Recent Advances in Pharmacological and Non-Pharmacological Strategies of Cardioprotection

Abstract

Ischemic heart diseases (IHD) are the leading cause of death worldwide. Although the principal form of treatment of IHD is myocardial reperfusion, the recovery of coronary blood flow after ischemia can cause severe and fatal cardiac dysfunctions, mainly due to the abrupt entry of oxygen and ionic deregulation in cardiac cells. The ability of these cells to protect themselves against injury including ischemia and reperfusion (I/R), has been termed “cardioprotection”. This protective response can be stimulated by pharmacological agents (adenosine, catecholamines and others) and non-pharmacological procedures (conditioning, hypoxia and others). Several intracellular signaling pathways mediated by chemical messengers (enzymes, protein kinases, transcription factors and others) and cytoplasmic organelles (mitochondria, sarcoplasmic reticulum, nucleus and sarcolemma) are involved in cardioprotective responses. Therefore, advancement in understanding the cellular and molecular mechanisms involved in the cardioprotective response can lead to the development of new pharmacological and non-pharmacological strategies for cardioprotection, thus contributing to increasing the efficacy of IHD treatment. In this work, we analyze the recent advances in pharmacological and non-pharmacological strategies of cardioprotection.

Mitochondrial proteomics alterations in rat hearts following ischemia/reperfusion and diazoxide post‑conditioning

“…Following the discovery in 1991 of mitoK ATP ( 14 ), which is located at the inner mitochondrial membrane, mitoK ATP was demonstrated to be a trigger for the protective effects of ischemic pre-conditioning ( 15 , 16 ). Pharmacological conditioning is currently being evaluated as an alternative method for the treatment of I/R injury ( 17 ). Similar myocardial protection can be obtained from drugs such as mitoK ATP openers, including diazoxide ( 15 , 18 ).…”

The Role of Cardiac N-Methyl-D-Aspartate Receptors in Heart Conditioning—Effects on Heart Function and Oxidative Stress

“…As well as the model of ischemic preconditioning, consisting of short periods of ischemia and reperfusion prior to prolonged ischemia, other pharmacological and non-pharmacological approaches of heart conditioning have evolved [13,14]. Pharmacological pre-and postconditioning aim to activate protective cellular pathways through the activation of receptors and intracellular signaling cascades which favor survival of cardiac cells [15].…”

Ginkgolide B for Myocardial Ischemia/Reperfusion Injury: A Preclinical Systematic Review and Meta-Analysis

“…Meanwhile, different cardioprotective pharmacological agents have been confirmed in preclinical studies. These pharmacological agents include agonists of β-adrenoceptors (β-AR) or adenosine receptors, L-type voltage-dependent Ca 2+ channels (VDCC) or mitochondrial Ca 2+ uniporter (MCU) blockers, anti-platelet, modulators of NO biosynthesis or Na + /Ca 2+ exchanger (NCX), resveratrol, methylene blue and intestinal lipase inhibitors (Caricati-Neto et al, 2019). In the future, nanotechnology-guided drug delivery systems will become new direction (Minamino, 2012), and novel cardioprotective mechanisms of GB should be investigated.…”