Decoding cardiac metabolic reprogramming through single-cell multi-omics: from mechanisms to therapeutic applications

Cardiac metabolic reprogramming is a central pathological mechanism underlying various cardiovascular diseases. Revolutionary advances in single-cell multi-omics technologies, such as single-cell transcriptomics, single-cell epigenomics, and spatial transcriptomics, have overcome the limitations of traditional bulk omics approaches. These advances now allow systematic dissection of metabolic heterogeneity, dynamic changes, and intercellular communication in cardiac cells at single-cell resolution under both physiological and pathological conditions. This review summarizes recent progress in the field, revealing how metabolic reprogramming drives the progression of conditions such as heart failure and myocardial infarction. It also discusses emerging metabolically targeted intervention strategies, including modulation of lactate shuttle, lipotoxicity, and immunometabolism. Finally, we critically assess the challenges in translating these findings into clinical practice and outline future directions, emphasizing the importance of interdisciplinary collaboration to advance precision medicine in cardiology.