Nanomedicine in cardiovascular and cerebrovascular diseases: targeted nanozyme therapies and their clinical potential and current challenges

Cardiovascular and cerebrovascular diseases continue to be significant public health problems, with high mortality and morbidity rates worldwide. Inflammation and ROS are believed to be the hallmarks of these diseases, but conventional therapies targeting inflammation and ROS have had limited success due to their limited pharmacokinetics, low bioavailability, shorter half-life, and notable side effects. Over the last decade, nanomedicine has rapidly evolved with diverse applications in diagnostics, drug delivery, and treatment of various diseases, including cardiovascular and cerebrovascular diseases. Nanomaterials such as nanozymes have gained success with remarkable therapeutic efficacy due to their stability, formulations, enzyme-mimetic activities, and ability to deliver more than one drug. Moreover, nanozymes can uphold a constant rate of drug release, maintaining a low frequency of dosing to reduce the side effects of drugs. Due to their multifunctional nature, they can be used as targeted delivery vehicles to the damaged brain, arterial, and other tissues to mitigate inflammation and ROS while promoting blood-brain barrier protection, ischemic stroke neurovascular recovery, and neuronal cell survival. In this review article, we have explored the mechanisms and different types of nanozyme-based targeted therapies for several cardiovascular and cerebrovascular diseases, including myocardial infarction, atherosclerosis, and ischemic stroke. We have discussed their enzyme-mimetic catalytic activities, immune-modulatory effects, ROS scavenging abilities, and anti-inflammatory properties. We have also discussed the challenges that slow down the clinical and translational success of these nanozyme-based therapies. Continuing work with integrated and multidisciplinary approaches, these nanozymes may offer potential solutions for cardiovascular and cerebrovascular diseases. Nanozymes offer high stability, low cost, and tunable activity. They mimic various enzymes, enabling diverse applications in biomedicine, including cardiac and cerebrovascular diseases. Recent advances focus on improving catalytic efficiency and substrate specificity through rational design involving size, shape, composition, and surface modification. Metal-based and carbon-based nanozymes have shown robust catalytic performance and biocompatibility. Nanozymes are explored by reducing oxidative stress, scavenging reactive oxygen species, and helping to control inflammation in damaged heart and brain tissues. Key challenges in treating cardiac and brain diseases include improving treatment specificity, understanding underlying mechanisms, and ensuring long-term safety and compatibility for real-world use. This photo abstract shows the cardiovascular and cerebrovascular disease applications of nanozymes (NEs). The classification of nanozymes includes carbon-based nanozymes, metal-based nanozymes, and other nanozymes. Nanozymes work by scavenging ROS, anti-inflammatory and immunomodulatory, as well as targeted delivery and controlled release. It is used in cardiovascular diseases (arteriosclerosis, myocardial infarction, thrombosis) and cerebrovascular disease (ischemic stroke, hemorrhagic stroke, nerve repair). Challenges include toxicity, large-scale production, and regulatory issues, and future directions include optimal design, clinical trials, and interdisciplinary collaboration. Nanozymes show great potential in the treatment of cardiovascular and cerebrovascular diseases by mimicking the activity of natural enzymes, effectively clearing ROS, regulating inflammation, and promoting tissue repair.