Non-anticoagulant heparin alleviates myocardial ischemia-reperfusion injury through inhibiting GSDMD-mediated cardiomyocyte pyroptosis via the HMGB1/RAGE pathway.

Background: Heparin reduces myocardial ischemia-reperfusion (I/R) injury, which is associated with pyroptosis. As a derivative of heparin, non-anticoagulant heparin (NAH) is rarely researched in this field. This study aims to explore the mechanisms of NAH in myocardial I/R injury and pyroptosis.

Methods: Cardiomyocytes (H9C2) were exposed to hypoxia/reoxygenation (H/R) to simulate myocardial I/R injury in vitro. Cells were treated with NAH, ov-gasdermin D (GSDMD), ov-caspase 11, HO, N-acetyl-L-cysteine (NAC), and recombinant HMGB1 (rHMGB1). The binding of NAH to HMGB1 was detected by molecular docking and DARTS. For in vivo validation, C57BL/6 J male mice underwent myocardial I/R surgery and received NAH and rHMGB1 treatment.

Results: NAH inhibited H/R-induced pyroptosis of H9C2 cells as evidenced by decreased caspase 11/GSDMD activation, decreased IL-18/IL-1β/LDH release, and increased ATP yields. These effects were attenuated by caspase 11 or GSDMD-N overexpression. Similar to NAC, NAH inhibited H/R and HO-induced oxidative stress. Moreover, NAH reversed the promoting effects of rHMGB1 on cell pyroptosis and oxidative stress. Mechanistically, NAH bound to HMGB1, blocking HMGB1/RAGE interaction. In mice, NAH alleviated myocardial infarction, injury, fibrosis, pyroptosis, and oxidative stress. These effects were reversed by rHMGB1.

Conclusions: NAH protects against myocardial I/R injury by inhibiting GSDMD-mediated pyroptosis via the HMGB1/RAGE pathway. NAH may serve as a potential drug for treating myocardial I/R injury.