate favorable outcomes from selective pathway modulation, including TLR4 antagonists (such as TAK-242 and eritoran), MyD88 pathway inhibitors, and nucleic-acid-directed TLR9 strategies.
Conclusions: Targeting TLR signaling has strong potential to limit inflammation, curb fibrotic remodeling, and preserve cardiac function across diverse cardiomyopathies. The most promising therapeutic direction involves developing subtype-specific and cell- or pathway-targeted interventions, supported by translational research to bridge preclinical findings with clinical application.
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