Document Type : Review Article
Authors
1 Yazd Neuroendocrine Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
2 Stem Cell Biology Research Center, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
3 Reproductive Immunology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
Abstract
Introduction: Myocardial infarction (MI) leads to irreversible cardiomyocyte loss and progressive ventricular remodeling largely driven by oxidative stress, inflammation, and mitochondrial dysfunction. Mitsugumin 53 (MG53/TRIM72) is a muscle-enriched membrane-repair protein that has emerged as a multifunctional regulator of cellular antioxidant responses, mitochondrial integrity, and anti-inflammatory signaling. This review synthesizes current evidence on the MG53’s mechanisms and therapeutic potential in MI.
Methods: We performed a narrative review of preclinical and translational literature focusing on MG53 in cardiac injury. Databases searched included PubMed and Google Scholar (through 2025), using keywords “MG53,” “TRIM72,” “myocardial infarction,” “ischemia-reperfusion,” “recombinant MG53,” and “cardioprotection.” Relevant mechanistic studies, recombinant protein interventions, and reports on the MG53’s systemic effects and safety were prioritized.
Results: Preclinical studies demonstrate that MG53 promotes plasma-membrane resealing, preserves mitochondrial membrane potential, reduces mitochondrial ROS production, attenuates mitophagy, and upregulates endogenous antioxidant enzymes (e.g., HO-1, catalase, SOD). Recombinant human MG53 (rhMG53) or MG53 overexpression reduces infarct size, limits cardiomyocyte apoptosis, and improves functional recovery in rodent ischemia–reperfusion models. Additional benefits include suppression of NF-κB–mediated inflammation and modulation of necroptotic pathways via RIPK1 ubiquitination. However, there are conflicting data: chronic MG53 upregulation in some models has been associated with insulin signaling perturbation, and human data remain limited with variable reports on the cardiac MG53 expression and circulating levels. Safety, pharmacokinetics, and optimal delivery strategies for rhMG53 require further characterization.
Conclusion: MG53 represents a promising cardioprotective target for MI through multimodal actions on membrane repair, mitochondrial protection, and antioxidant gene regulation. Translation to clinical therapy will require rigorous preclinical safety profiling, clarification of MG53’s systemic metabolic effects, and well-designed early-phase studies to evaluate pharmacology, dosing, and efficacy in humans. Future studies should explicitly address human expression patterns and reconcile metabolic concerns to safely harness MG53-based interventions.
Keywords
Main Subjects
- Tuama RM, Mustafa AA, Yahya ZS. A review on brain-heart axis physiology and its clinical implications. Int J Med Sci 2025;7(1):41-51. doi:https://www.doi. org/10.33545/26648881.2025.v7.i1a.59
- Campbell E. It’s more than the mouth: the effects of periodontal disease on systemic health. Dent Assist 2007;76(3):26-8.
- World Health Organization (WHO). Cardiovascular Diseases (CVDs): Key Facts. Geneva: WHO; 2021.
- Ip JH, Levin RI. Myocardial preservation during ischemia and reperfusion. Am Heart J 1988;115(5):1094-104. doi:10.1016/0002-8703(88)90082-8
- Chapman AR, Shah ASV, Lee KK, Anand A, Francis O, Adamson P, et al. Long-term outcomes in patients with type 2 myocardial infarction and myocardial injury. Circulation 2018;137(12):1236-45. doi:10.1161/ circulationaha.117.031806
- Talman V, Ruskoaho H. Cardiac fibrosis in myocardial infarction-from repair and remodeling to regeneration. Cell Tissue Res 2016;365(3):563-81. doi:10.1007/s00441-016- 2431-9
- Nojiri H, Shimizu T, Funakoshi M, Yamaguchi O, Zhou H, Kawakami S, et al. Oxidative stress causes heart failure with impaired mitochondrial respiration. J Biol Chem 2006;281(44):33789-801. doi:10.1074/jbc.M602118200
- Duan D, Li H, Chai S, Zhang L, Fan T, Hu Z, et al. The relationship between cardiac oxidative stress, inflammatory cytokine response, cardiac pump function, and prognosis post-myocardial infarction. Sci Rep 2024;14(1):8985. doi:10.1038/ s41598-024-59344-5
- Praetner M, Zuchtriegel G, Holzer M, Uhl B, Schaubächer J, Mittmann L, et al. Plasminogen activator inhibitor-1 promotes neutrophil infiltration and tissue injury on ischemia-reperfusion. Arterioscler Thromb Vasc Biol 2018;38(4):829-42. doi:10.1161/ atvbaha.117.309760
- Neri M, Fineschi V, Di Paolo M, Pomara C, Riezzo I, Turillazzi E, et al. Cardiac oxidative stress and inflammatory cytokines response after myocardial infarction. Curr Vasc Pharmacol 2015;13(1):26-36. doi:10.2174/15701611113119990003
- Aleksandrowicz M, Konop M, Rybka M, Mazurek Ł, Stradczuk- Mazurek M, Kciuk M, et al. Dysfunction of microcirculation in atherosclerosis: implications of nitric oxide, oxidative stress, and inflammation. Int J Mol Sci 2025;26(13):6467. doi:10.3390/ ijms26136467
- Daiber A, Steven S, Euler G, Schulz R. Vascular and cardiac oxidative stress and inflammation as targets for cardioprotection. Curr Pharm Des 2021;27(18):2112-30. doi:10.2174/13816128 27666210125155821
- Ren Y, Zhang H. Emerging role of exosomes in vascular diseases. Front Cardiovasc Med 2023;10:1090909. doi:10.3389/ fcvm.2023.1090909
- Azizian H, Farhadi Z, Bader M, Alizadeh Ghalenoei J, Ghafari MA, Mahmoodzadeh S. GPER activation attenuates cardiac dysfunction by upregulating the SIRT1/3-AMPK-UCP2 pathway in postmenopausal diabetic rats. PLoS One 2023;18(12) :e0293630. doi:10.1371/journal.pone.0293630
- Ray PD, Huang BW, Tsuji Y. Reactive oxygen species (ROS) homeostasis and redox regulation in cellular signaling. Cell Signal 2012;24(5):981-90. doi:10.1016/j.cellsig.2012.01.008
- Rodríguez M, Lucchesi BR, Schaper J. Apoptosis in myocardial infarction. Ann Med 2002;34(6):470-9. doi:10.1080/078538902321012414
- McElhanon KE, Bhattacharya S. Altered membrane integrity in the progression of muscle diseases. Life Sci 2018;192:166-72. doi:10.1016/j.lfs.2017.11.035
- Guan F, Huang T, Wang X, Xing Q, Gumpper K, Li P, et al. The TRIM protein mitsugumin 53 enhances survival and therapeutic efficacy of stem cells in murine traumatic brain injury. Stem Cell Res Ther 2019;10(1):352. doi:10.1186/s13287-019-1433-4
- Ma S, Wang Y, Zhou X, Li Z, Zhang Z, Wang Y, et al. MG53 protects hUC-MSCs against inflammatory damage and synergistically enhances their efficacy in neuroinflammation injured brain through inhibiting NLRP3/caspase-1/IL-1β ACS Chem Neurosci 2020;11(17):2590-601. doi:10.1021/ acschemneuro.0c00268
- Chen J, Wang B, Meng T, Li C, Liu C, Liu Q, et al. Oxidative stress and inflammation in myocardial ischemia-reperfusion injury: protective effects of plant-derived natural active compounds. J Appl Toxicol 2025;45(7):1103-23. doi:10.1002/ jat.4719
- Tian K, Yang Y, Zhou K, Deng N, Tian Z, Wu Z, et al. The role of ROS-induced pyroptosis in CVD. Front Cardiovasc Med 2023;10:1116509. doi:10.3389/fcvm.2023.1116509
- Poon HF, Calabrese V, Scapagnini G, Butterfield DA. Free radicals and brain aging. Clin Geriatr Med 2004;20(2):329- 59. doi:10.1016/j.cger.2004.02.005
- Zhu H, Itoh K, Yamamoto M, Zweier JL, Li Y. Role of Nrf2 signaling in regulation of antioxidants and phase 2 enzymes in cardiac fibroblasts: protection against reactive oxygen and nitrogen species-induced cell injury. FEBS Lett 2005;579(14):3029-36. doi:10.1016/j.febslet.2005.04.058
- Dai X, Huang Z, Lyu R. Free radicals in health and disease. MedComm (2020) 2025;6(10) :e70396. doi:10.1002/ mco2.70396
- Andreadou I, Schulz R, Papapetropoulos A, Turan B, Ytrehus K, Ferdinandy P, et al. The role of mitochondrial reactive oxygen species, NO and H2S in ischaemia/reperfusion injury and cardioprotection. J Cell Mol Med 2020;24(12):6510-22. doi:10.1111/jcmm.15279
- Sundaramoorthy A, Shanmugam N. Potential therapeutic effect of Salvia coccinea leaf extract in chronic disorders: myocardial infarction, cataract, and arthritis in rat. Pharm Sci Adv 2023;1(2):100017. doi:10.1016/j.pscia.2023.100017
- Welcome MO, Dogo D, Nikos EM. Cellular mechanisms and molecular pathways linking bitter taste receptor signalling to cardiac inflammation, oxidative stress, arrhythmia and contractile dysfunction in heart diseases. Inflammopharmacology 2023;31(1):89-117. doi:10.1007/ s10787-022-01086-9
- Nakamura TY, Nakao S, Wakabayashi S. Neuronal Ca2+ sensor-1 contributes to stress tolerance in cardiomyocytes via activation of mitochondrial detoxification pathways. J Mol Cell Cardiol 2016;99:23-34. doi:10.1016/j.yjmcc.2016.08.013
- Liang B, Zhang XX, Li R, Zhu YC, Tian XJ, Gu N. Guanxin V alleviates acute myocardial infarction by restraining oxidative stress damage, apoptosis, and fibrosis through the TGF-β1 signalling pathway. Phytomedicine 2022;100:154077. doi:10.1016/j.phymed.2022.154077
- Singh V, Kaur R, Kumari P, Pasricha C, Singh R. ICAM- 1 and VCAM-1: gatekeepers in various inflammatory and cardiovascular disorders. Clin Chim Acta 2023;548:117487. doi:10.1016/j.cca.2023.117487
- Alfonso-Jaume MA, Bergman MR, Mahimkar R, Cheng S, Jin ZQ, Karliner JS, et al. Cardiac ischemia-reperfusion injury induces matrix metalloproteinase-2 expression through the AP-1 components FosB and JunB. Am J Physiol Heart Circ Physiol 2006;291(4) :H1838-46. doi:10.1152/ajpheart.00026.2006
- Gardlík R, Pálffy R, Hodosy J, Lukács J, Turna J, Celec P. Vectors and delivery systems in gene therapy. Med Sci Monit 2005;11(4) :RA110-21.
- Mensah GA, Fuster V, Murray CJL, Roth GA. Global burden of cardiovascular diseases and risks, 1990-2022. J Am Coll Cardiol 2023;82(25):2350-473. doi:10.1016/j.jacc.2023.11.007
- Mata A, Cadenas S. The antioxidant transcription factor Nrf2 in cardiac ischemia-reperfusion injury. Int J Mol Sci 2021;22(21):111939. doi:10.3390/ijms222111939
- Xu X, Pang Y, Fan X. Mitochondria in oxidative stress, inflammation and aging: from mechanisms to therapeutic advances. Signal Transduct Target Ther 2025;10(1):190. doi:10.1038/s41392-025-02253-4
- Suematsu N, Tsutsui H, Wen J, Kang D, Ikeuchi M, Ide T, et al. Oxidative stress mediates tumor necrosis factor-alpha-induced mitochondrial DNA damage and dysfunction in cardiac myocytes. Circulation 2003;107(10):1418-23. doi:10.1161/01. cir.0000055318.09997.1f
- Xu HX, Cui SM, Zhang YM, Ren J. Mitochondrial Ca2+ regulation in the etiology of heart failure: physiological and pathophysiological implications. Acta Pharmacol Sin 2020;41(10):1301-9. doi:10.1038/s41401-020-0476-5
- Siasos G, Tsigkou V, Kosmopoulos M, Theodosiadis D, Simantiris S, Tagkou NM, et al. Mitochondria and cardiovascular diseases-from pathophysiology to treatment. Ann Transl Med 2018;6(12):256. doi:10.21037/atm.2018.06.21
- Gong G, Wan W, Zhang X, Chen X, Yin J. Management of ROS and regulatory cell death in myocardial ischemia-reperfusion injury. Mol Biotechnol 2025;67(5):1765-83. doi:10.1007/ s12033-024-01173-y
- Nan J, Zhu W, Rahman MS, Liu M, Li D, Su S, et al. Molecular regulation of mitochondrial dynamics in cardiac disease. Biochim Biophys Acta Mol Cell Res 2017;1864(7):1260-73. doi:10.1016/j.bbamcr.2017.03.006
- Vásquez-Trincado C, García-Carvajal I, Pennanen C, Parra V, Hill JA, Rothermel BA, et al. Mitochondrial dynamics, mitophagy and cardiovascular disease. J Physiol 2016;594(3):509-25. doi:10.1113/jp271301
- Kroemer G, Galluzzi L, Brenner C. Mitochondrial membrane permeabilization in cell death. Physiol Rev 2007;87(1):99-163. doi:10.1152/physrev.00013.2006
- Li P, Nijhawan D, Budihardjo I, Srinivasula SM, Ahmad M, Alnemri ES, et al. Cytochrome c and dATP-dependent formation of Apaf-1/caspase-9 complex initiates an apoptotic protease cascade. Cell 1997;91(4):479-89. doi:10.1016/s0092- 8674(00)80434-1
- Zhao Q, Hu X, Shao L, Wu G, Du J, Xia J. LipoxinA4 attenuates myocardial ischemia reperfusion injury via a mechanism related to downregulation of GRP-78 and caspase-12 in rats. Heart Vessels 2014;29(5):667-78. doi:10.1007/s00380-013-0418-y
- Fazal L, Laudette M, Paula-Gomes S, Pons S, Conte C, Tortosa F, et al. Multifunctional mitochondrial Epac1 controls myocardial cell death. Circ Res 2017;120(4):645-57. doi:10.1161/ circresaha.116.309859
- Gao P, Yan Z, Zhu Z. Mitochondria-associated endoplasmic reticulum membranes in cardiovascular diseases. Front Cell Dev Biol 2020;8:604240. doi:10.3389/fcell.2020.604240
- Kurian GA, Jayaraman S, Gino ER. Strategic targeting of mitochondria: bridging biology and therapy for health benefits. Cell Biochem Biophys 2026;84(1):283-309. doi:10.1007/ s12013-025-01915-y
- Ji Y, Leng Y, Lei S, Qiu Z, Ming H, Zhang Y, et al. The mitochondria-targeted antioxidant MitoQ ameliorates myocardial ischemia-reperfusion injury by enhancing PINK1/ Parkin-mediated mitophagy in type 2 diabetic rats. Cell Stress Chaperones 2022;27(4):353-67. doi:10.1007/s12192-022- 01273-1
- Piot C, Croisille P, Staat P, Thibault H, Rioufol G, Mewton N, et al. Effect of cyclosporine on reperfusion injury in acute myocardial infarction. N Engl J Med 2008;359(5):473-81. doi:10.1056/NEJMoa071142
- Abu Shelbayeh O, Arroum T, Morris S, Busch KB. PGC-1α is a master regulator of mitochondrial lifecycle and ROS stress response. Antioxidants (Basel) 2023;12(5):1075. doi:10.3390/ antiox12051075
- Dézsi CA. Trimetazidine in practice: review of the clinical and experimental evidence. Am J Ther 2016;23(3) :e871-9. doi:10.1097/mjt.0000000000000180
- Andelova K, Bacova BS, Sykora M, Hlivak P, Barancik M, Tribulova N. Mechanisms underlying antiarrhythmic properties of cardioprotective agents impacting inflammation and oxidative stress. Int J Mol Sci 2022;23(3):1416. doi:10.3390/ ijms23031416
- Rakhshan K, Azizi Y, Naderi N, Ghardashi Afousi A, Aboutaleb N. ELABELA (ELA) peptide exerts cardioprotection against myocardial infarction by targeting oxidative stress and the improvement of heart function. Int J Pept Res Ther 2019;25(2):613-21. doi:10.1007/s10989-018-9707-8
- Gumpper-Fedus K, Park KH, Ma H, Zhou X, Bian Z, Krishnamurthy K, et al. MG53 preserves mitochondrial integrity of cardiomyocytes during ischemia reperfusion-induced oxidative stress. Redox Biol 2022;54:102357. doi:10.1016/j. redox.2022.102357
- Xue Y, Song T, Ke J, Lin S, Zhang J, Chen Y, et al. MG53 protects against coxsackievirus B3-induced acute viral myocarditis in mice by inhibiting NLRP3 inflammasome-mediated pyroptosis via the NF-κB signaling pathway. Biochem Pharmacol 2024;223:116173. doi:10.1016/j.bcp.2024.116173
- Hori M, Nishida K. Oxidative stress and left ventricular remodelling after myocardial infarction. Cardiovasc Res 2009;81(3):457-64. doi:10.1093/cvr/cvn335
- Pfeffer MA, Braunwald E. Ventricular remodeling after myocardial infarction. Experimental observations and clinical implications. Circulation 1990;81(4):1161-72. doi:10.1161/01. cir.81.4.1161
- Sies H, Belousov VV, Chandel NS, Davies MJ, Jones DP, Mann GE, et al. Defining roles of specific reactive oxygen species (ROS) in cell biology and physiology. Nat Rev Mol Cell Biol 2022;23(7):499-515. doi:10.1038/s41580-022-00456-z
- Blaser H, Dostert C, Mak TW, Brenner D. TNF and ROS crosstalk in inflammation. Trends Cell Biol 2016;26(4):249- 61. doi:10.1016/j.tcb.2015.12.002
- Michalak KP, Michalak AZ. Understanding chronic inflammation: couplings between cytokines, ROS, NO, Cai 2+, HIF-1α, Nrf2 and autophagy. Front Immunol 2025;16:1558263. doi:10.3389/fimmu.2025.1558263
- Herpel E, Singer S, Flechtenmacher C, Pritsch M, Sack FU, Hagl S, et al. Extracellular matrix proteins and matrix metalloproteinases differ between various right and left ventricular sites in end-stage cardiomyopathies. Virchows Arch 2005;446(4):369-78. doi:10.1007/s00428-004-1177-z
- Chen Z, Siu B, Ho YS, Vincent R, Chua CC, Hamdy RC, et al. Overexpression of MnSOD protects against myocardial ischemia/reperfusion injury in transgenic mice. J Mol Cell Cardiol 1998;30(11):2281-9. doi:10.1006/jmcc.1998.0789
- Xu L, Wang H, Jiang F, Sun H, Zhang D. LncRNA AK045171 protects the heart from cardiac hypertrophy by regulating the SP1/MG53 signalling pathway. Aging (Albany NY) 2020;12(4):3126-39. doi:10.18632/aging.102668
- Wang Q, Park KH, Geng B, Chen P, Yang C, Jiang Q, et al. MG53 inhibits necroptosis through ubiquitination-dependent RIPK1 degradation for cardiac protection following ischemia/ reperfusion injury. Front Cardiovasc Med 2022;9:868632. doi:10.3389/fcvm.2022.868632
- Dabravolski SA, Kalmykov VA, Maksaeva AO, Rozhkova UV, Lapshina KO, Orekhov AN. Necroptosis in myocardial ischaemia-reperfusion injury: current update on mechanisms, therapeutic targets, and translational potential. Apoptosis 2025;30(5-6):1216-34. doi:10.1007/s10495-025-02108-x
- Su J, Wu S, Zhou F, Tong Z. Research progress of macromolecules in the prevention and treatment of sepsis. Int J Mol Sci 2023;24(16):13017. doi:10.3390/ijms241613017
- Yun M, Langford L, Russell L, Ndiforamang N, Zhang A, Bai W. Emerging stimuli-responsive hydrogels for enhancing chronic wound healing. RSC Appl Polym 2026;4(1):53-82. doi:10.1039/ d5lp00092k
- Shan D, Guo S, Wu HK, Lv F, Jin L, Zhang M, et al. Cardiac ischemic preconditioning promotes MG53 secretion through H2O2-activated protein kinase C-δ signaling. Circulation 2020;142(11):1077-91. doi:10.1161/ circulationaha.119.044998
- Wang Y, Zhou H, Wu J, Ye S. MG53 alleviates hypoxia/ reoxygenation-induced cardiomyocyte injury by succinylation and ubiquitination modification. Clin Exp Hypertens 2023;45(1):2271196. doi:10.1080/10641963.2023.2271196
- Cao CM, Zhang Y, Weisleder N, Ferrante C, Wang X, Lv F, et al. MG53 constitutes a primary determinant of cardiac ischemic preconditioning. Circulation 2010;121(23):2565-74. doi:10.1161/circulationaha.110.954628
- Wang X, Li X, Ong H, Tan T, Park KH, Bian Z, et al. MG53 suppresses NF-κB activation to mitigate age-related heart failure. JCI Insight 2021;6(17) :e148375. doi:10.1172/jci. insight.148375
- Romanova N, Sule K, Issler T, Hebrok D, Persicke M, Thévenod F, et al. Cadmium-cardiolipin disruption of respirasome assembly and redox balance through mitochondrial membrane rigidification. J Lipid Res 2025;66(3):100750. doi:10.1016/j. jlr.2025.100750
- Zhu XZ, Wang JQ, Wu YH. MG53 ameliorates nerve injury induced neuropathic pain through the regulation of Nrf2/ HO-1 signaling in rats. Behav Brain Res 2023;449:114489. doi:10.1016/j.bbr.2023.114489
- Han X, Chen D, Liufu N, Ji F, Zeng Q, Yao W, et al. MG53 protects against sepsis-induced myocardial dysfunction by upregulating peroxisome proliferator-activated receptor-α. Oxid Med Cell Longev 2020;2020:7413693. doi:10.1155/2020/7413693
- Zhao L, Cheng J, Liu D, Gong H, Bai D, Sun W. Potentilla anserina polysaccharide alleviates cadmium-induced oxidative stress and apoptosis of H9c2 cells by regulating the MG53- mediated RISK pathway. Chin J Nat Med 2023;21(4):279-91. doi:10.1016/s1875-5364(23)60436-4
- Zhu H, Hou J, Roe JL, Park KH, Tan T, Zheng Y, et al. Amelioration of ischemia-reperfusion-induced muscle injury by the recombinant human MG53 protein. Muscle Nerve 2015;52(5):852-8. doi:10.1002/mus.24619
- Sermersheim M, Kenney AD, Lin PH, McMichael TM, Cai C, Gumpper K, et al. MG53 suppresses interferon-β and inflammation via regulation of ryanodine receptor-mediated intracellular calcium signaling. Nat Commun 2020;11(1):3624. doi:10.1038/s41467-020-17177-6
- Esmailidehaj M, Esmaeili H, Chavoushi E, Rezvani ME, Azizian H. Lack of effect of plasma of myocardial preconditioned, ischemic and ischemic-reperfused rats of myocardium on differentiation of mesenchymal stem cells into cardiomyocytes. J Shahid Sadoughi Univ Med Sci 2022;30(4):4778-92. doi:10.18502/ssu.v30i4.9902
- Li J, Jiang R, Hou Y, Lin A. Mesenchymal stem cells-derived exosomes prevent sepsis-induced myocardial injury by a CircRTN4/miR-497-5p/MG53 pathway. Biochem Biophys Res Commun 2022;618:133-40. doi:10.1016/j.bbrc.2022.05.094
- Gotto AM Jr. Jeremiah Metzger Lecture: cholesterol, inflammation and atherosclerotic cardiovascular disease: is it all LDL? Trans Am Clin Climatol Assoc 2011;122:256-89.
- Zhuang J, Cheng G, Huang J, Guo H, Lai Y, Wang J, et al. Rosuvastatin exerts cardioprotective effect in lipopolysaccharide-mediated injury of cardiomyocytes in an MG53-dependent manner. BMC Cardiovasc Disord 2022;22(1):69. doi :https:// doi.org/10.1186/s12872-022-02458-3