Aging and Remodeling During Healing of the Wounded Heart: Current Therapies and Novel Drug Targets

Bodh   I.   Jugdutt

Abstract

Aging has become a major health care problem and socio-economic burden worldwide. Myocardial infarction (MI) is the major killer worldwide and coronary reperfusion is the major form of acute post-MI therapy. The aging population is increasing, and with it, morbidity and mortality due to impaired healing after ST-segment elevation MI (STEMI) and its consequences. Optimal healing of the wounded heart is critical for preservation of structural and functional integrity of the pumping chambers, survival, and a favorable outcome irrespective of age. Although STEMI is more prevalent in the elderly and impaired healing during aging may promote adverse remodeling and thereby jeopardize outcome, there is an information gap on post-STEMI healing and its therapy in the elderly. Current therapies during post-STEMI healing are aimed primarily at the < 65 age-group and preclinical studies tend to test drugs in mostly young animals. Therapies over the last decade have improved post-MI survival mainly in patients aged < 65 years. Novel healing-specific proteins may provide potential targets for improving healing and limiting adverse remodeling of the post-STEMI heart in the elderly, thereby improving outcome.

Keywords: Aging, ST-segment elevation myocardial infarction, ventricular remodeling, extracellular matrix, healing-specific proteins, secretory leucocyte protease inhibitor, osteopontin, secreted protein acidic and rich in cysteine