Internal medicine

Cystathionine beta synthase

Enzyme

Heart failure

Coronary artery disease

Disease

Cysteine

Myocardial infarction

Bioinformatics

Biology

Cystathionine gamma-lyase

Nitric oxide

Biochemistry

Medicine

Pharmacology

Nature Reviews Cardiology

Hydrogen sulfide (H2S) has emerged as a gaseous signalling molecule with crucial implications for cardiovascular health. H2S is involved in many biological functions, including interactions with nitric oxide, activation of molecular signalling cascades, post-translational modifications and redox regulation. Various preclinical and clinical studies have shown that H2S and its synthesizing enzymes — cystathionine γ-lyase, cystathionine β-synthase and 3-mercaptosulfotransferase — can protect against cardiovascular pathologies, including arrhythmias, atherosclerosis, heart failure, myocardial infarction and ischaemia–reperfusion injury. The bioavailability of H2S and its metabolites, such as hydropersulfides and polysulfides, is substantially reduced in cardiovascular disease and has been associated with single-nucleotide polymorphisms in H2S synthesis enzymes. In this Review, we highlight the role of H2S, its synthesizing enzymes and metabolites, their roles in the cardiovascular system, and their involvement in cardiovascular disease and associated pathologies. We also discuss the latest clinical findings from the field and outline areas for future study. Hydrogen sulfide (H2S) is a gaseous signalling molecule with important roles in cardiovascular health and disease. In this Review, Kevil and colleagues discuss the role of H2S, its synthesizing enzymes and metabolites, their roles in the cardiovascular system, and their involvement in cardiovascular disease and associated pathologies.

Sulfide regulation of cardiovascular function in health and disease