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Cells
Volume 15
Issue 13
10.3390/cells15131185
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Review

Oxidative Stress and Its Impact on Reperfused Myocardium: Pathophysiological Insights and Therapeutic Perspectives

by
Iris Bararu Bojan
1,
Carmen Plesoianu
2,
Maria-Cristina Vladeanu
1,
Stefan Dobreanu
2,
Dragos-Florin Tesoi
1,
Codruta Badescu
2,
Cezar Ilie Foia
3,
Otilia Elena Frasinariu
4,
Dan Iliescu
2,
Oana Viola Badulescu
1,*,
Codruta Olimpiada Iliescu Halitchi
4,
Amin Bazyani
5 and
Manuela Ciocoiu
1
1
Department of Morpho Functional Sciences, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
2
Department of Internal Medicine II, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
3
Department of Surgical Sciences, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
4
Department of Pediatrics, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
5
Heart Institute Prof dr. George I.M. Georgescu Iasi, Romania, 50 Bd Carol I, 700503 Iași, Romania
*
Author to whom correspondence should be addressed.
Cells 2026, 15(13), 1185; https://doi.org/10.3390/cells15131185 (registering DOI)
Submission received: 19 May 2026 / Revised: 15 June 2026 / Accepted: 24 June 2026 / Published: 29 June 2026
(This article belongs to the Special Issue The Role of Oxidative Stress in Cardiovascular Diseases—2nd Edition)
Versions Notes

Abstract

Myocardial ischemia–reperfusion injury (MIRI) represents a major contributor to morbidity and mortality in patients undergoing reperfusion therapy after acute myocardial infarction. Although timely restoration of coronary blood flow is essential for myocardial salvage, reperfusion paradoxically initiates a complex cascade of molecular and cellular events that may aggravate myocardial injury. Oxidative stress is considered one of the central mechanisms underlying MIRI, primarily through excessive production of reactive oxygen species (ROS) and reactive nitrogen species (RNS), leading to mitochondrial dysfunction, calcium overload, endothelial injury, inflammatory activation, and cardiomyocyte death. This review summarizes the current understanding of the pathophysiological mechanisms involved in oxidative stress-mediated reperfusion injury, with emphasis on mitochondrial permeability transition pore opening, inflammasome activation, cytokine release, neutrophil extracellular trap formation, macrophage polarization, and interconnected cell death pathways including PANoptosis. Emerging evidence regarding immunometabolic regulation and epigenetic modulation in MIRI is also discussed. In addition, current pharmacological and non-pharmacological cardioprotective strategies targeting oxidative stress, mitochondrial dysfunction, and inflammatory signaling are reviewed, highlighting both promising experimental findings and the persistent challenges in clinical translation. A deeper understanding of the molecular interplay between oxidative stress and inflammatory pathways may facilitate the development of integrated therapeutic approaches aimed at improving myocardial recovery and long-term cardiovascular outcomes following reperfusion therapy.
Keywords: Myocardial ischemia–reperfusion injury, Oxidative stress, Reactive oxygen species Myocardial ischemia–reperfusion injury, Oxidative stress, Reactive oxygen species

Share and Cite

MDPI and ACS Style

Bararu Bojan, I.; Plesoianu, C.; Vladeanu, M.-C.; Dobreanu, S.; Tesoi, D.-F.; Badescu, C.; Foia, C.I.; Frasinariu, O.E.; Iliescu, D.; Badulescu, O.V.; et al. Oxidative Stress and Its Impact on Reperfused Myocardium: Pathophysiological Insights and Therapeutic Perspectives. Cells 2026, 15, 1185. https://doi.org/10.3390/cells15131185

AMA Style

Bararu Bojan I, Plesoianu C, Vladeanu M-C, Dobreanu S, Tesoi D-F, Badescu C, Foia CI, Frasinariu OE, Iliescu D, Badulescu OV, et al. Oxidative Stress and Its Impact on Reperfused Myocardium: Pathophysiological Insights and Therapeutic Perspectives. Cells. 2026; 15(13):1185. https://doi.org/10.3390/cells15131185

Chicago/Turabian Style

Bararu Bojan, Iris, Carmen Plesoianu, Maria-Cristina Vladeanu, Stefan Dobreanu, Dragos-Florin Tesoi, Codruta Badescu, Cezar Ilie Foia, Otilia Elena Frasinariu, Dan Iliescu, Oana Viola Badulescu, and et al. 2026. "Oxidative Stress and Its Impact on Reperfused Myocardium: Pathophysiological Insights and Therapeutic Perspectives" Cells 15, no. 13: 1185. https://doi.org/10.3390/cells15131185

APA Style

Bararu Bojan, I., Plesoianu, C., Vladeanu, M.-C., Dobreanu, S., Tesoi, D.-F., Badescu, C., Foia, C. I., Frasinariu, O. E., Iliescu, D., Badulescu, O. V., Halitchi, C. O. I., Bazyani, A., & Ciocoiu, M. (2026). Oxidative Stress and Its Impact on Reperfused Myocardium: Pathophysiological Insights and Therapeutic Perspectives. Cells, 15(13), 1185. https://doi.org/10.3390/cells15131185

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