Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, China.
Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, China.
Thromb Res. 2023 Sep;229:114-126. doi: 10.1016/j.thromres.2023.06.022. Epub 2023 Jun 29.
Myocardial ischemia-reperfusion injury (MIRI), the joint result of ischemic injury and reperfusion injury, is associated with poor outcomes in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention. Accumulating evidence demonstrates that activated platelets directly contribute to the pathogenesis of MIRI through participating in the formation of microthrombi, interaction with leukocytes, secretion of active substances, constriction of microvasculature, and activation of spinal afferent nerves. The molecular mechanisms underlying the above detrimental effects of activated platelets include the homotypic and heterotypic interactions through surface receptors, transduction of intracellular signals, and secretion of active substances. Revealing the roles of platelet activation in MIRI and the associated mechanisms would provide potential targets/strategies for the clinical evaluation and treatment of MIRI. Further studies are needed to characterize the temporal (ischemia phase vs. reperfusion phase) and spatial (systemic vs. local) distributions of platelet activation in MIRI by multi-omics strategies. To improve the likelihood of translating novel cardioprotective interventions into clinical practice, basic researches maximally replicating the complexity of clinical scenarios would be necessary.
心肌缺血再灌注损伤（MIRI）是缺血损伤和再灌注损伤的共同结果，与接受直接经皮冠状动脉介入治疗的急性心肌梗死患者的预后不良有关。越来越多的证据表明，激活的血小板通过参与微血栓的形成、与白细胞相互作用、分泌活性物质、微血管收缩和激活脊神经传入神经，直接促成 MIRI 的发病机制。激活的血小板产生上述有害影响的分子机制包括通过表面受体的同型和异型相互作用、细胞内信号转导和活性物质的分泌。揭示血小板激活在 MIRI 中的作用及其相关机制将为 MIRI 的临床评估和治疗提供潜在的靶点/策略。需要通过多组学策略来描述 MIRI 中血小板激活的时间（缺血相和再灌注相）和空间（全身和局部）分布。为了提高将新型心脏保护干预措施转化为临床实践的可能性，有必要进行最大限度地复制临床情况复杂性的基础研究。
