Therapeutic potential of tanshinones in ischaemia–reperfusion injury: Bioactive analogues, pharmacology and mechanisms

Ischaemia-reperfusion (I/R) injury affects vital organs, including the heart, brain, liver and kidney, and represents a major pathological process associated with high morbidity and mortality. I/R injury initiates complex molecular and cellular cascades that drive cellular dysfunction, structural damage and both acute and chronic organ failure. Despite advances in supportive care, pharmacological intervention remains the primary strategy for protecting organs from I/R injury. Tanshinones, a group of lipophilic abietane diterpenoids derived from Salvia miltiorrhiza, display convergent, multi-target pharmacological activities that closely correspond to the core pathogenic mechanisms of I/R injury. Over the past two decades, tanshinones, particularly Tan IIA, Tan I and cryptotanshinone, have shown cardioprotective and neuroprotective effects. Increasing evidence further indicates that tanshinones also protect against I/R injury in other organs. This review synthesizes current findings on bioactive tanshinone analogues, their pharmacodynamic properties and underlying mechanisms of action and discusses biomarker-guided strategies to advance tanshinones as practical, pleiotropic therapeutic candidates for multi-organ I/R injury.