Nouf Al-Rawahi, Ali Abduwani, Ayman N Alhabsi, Abdullah Al Lawati, Hanan Al Lawati, Srijit Das
Myocardial infarction (MI) is characterized by sudden cardiomyocyte death due to impaired blood supply and remains a leading cause of mortality despite advances in management. Aloe vera, a plant rich in over 75 bioactive compounds, including vitamins, minerals, polysaccharides, and anthraquinones, has been widely used in traditional medicine and modern healthcare. Increasing evidence supports its cardioprotective potential through multiple mechanisms. Aloe vera and its derivatives have demonstrated antioxidative, anti-apoptotic, anti-inflammatory, antimicrobial, immunomodulatory, and vasodilatory effects relevant to MI pathophysiology. Compounds such as aloe-emodin, emodin, aloin, barbaloin, and selenium-enriched polysaccharides have been shown to modulate pathways including Nrf2/HO-1, TGF-β/SMAD, ERK, ferroptosis inhibition, ionic pump activity, and microRNA regulation. These molecular effects translate into reductions in oxidative damage, apoptotic signaling, inflammatory cytokine release, calcium imbalance, and creatine kinase/LDH leakage, while preserving myocardial structure and function in preclinical models. Collectively, preclinical studies suggest the potential cardioprotective effects of Aloe vera-derived preparations and compounds; however, robust clinical evidence in myocardial infarction is lacking, and their therapeutic relevance remains uncertain.