Targeting antioxidant mechanisms in myocardial ischemia-reperfusion injury: A review of therapeutic strategies and clinical progress

Myocardial ischemia-reperfusion injury (MIRI) is a secondary injury that occurs upon the restoration of blood flow to ischemic myocardium, significantly diminishing the clinical benefits of reperfusion therapy. Excessive production of reactive oxygen species (ROS) and subsequent oxidative stress are recognized as central pathological mechanisms underlying MIRI, making antioxidant intervention a key therapeutic strategy. In recent years, significant progress has been made in the development of antioxidant agents targeting ROS scavenging and the modulation of oxidative stress. This review systematically summarizes recent advancements in MIRI interventions based on antioxidant mechanisms, including strategies for direct ROS elimination and the activation of endogenous antioxidant pathways. Through integrated target prediction and network analysis, the molecular basis and interactions of various antioxidant strategies are elucidated, highlighting compounds such as Honokiol as critical nodes within the intervention network. Additionally, utilizing the National Center for Biotechnology Information (NCBI) database, this work compiles and discusses the clinical progress of related antioxidant drugs in myocardial protection, offering a comprehensive overview and future perspectives. Ultimately, this review provides valuable insights for the future development of effective and low-toxicity antioxidant-based therapies for MIRI.