Acupuncture preconditioning protects against myocardial ischemia/reperfusion injury mediated apoptosis through miR214/NCX1 activation: a hypothesis

Early reperfusion of ischemic cardiac tissue is usually the best option to improve clinical outcome of angina pectoris, especially of acute myocardial infarction. However, myocardial reperfusion may cause an abnormal increase of intracellular Ca2+mediated cardiomyocyte death and consequent loss of cardiac function, which is referred to myocardial ischemia/reperfusion (I/R) injury. Recently, the microRNA214 (miR214)/Na+/Ca2+ exchanger (NCX) 1 coexpression is a key factor in cellular protection against myocardial apoptosis for myocardial I/R injury. Once activated, miR214/NCX1 axis can inhibit several Ca2+ downstream signaling effectors that mediate cell death simultaneously. Studies have shown that acupuncture preconditioning has a protective effect on myocardial I/R injury, but its mechanism deserves further research. It has been proved that acupuncture preconditioning for ischemic myocardium successfully inhibit multiple Ca2+ handling related microRNAs that mediate cell death pathways, and miR214 is one of its targets. In terms of clinical practice, coronary heart disease (CHD) patients benefit a lot from this intervention. However, there is barely no study correlating acupuncture preconditioning to the miR214/NCX1 coexpression in patients with CHD. This review aims to discuss whether there is some evidence to justify a recommendation of acupuncture preconditioning in CHD patients as a nonpharmacological therapeutic method to activate the miR214/NCX1 coexpression network model.