Orchestrating cell death and microenvironment: Natural products as multi-target modulators of pyroptosis in myocardial ischemia-reperfusion injury

Myocardial ischemia–reperfusion injury (MIRI) is a serious clinical problem. Pyroptosis is a metabolic inflammation linking mechanism to MIRI as of now. The clinical translation of single-target synthetic inhibitors has been limited by off-target toxicity and their inability to halt the complex compensatory signaling of cell death despite mechanistic advances. The current review aims to tackle the translational bottlenecks through an integration of the evolving landscape of pyroptosis and PANoptosis network and multicellular microenvironmental crosstalk beyond isolated pathways. We consider natural bioactive products as superior therapeutic candidates, as they are not just inhibitors but pleiotropic system regulators. Unlike synthetic agents, these do exhibit synergy across processes such as metabolism, epigenetics, and immunity. Additionally, we propose integration with organelle-targeted nanomedicine to overcome the natural compounds’ inherent pharmacokinetic limitations. Through a paradigm shift from single-target blockade to multi-dimensional network regulation through precision delivery, using this review offers a roadmap for developing next-generation cardioprotective strategies. • Necrosis plays a crucial role as a key driver of myocardial ischemia-reperfusion injury. • Multicellular crosstalk dictates the inflammatory microenvironment in MIRI. • Natural products exert systemic regulation unlike single-target inhibitors. • Organelle-specific nanomedicine enhances the precision delivery of bioactive agents.