Meldonium: current and emerging therapeutic applications

Meldonium functions as an inhibitor of γ-butyrobetaine hydroxylase, the enzyme responsible for catalyzing the biosynthesis of L-carnitine. By inhibiting mitochondrial β-oxidation of fatty acids under hypoxic conditions, meldonium exerts cytoprotective effects on cardiac, hepatic, and pulmonary tissues. Meldonium attenuates the deleterious effects of myocardial infarction, arrhythmias, and diabetes. It is recognized as a promising therapeutic agent for neurodegenerative disorders, including Alzheimer's disease, Parkinson's disease, and Huntington's disease, as well as painful neuropathies. Its neuroprotective properties are attributed to its ability to mitigate age-related alterations in the central nervous system by reducing oxidative stress and inflammation. Moreover, it inhibits neuronal apoptosis and facilitates cognitive functions, particularly learning and memory processes. Meldonium has been designated as a prohibited doping agent by the World Anti-Doping Agency (WADA), and its use is strictly banned in professional sports. Recent scientific investigations indicate that meldonium may exhibit additional therapeutic potential beyond its currently recognized clinical applications.