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Cyclosporine is a calcineurin inhibitor traditionally used as an immunosuppressant in organ transplantation and autoimmune diseases. In the context of acute myocardial infarction (AMI) and cardiogenic shock, it is being investigated for its cardioprotective properties, specifically its ability to inhibit the opening of the mitochondrial permeability transition pore (mPTP). Opening of the mPTP during reperfusion is a key mediator of lethal reperfusion injury and cell death. By binding to Cyclophilin D, cyclosporine prevents mPTP opening, thereby reducing infarct size and potentially improving clinical outcomes in patients with severe cardiac injury. The CLOTILDE trial, sponsored by Hospices Civils de Lyon, evaluated a specific Cremophor-free lipid emulsion formulation (CicloMulsion) developed by NeuroVive Pharmaceutical for intravenous bolus administration in patients with AMI complicated by cardiogenic shock.
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