Potential and application prospects of combined treatment of acute myocardial infarction with hydrogel cardiac patches and traditional Chinese medicine

Abstract

BACKGROUND: Hydrogel cardiac patches, with their excellent biocompatibility and tunable mechanical properties, demonstrate significant potential in treating acute myocardial infarction, especially when combined with stem cell technology. Hydrogels modified with active components of traditional Chinese medicine (TCM) can promote the proliferation, differentiation, migration, and homing of stem cells. This synergistic effect provides a new approach for stem cell transplantation therapy based on hydrogel cardiac patches. OBJECTIVE: To focus on the application scenarios of novel biomaterial hydrogel cardiac patches combined with TCM in the treatment of myocardial infarction, and to discuss their development prospects. METHODS: PubMed and CNKI databases were searched for literature on TCM combined with hydrogel cardiac patches for the treatment of acute myocardial infarction from January 2010 to January 2025. English search terms included "hydrogel, cardiac patch, myocardial infarction, Chinese medicine, stem cell, drug delivery system"; Chinese search terms included "水凝胶, 心脏贴片, 心肌梗死, 中药, 干细胞, 递药系统". According to inclusion and exclusion criteria, 99 articles were finally included for review. RESULTS AND CONCLUSION: Hydrogel cardiac patches, with their excellent biocompatibility, tunable mechanical properties, and drug-loading capacity, provide ideal mechanical support and microenvironment for myocardial repair. As a hydrophilic polymer biomaterial, the three-dimensional network structure of hydrogel cardiac patches can highly mimic the physical properties of the natural cardiac extracellular matrix, providing a microenvironment for loaded biological cells to proliferate or maintain activity, and helping cell migration, adhesion, spreading, differentiation, and intercellular connection formation. Hydrogels modified with TCM can load stem cells, fully induce and regulate them, and more effectively perform cell regeneration therapy in the myocardial infarction area to achieve better repair. Therefore, the combined application of TCM and hydrogel cardiac patches has great development potential and prospects. Currently, the combined application mainly focuses on the following aspects: precise sustained-release therapy of TCM active ingredients via hydrogel cardiac patch loading; cell regeneration therapy via induced pluripotent stem cells delivered by TCM-modified hydrogel patches; and repair of cardiac electrophysiological function via TCM combined with conductive hydrogels. In future research, it is necessary to deeply understand the characteristics of hydrogels made from different materials and methods, and the therapeutic effects and mechanisms of TCM monomers and compound extracts, to achieve more combined applications of TCM and hydrogel cardiac patches.

1. Introduction

Acute myocardial infarction (AMI) is mostly caused by thrombus formation on the basis of coronary atherosclerosis, leading to narrowing of the coronary lumen, sharp reduction or interruption of coronary blood supply, and severe and persistent ischemia of the corresponding myocardium, resulting in necrosis [1], with a high mortality rate. Clinically, emergency revascularization treatments such as percutaneous coronary intervention, coronary artery bypass grafting, and drug thrombolysis are often used to reduce the acute mortality of patients with myocardial infarction. However, these revascularization procedures can cause ischemia-reperfusion injury, which catalyzes the production of large amounts of reactive oxygen species from xanthine in cells, exacerbating oxidative stress; activates endothelial cells to release inflammatory factors, triggering a cascade of inflammatory responses, further aggravating myocardial damage [2-4] and reducing cardiac function. Abnormal increase in matrix metalloproteinases in cells leads to excessive degradation of the extracellular matrix, causing pathological collagen deposition and tissue fibrosis, severely weakening the elasticity and contractile function of myocardial tissue [5-6]; it also causes dysfunction of myocardial ion channels, leading to abnormal electrophysiological coupling, increasing the risk of arrhythmias, and resulting in ventricular structural remodeling and electrical remodeling [7-8].

In recent years, tissue engineering and regenerative medicine have provided new strategies for the treatment of myocardial infarction. Hydrogel cardiac patches, as a type of bioactive material, have attracted much attention due to their excellent biocompatibility and tunable mechanical properties. They can mimic the natural extracellular matrix and provide a supportive microenvironment for cell growth and tissue regeneration. Furthermore, the combination of traditional Chinese medicine (TCM) with hydrogel cardiac patches has shown great potential in enhancing the therapeutic efficacy for myocardial infarction. TCM active ingredients can be loaded into hydrogels for sustained release, and TCM-modified hydrogels can regulate stem cell behavior, promoting cardiac repair. This review aims to explore the application scenarios and future prospects of hydrogel cardiac patches combined with TCM in the treatment of acute myocardial infarction.