MOLECULAR AND REGENERATIVE APPROACHES TO THE TREATMENT OF ISCHEMIC HEART DISEASE

Highlights      

• Contemporary approaches to the treatment of ischemic heart disease (IHD) extend beyond conventional invasive techniques such as percutaneous coronary intervention and coronary artery bypass grafting. Although these procedures remain effective, they are often associated with significant risks, particularly in patients with multiple comorbidities. This underscores the growing need for safer and more personalized therapeutic strategies. Increasing attention is being directed toward molecular and regenerative technologies aimed at targeting the underlying pathogenic mechanisms of the disease.
• Nanotechnology, RNA-based therapy, and cell-based platforms have demonstrated promising potential to transform clinical practice. The use of polymeric, lipid-based, and metallic nanoparticles enables targeted drug delivery, attenuation of inflammation, and stabilization of atherosclerotic plaques. Small interfering RNAs (siRNAs) and microRNAs (miRNAs) regulate gene expression involved in lipid metabolism and inflammatory responses, while stem cells promote myocardial regeneration and immunomodulation. These innovations are forming the foundation of a new paradigm in precision IHD therapy.
• The integration of artificial intelligence (AI) into cardiology practice enhances the analytical potential of diagnosis and prognosis. AI algorithms (e.g., systems for coronary CT angiography analysis, automatic calcium index calculation, and ECG analysis, such as HeartFlow and KardiaAI) are successfully applied to medical image evaluation, risk stratification, biomarker analysis, and complication prediction. Taken together, this comprehensive approach, combining advances in invasive cardiology, molecular biology, regenerative medicine, and digital technologies, paves the way for personalized and pathogenetically based treatment of coronary artery disease.

Abstract

Coronary artery disease (CAD) remains a leading cause of death, despite significant progress in cardiology. This article presents a systematic review of current approaches to CAD treatment, including traditional invasive methods, nanomedicine, gene therapy, and cell technologies. Percutaneous coronary intervention and coronary artery bypass grafting remain the mainstays of treatment for critical stenoses. However, in some patients, these methods are associated with a high risk of complications, such as nephropathy, atrial fibrillation, or graft failure. Therefore, the attention of researchers is increasingly shifting to high-tech molecular strategies. Experimental studies in animal models (in vivo) have demonstrated that pitavastatin-loaded nanoparticles based on the copolymer of lactic and glycolic acids (PLGA) have the ability to reduce inflammation and stabilize atherosclerotic plaques. Preclinical studies indicate that the use of liposomal forms of prednisolone can provide targeted delivery of the drug to sites of restenosis. However, the clinical translation of nanotechnology faces challenges related to safety, toxicity, biodistribution, high production costs, and regulatory barriers. Photoacoustic and fluorescence imaging using functionalized nanoparticles opens up new diagnostic possibilities. Delivery of small interfering RNA (siRNA), particularly siPCSK9, via lipid carriers leads to a significant reduction in low-density lipoprotein levels in experimental models. Experimental data, primarily obtained in animal models and in vitro, link the use of microRNAs such as miR-124 and miR-34 to the modulation of inflammation and apoptosis in atherosclerosis, but their therapeutic potential in humans requires further study. Stem cells (MSCs, UCSCs) demonstrate potential for myocardial regeneration and immune response regulation. The role of artificial intelligence (e.g., deep learning algorithms for plaque segmentation, radiomics, and machine-learning-based prognostic models) in imaging data analysis, intervention planning, and outcome prediction is also discussed. Overall, the article highlights the transformation of coronary heart disease treatment toward precision, targeted, and bioengineered therapies, opening new horizons in cardiology practice.

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