Heme oxygenase in cardiac repair and regeneration

The incidence of cardiac complications such as myocardial infarction and congestive heart failure is increasing. Once congestive heart failure emerges, little can be done to improve long-term cardiac function. The cellular basis of this downward spiral may be the dramatic loss of viable cardiomyocytes following acute ischemia and/or chronic apoptosis/necrosis which are not adequately replaced. Contrary to the old postulates of developmental biology, tissue self-renewal is not limited to blood, intestines and skin, but other organs including the heart have some capabilities of self-renewal. However, the intrinsic ability of self-renewal of adult myocardium or cardiomyogenesis is limited and thus novel paradigms capable of potentiating this process of regenerative organogenesis should be sought. Several strategies and paradigms are being currently explored, and among these is the heme-oxygenase system. Emerging evidence indicate that the heme-oxygenase system could be explored in regenerative medicine given its unique ability to concomitantly suppress apoptosis and necrosis, while facilitating tissue regeneration/repair and the formation of new blood vessels. This review highlights the recent development of heme-oxygenase in myocardial repair and regeneration.