Alomair Basil Mohammed, Al-Kuraishy Hayder M, Al-Gareeb Ali I, Al-Hamash Sadiq M, De Waard Michel, Sabatier Jean-Marc, Saad Hebatallah M, El-Saber Batiha Gaber
Internal Medicine, Endocrinology and Diabetes, Department of Medicine, College of Medicine, Aljouf University, Sakaka 72388, Saudi Arabia.
Department of Pharmacology and Toxicology, College of Medicine, Al-Mustansiriyah University, Baghdad P.O. Box 14132, Iraq.
Pharmaceuticals (Basel). 2022 Sep 14;15(9):1147. doi: 10.3390/ph15091147.
Acute coronary syndrome (ACS) is a set of signs and symptoms caused by a reduction of coronary blood flow with subsequent myocardial ischemia. ACS is associated with activation of the leukotriene (LT) pathway with subsequent releases of various LTs, including LTB4, LTC4, and LTD4, which cause inflammatory changes and induction of immunothrombosis. LTs through cysteine leukotriene (CysLT) induce activation of platelets and clotting factors with succeeding coronary thrombosis. CysLT receptor (CysLTR) antagonists such as montelukast (MK) may reduce the risk of the development of ACS and associated complications through suppression of the activation of platelet and clotting factors. Thus, this critical review aimed to elucidate the possible protective role of MK in the management of ACS. The LT pathway is implicated in the pathogenesis of atherosclerosis, cardiac hypertrophy, and heart failure. Inhibition of the LT pathway and CysL1TR by MK might be effective in preventing cardiovascular complications. MK could be an effective novel therapy in the management of ACS through inhibition of pro-inflammatory CysLT1R and modulation of inflammatory signaling pathways. MK can attenuate thrombotic events by inhibiting platelet activation and clotting factors that are activated during the development of ACS. In conclusion, MK could be an effective agent in reducing the severity of ACS and associated complications. Experimental, preclinical, and clinical studies are recommended to confirm the potential therapeutic of MK in the management of ACS.
急性冠状动脉综合征（ACS）是一组由冠状动脉血流减少及随后的心肌缺血引起的体征和症状。ACS与白三烯（LT）途径的激活以及随后各种白三烯（包括LTB4、LTC4和LTD4）的释放有关，这些白三烯会引起炎症变化并诱导免疫血栓形成。LT通过半胱氨酰白三烯（CysLT）诱导血小板和凝血因子激活，继而导致冠状动脉血栓形成。诸如孟鲁司特（MK）之类的CysLT受体（CysLTR）拮抗剂可能通过抑制血小板和凝血因子的激活来降低ACS发生及相关并发症的风险。因此，本综述旨在阐明MK在ACS管理中可能的保护作用。LT途径与动脉粥样硬化、心脏肥大和心力衰竭的发病机制有关。MK对LT途径和CysL1TR的抑制可能对预防心血管并发症有效。通过抑制促炎性CysLT1R和调节炎症信号通路，MK可能成为ACS管理中一种有效的新型疗法。MK可通过抑制ACS发生过程中激活的血小板和凝血因子来减轻血栓形成事件。总之，MK可能是减轻ACS严重程度及相关并发症的有效药物。建议进行实验、临床前和临床研究以证实MK在ACS管理中的潜在治疗作用。
