Endogenous and exogenous stimuli-driven intelligent nanocarriers: emerging strategies for the treatment of myocardial infarction

Myocardial infarction (MI) is one of the leading causes of death worldwide, characterized by irreversible loss of cardiomyocytes caused by ischemic injury. Despite the development of various therapeutic approaches in recent years, persistently high mortality underscores the urgent need for more advanced treatment strategies. Nanomaterials have attracted considerable attention in drug delivery due to their nanoscale dimensions, facile surface modification, and multifunctional properties. In particular, stimuli-responsive nanomaterials have demonstrated significant potential. These materials are capable of responding to endogenous cues (e.g., pH, ROS, and enzymes) or exogenous triggers (e.g., thermal, magnetic, and ultrasonic stimuli). This review systematically summarizes the recent advances and application prospects of stimuli-responsive nanomaterials for MI therapy. Through the summary and analysis of existing research, we examine the key pathological stimuli present in the infarcted microenvironment and classify nanocarriers according to their response mechanisms. We also discuss the diverse therapeutic and diagnostic applications of these stimuli-responsive nanomaterials in the context of MI. Overall, this article provides researchers and clinicians with an integrated perspective on harnessing stimuli-responsive nanomaterials for the precision diagnosis and treatment of MI. Classifies MI nanocarriers by stimulus type of endogenous and exogenous responsiveness. Maps stimulus mechanisms to MI pathological stages for design guidance. Compares advantages, limitations, and translational feasibility of endogenous and exogenous stimuli-driven intelligent nanocarriers. Proposes multi-responsive, theranostic, and biomimetic directions for translation.