Medicinal, Psychological, and Health Research Journal (MPHRJ)

Intravenous Dexmedetomidine in Cardiomyocyte Biology: A Systematic Review

Document Type : Systematic Review

Authors

Solmaz Fakhari 1
Artin Bilehjani 2
Eissa Bilehjani 1

1 Professor of Anesthesiology, Department of Anesthesiology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran

2 : Medical student, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

https://doi.org/10.22034/mphrj.2026.586239.1093
Abstract
Introduction: Intravenous dexmedetomidine may influence cardiomyocyte biology through effects on apoptosis, inflammation, oxidative stress, and mitochondrial function, with possible relevance in perioperative and critical care settings. However, available evidence remains heterogeneous and translationally uncertain. This study aims to systematically evaluate its cellular effects on cardiomyocytes and clarify their clinical relevance.

Material and methods: This systematic review followed PRISMA guidelines, searched PubMed, Scopus, Web of Science, and Embase without time restriction using Boolean operators, and included original English studies on intravenous dexmedetomidine and cardiomyocyte biology. Study selection and quality assessment were performed independently by two reviewers, and key methodological and outcome data were extracted from each article.

Results: Dexmedetomidine consistently exerts direct cardiomyocyte-protective effects by attenuating apoptosis, oxidative stress, and inflammation across various stress models. Key mechanisms include activation of antioxidant pathways, enhanced autophagic flux via adrenergic signaling, and epigenetic regulation of anti-inflammatory axes. Additionally, it modulates electrophysiological properties by suppressing sodium and calcium currents, demonstrating a pleiotropic capacity to preserve cellular homeostasis and functional integrity.

Conclusion: Dexmedetomidine functions as a potent pleiotropic modulator of cardiomyocyte biology, providing robust protection against ischemic and oxygen-related stress. Beyond its sedative properties, it directly influences survival signaling, redox balance, and electrophysiology through diverse molecular pathways. These findings underscore its potential as a targeted cardioprotective agent, necessitating further clinical exploration to translate these cellular benefits into perioperative patient care.

Graphical Abstract

Intravenous Dexmedetomidine in Cardiomyocyte Biology: A Systematic Review

Keywords

Dexmedetomidine
Cardiomyocytes
Cardioprotection
Signal transduction
Systematic review
Subjects
[1]    Agha Mohammadi, D., Bilehjani, E., Farzin, H., Fakhari, S., & Naderpour, M. (2020). Effect of pressure on the Yinmen point in relief of pain after middle ear surgery: A randomized clinical trial. Anesthesiology and Pain Medicine, *10*(5), e103328.
[2]    Bilehjani, E., Fakhari, S., Farzin, H., Tajlil, A., & Nader, N. D. (2024). Diagnosis and treatment of cardiovascular manifestations of COVID-19: A narrative review. Acta Cardiologica, *79*(3), 267–273.
[3]    Bilehjani, E., Nader, N., Farzin, H., Haghighate Azari, M., & Fakhari, S. (2020). The evaluation of factors affecting hemodynamic variability in mechanically-ventilated patients after cardiac surgery. Anesthesiology and Pain Medicine, *10*(4), e101832.
[4]    Boerma, M., Kruse, J. J., van Loenen, M., Klein, H. R., Bart, C. I., Zurcher, C., & Wondergem, J. (2004). Increased deposition of von Willebrand factor in the rat heart after local ionizing irradiation. Strahlentherapie und Onkologie, *180*(2), 109–116.
[5]    Borger, M., von Haefen, C., Bührer, C., & Endesfelder, S. (2023). Cardioprotective effects of dexmedetomidine in an oxidative-stress in vitro model of neonatal rat cardiomyocytes. Antioxidants (Basel), *12*(6), 1206.
[6]    Cai, S., Liu, Y., Cheng, Y., Yuan, J., & Fang, J. (2022). Dexmedetomidine protects cardiomyocytes against hypoxia/reoxygenation injury via multiple mechanisms. Journal of Clinical Laboratory Analysis, *36*(7), e24119.
[7]    Fakhari, S., Pishghahi, A., Pourfathi, H., Farzin, H., & Bilehjani, E. (2021). A comparison between low-level laser therapy and intra-articular ozone injection in knee osteoarthritis treatment: A randomized clinical trial. Journal of Lasers in Medical Sciences, *12*, e44.
[8]    Heidenreich, P. A., & Kapoor, J. R. (2009). Radiation induced heart disease: Systemic disorders in heart disease. Heart, *95*(3), 252–258.
[9]    Hu, Y., Zhou, H., Zhang, H., Sui, Y., Zhang, Z., Zou, Y., Li, K., Zhao, Y., Xie, J., & Zhang, L. (2022). The neuroprotective effect of dexmedetomidine and its mechanism. Frontiers in Pharmacology, *13*, 965661.
[10] Jang, Y., Yeom, M. Y., Kang, E. S., Kang, J. W., & Song, H. K. (2014). The antinociceptive effect of dexmedetomidine modulates spleen cell immunity in mice. International Journal of Medical Sciences, *11*(3), 226–233.
[11] Laugaard Lorenzen, E., Christian Rehammar, J., Jensen, M. B., Ewertz, M., & Brink, C. (2020). Radiation-induced risk of ischemic heart disease following breast cancer radiotherapy in Denmark, 1977–2005. Radiotherapy and Oncology, *152*, 103–110.
[12] Liu, C., & Xu, R. (2022). Dexmedetomidine protects H9C2 rat cardiomyocytes against hypoxia/reoxygenation injury by regulating the long non-coding RNA colon cancer-associated transcript 1/microRNA-8063/Wnt/beta-catenin axis. Bioengineered, *13*(5), 13300–13311.
[13] Ping, Z., Peng, Y., Lang, H., Xinyong, C., Zhiyi, Z., Xiaocheng, W., Hong, Z., & Liang, S. (2020). Oxidative stress in radiation-induced cardiotoxicity. Oxidative Medicine and Cellular Longevity, *2020*, 3579143.
[14] Puukila, S., Lemon, J. A., Lees, S. J., Tai, T. C., Boreham, D. R., & Khaper, N. (2017). Impact of ionizing radiation on the cardiovascular system: A review. Radiation Research, *188*(4.2), 539–546.
[15] Rakocevic, J., Orlic, D., Mitrovic-Ajtic, O., Tomasevic, M., Dobric, M., Zlatic, N., Milasinovic, D., Stankovic, G., Ostojic, M., & Labudovic-Borovic, M. (2017). Endothelial cell markers from clinician's perspective. Experimental and Molecular Pathology, *102*(2), 303–313.
[16] Rubin, E., Camara, J., Grayzel, D. M., & Zak, F. G. (1963). Radiation-induced cardiac fibrosis. The American Journal of Medicine, *34*(1), 71–75.
[17] Ruckert, M., Flohr, A. S., Hecht, M., & Gaipl, U. S. (2021). Radiotherapy and the immune system: More than just immune suppression. Stem Cells, *39*(9), 1155–1165.
[18] Sarkozy, M., Varga, Z., Gaspar, R., Szucs, G., Kovacs, M. G., Kovacs, Z. Z. A., Dux, L., Kahan, Z., & Csont, T. (2021). Path mechanisms and therapeutic opportunities in radiation-induced heart disease: From bench to bedside. Clinical Research in Cardiology, *110*(4), 507–531.
[19] Seemann, I., Gabriels, K., Visser, N. L., Hoving, S., te Poele, J. A., Pol, J. F., Gijbels, M. J., Janssen, B. J., van Leeuwen, F. W., Daemen, M. J., ... & Stewart, F. A. (2012). Irradiation induced modest changes in murine cardiac function despite progressive structural damage to the myocardium and microvasculature. Radiotherapy and Oncology, *103*(2), 143–150.
[20] Slezak, J., Kura, B., Babal, P., Barancik, M., Ferko, M., Frimmel, K., Kalocayova, B., Kukreja, R. C., Lazou, A., Mezesova, L., ... & Lukacova, N. (2017). Potential markers and metabolic processes involved in the mechanism of radiation-induced heart injury. Canadian Journal of Physiology and Pharmacology, *95*(10), 1190–1203.
[21] Tapio, S. (2016). Pathology and biology of radiation-induced cardiac disease. Journal of Radiation Research, *57*(5), 439–448.
[22] Nazari,M. , Akhlaghi, F. and Nematabad, H. P. (2025). Comparison of Postoperative nausea and vomiting prevalence in patients with routine NPO and NPO with clear fluids 2 hours before cataract surgery. Journal of Advanced in Medicinal, Pharmaceutical and Biomedical Research, 1(5), 132-139.
[23] Wang, L., Wang, S., Jia, T., Sun, X., Xing, Z., Liu, H., Yao, J., & Chen, Y. (2022). Dexmedetomidine prevents cardiomyocytes from hypoxia/reoxygenation injury via modulating tetmethylcytosine dioxygenase 1-mediated DNA demethylation of Sirtuin1. Bioengineered, *13*(4), 9369–9386.
[24] Xiao, Y., Li, J., Qiu, L., Jiang, C., Huang, Y., Liu, J., Sun, Q., Hong, H., & Ye, L. (2021). Dexmedetomidine protects human cardiomyocytes against ischemia-reperfusion injury through α2-adrenergic receptor/AMPK-dependent autophagy. Frontiers in Pharmacology, *12*, 615424.
[25] Yang, L., Gong, Y., Tan, Y., Wu, L., Witman, N., Zheng, J., Zhang, J., Fu, W., & Wang, W. (2021). Dexmedetomidine exhibits antiarrhythmic effects on human-induced pluripotent stem cell-derived cardiomyocytes through a Na/Ca channel-mediated mechanism. Annals of Translational Medicine, *9*(5), 399.
[26] Yu, P., Zhang, J., Ding, Y., Chen, D., Sun, H., Yuan, F., Li, S., Li, X., Yang, P., Fu, L., ... & Zhang, M. (2022). Dexmedetomidine post-conditioning alleviates myocardial ischemia-reperfusion injury in rats by ferroptosis inhibition via SLC7A11/GPX4 axis activation. Human Cell, *35*(3), 836–848.
[27] Yu, Q., Zou, L., Yuan, X., Fang, F., & Xu, F. (2021). Dexmedetomidine protects against septic liver injury by enhancing autophagy through activation of the AMPK/SIRT1 signaling pathway. Frontiers in Pharmacology, *12*, 658677.
[28] Zhang, L., Xiao, F., Zhang, J., Wang, X., Ying, J., Wei, G., Chen, S., Huang, X., Yu, W., Liu, X., ... & Zhang, Y. (2021). Dexmedetomidine mitigated NLRP3-mediated neuroinflammation via the ubiquitin-autophagy pathway to improve perioperative neurocognitive disorder in mice. Frontiers in Pharmacology, *12*, 646265.
[29] Zhao, S., Wu, W., Lin, X., Shen, M., Yang, Z., Yu, S., & Luo, Y. (2022). Protective effects of dexmedetomidine in vital organ injury: Crucial roles of autophagy. Cellular & Molecular Biology Letters, *27*(1), 34.
[30]    Shojaei, M. (2025). The preliminary investigation of Orexigenic hormone gene polymorphisms on posttraumatic stress disorder symptoms. Journal of Advanced in Medicinal, Pharmaceutical and Biomedical Research, 1(5), 140-146.
Medicinal, Psychological, and Health Research Journal (MPHRJ)
Volume 2, Issue 5
September and October 2026
Pages 360-371

Home

Editorial Board

Guide for Authors

Submit Manuscript

Contact Us