Silk-Fibroin-Based Strategies for Myocardial Infarction Repair: A Comprehensive Review.

Myocardial infarction is a major cardiovascular event that leads to heart failure and death. Although current vascular regeneration and pharmacological therapies can salvage some myocardial tissue, they cannot effectively reverse established necrosis, fibrosis, or adverse ventricular remodeling, thus necessitating novel repair strategies. Silk fibroin (SF), a natural biomaterial, has emerged as an ideal substrate for cardiac tissue engineering owing to its excellent biocompatibility, tunable mechanical properties, and controllable biodegradability. This paper systematically reviews SF-based myocardial repair strategies: SF cardiac patches can be directly applied to infarct areas, providing mechanical support and delivering bioactive substances, while injectable SF hydrogels can be formed in situ via minimally invasive methods, serving as three-dimensional delivery vehicles for cells or drugs. These approaches synergistically promote cardiac repair through multiple mechanisms, including active regulation of inflammation, promotion of angiogenesis, and inhibition of fibrosis. Future development of SF-based therapies will focus on creating smart responsive materials, constructing biomimetic structures via advanced biomanufacturing techniques, and accelerating clinical translation, thereby providing comprehensive solutions for myocardial infarction repair.