Recent Advances in Natural Plant-based Treatment of Myocardial Ischemia-reperfusion Injury

Review Recent Advances in Natural Plant-based Treatment of Myocardial Ischemia-reperfusion Injury Peixun Yang 1,3,4, Minxuan Liu 2,3,4, Xiaoxue Fan 3,4, Xinzhuang Zhang 3,4, Liang Cao 3,4, Zhenzhong Wang 3,4, and Wei Xiao 3,4, * 1 Kanion School of Chinese Materia Medica, Nanjing University of Chinese Medicine, 138 Xianlin Avenue Qixia District, Nanjing 210046, China 2 School of Pharmacy, Nanjing University of Chinese Medicine, 138 Xianlin Avenue Qixia District, Nanjing 210046, China 3 National Key Laboratory on Technologies for Chinese Medicine Pharmaceutical Process Control and Intelligent Manufacture, Jiangning Industrial City, Economic and Technological Development Zone of Lianyungang, Lianyungang 222001, China 4 Jiangsu Kanion Pharmaceutical Co Ltd, Jiangning Industrial City, Economic and Technological Development Zone of Lianyungang, Lianyungang 222001, China * Correspondence: xw_kanion@163.com ( Wei Xiao)     Received: 23 March 2023 Accepted: 10 May 2023   Abstract: Cardiovascular disease (CDV) is the primary cause of death in the world, and myocardial ischemia (MI) is one of the high-risk CVDs. The myocardial blood supply must be restored as soon as possible to reduce the mortality risk, however, reperfusion itself paradoxically leads to further death of cardiomyocytes and increases the infarct size; this is known as myocardial ischemia/reperfusion injury (MIRI). The pathological mechanism of MIRI is complex, and current research mainly focuses on oxidative stress, dysfunctional mitochondrial energy metabolism, Ca 2+ overload, endoplasmic reticulum stress (ERs) and the inflammatory response. This review briefly summarizes the mechanism of MIRI, and natural plant product (NPP) components proven to ameliorate MIRI and their related signaling pathways. NPPs can alleviate MIRI by regulating oxidative stress, inflammation, ERs, Ca 2+ overload and mitochondrial function maintenance. This review will deepen our understanding of how NPPs reduce MIRI and the future value of NPPs in cardio-protection.