sibmedСибирский научный медицинский журналСибирский научный медицинский журнал2410-25122410-2520ИЦиГ СО РАН10.18699/SSMJ20250204sibmed-2071Research ArticleОБЗОРЫREVIEWSКардиопротекторный эффект пептидных и непептидных агонистов опиоидных рецепторов при реперфузии сердца: возможность клинического применения экспериментальных данныхCardioprotective effect of peptide and non-peptide opioid receptor agonists in cardiac reperfusion: potential clinical application of experimental datahttps://orcid.org/0000-0003-1808-556XМухомедзяновА. В.MukhomedzyanovA. V.

 Мухомедзянов Александр Валерьевич, к.м.н. 

634012, г. Томск, ул. Киевская, 111а 

 Aleksandr V. Mukhomedzyanov, candidate of medical sciences 

 634012, Tomsk, Kievskaya st., 111a 

sasha_m91@mail.ruhttps://orcid.org/0000-0002-6020-1598МасловЛ. Н.MaslovL. N.

Маслов Леонид Николаевич, д.м.н., проф.

634012, г. Томск, ул. Киевская, 111а 

 Leonid N. Maslov, doctor of medical sciences, professor 

 634012, Tomsk, Kievskaya st., 111a 

maslov@cardio-tomsk.ruhttps://orcid.org/0000-0002-1607-1482ПоповС. В.PopovS. V.

Попов Сергей Валентинович, д.м.н., проф., акад. РАН

634012, г. Томск, ул. Киевская, 111а 

 Sergey V. Popov, doctor of medical sciences, professor, academician of the RAS 

 634012, Tomsk, Kievskaya st., 111a 

press@cardio-tomsk.ruhttps://orcid.org/0009-0004-2215-5414СлидневскаяА. С.SlidnevskayaA. S.

Слидневская Алиса Сергеевна

634012, г. Томск, ул. Киевская, 111а 

 Alisa S. Slidnevskaya 

 634012, Tomsk, Kievskaya st., 111a 

alisaslidnevskaa@gmail.comhttps://orcid.org/0000-0002-6418-1643КанА. С.KanA.

Кан Артур

634012, г. Томск, ул. Киевская, 111а 

 Artur Kan 

 634012, Tomsk, Kievskaya st., 111a 

kan989817@gmail.comhttps://orcid.org/0000-0003-2264-1928НарыжнаяН. В.NaryzhnayaN. V.

Нарыжная Наталья Владимировна, д.м.н.

634012, г. Томск, ул. Киевская, 111а 

 Natalya V. Naryzhnaya, doctor of medical sciences 

 634012, Tomsk, Kievskaya st., 111a 

natalynar@yandex.ruНИИ кардиологии, Томский национальный исследовательский медицинский центр РАНРоссияCardiology Research Institute, Tomsk National Research Medical Center of the RASRussian Federation2025060520254524156Copyright © Мухомедзянов А.В., Маслов Л.Н., Попов С.В., Слидневская А.С., Кан А.С., Нарыжная Н.В., 20252025Мухомедзянов А.В., Маслов Л.Н., Попов С.В., Слидневская А.С., Кан А.С., Нарыжная Н.В.Mukhomedzyanov A.V., Maslov L.N., Popov S.V., Slidnevskaya A.S., Kan A., Naryzhnaya N.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://sibmed.elpub.ru/jour/article/view/2071

Летальность у пациентов с острым инфарктом миокарда составляет 5–8 % и не снижается в последние годы. Одной из причин смерти является реперфузионное повреждение сердца. Совершенно очевидно, что существует острая необходимость в разработке принципиально новых препаратов, которые могут эффективно снижать летальность при ОИМ. Такими препаратами могут стать опиоиды. Активация периферических µ2-, δ2-, κ1- опиоидных рецепторов уменьшает размер инфаркта и улучшает сократимость при реперфузии. Периферические µ1-, δ1-, κ2-рецепторы не участвуют в регуляции толерантности сердца к реперфузионному повреждению сердца. Опиоидное посткондиционирование ограничивает воспалительный процесс в миокарде, уменьшает микрососудистую обструкцию, подавляет апоптоз кардиомиоцитов и уменьшает неблагоприятное постинфарктное ремоделирование. Опиоиды могут снижать избыточную продукцию активных форм кислорода в реперфузируемом миокарде. Наиболее перспективными препаратами могут оказаться опиоидные пептиды, которые не проникают через гематоэнцефалический барьер и поэтому, в отличие от других опиоидов, не вызывают тошноту, рвоту и угнетение дыхания.

Mortality in patients with acute myocardial infarction is 5–8 % and has not decreased in recent years. One of the causes of death is reperfusion cardiac injury. It is quite obvious that there is an urgent need to develop drugs that can effectively reduce mortality in AMI. Opioids could become such drugs. The activation of peripheral µ2-, δ2-, κ1- opioid receptors reduces in infarct size and improves contractility in reperfusion. Peripheral µ1-, δ1-, κ2-receptors are not involved in the regulation of cardiac tolerance to reperfusion cardiac injury. Opioid postconditioning limits myocardial inflammation, reduces microvascular obstruction, inhibits apoptosis of cardiomyocytes and mitigates adverse postinfarction remodeling. Opioids can reduce excess reactive oxygen species production in the reperfused myocardium. The most promising drugs may be opioid peptides that do not penetrate the blood-brain barrier and therefore, unlike other opioids, do not cause nausea, vomiting, and respiratory depression.

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The authors declare that there are no conflicts of interest present.