Macrophage Membrane-Coated Nanocarriers in Myocardial Infarction: A Paradigm Shift in Targeted Cardiac Therapy

Myocardial infarction remains a major contributor to global morbidity and mortality, with current therapeutic strategies often falling short in addressing post-infarction inflammation, fibrotic remodeling, and suboptimal drug localization. Macrophages are key modulators of the cardiac immune microenvironment, play a dual role in tissue damage and repair by polarizing into distinct inflammatory and reparative phenotypes. Recent advancements in biomimetic nanotechnology have facilitated the development of macrophage membrane-coated nanocarrier engineered systems that replicate the functional surface characteristics of native macrophages. These nanocarriers offer enhanced therapeutic precision by enabling immune evasion, targeted delivery to infarcted myocardium, and sustained release of bioactive agents. Their prolonged systemic circulation further augments therapeutic efficacy. Current clinical strategies remain insufficient in preventing long-term complications such as adverse cardiac remodeling and the development of heart failure, highlighting a critical need for targeted and effective post-MI therapies. This review comprehensively evaluates the biological role of macrophages in the context of myocardial infarction and highlights current innovations in the fabrication and functional optimization of macrophage membrane-coated nanocarriers. We further discuss their mechanisms of action, therapeutic benefits demonstrated in preclinical models, and their prospective integration into regenerative treatment paradigms. Critical challenges, including regulatory approval, manufacturing scalability, and clinical translation, are also discussed. These nanocarriers represent a promising frontier in myocardial infarction therapy, offering targeted, biocompatible, and immune-responsive drug delivery platforms.