Cardiac Exosomes in Ischemic Heart Disease—A Narrative Review

Abstract

Ischemic heart disease (IHD) is the primary cause of death globally. IHD is associated with the disruption of blood supply to the heart muscles, which often results in myocardial infarction (MI) that further may progress to heart failure (HF). Exosomes are a subgroup of extracellular vesicles that can be secreted by virtually all types of cells, including cardiomyocytes, cardiac fibroblasts, endothelial cells, and stem and progenitor cells. Exosomes represent an important means of cell–cell communication through the transport of proteins, coding and non-coding RNA, and other bioactive molecules. Several studies show that exosomes play an important role in the progression of IHD, including endothelial dysfunction, the development of arterial atherosclerosis, ischemic reperfusion injury, and HF development. Recently, promising data have been shown that designates exosomes as carriers of cardioprotective molecules that enhance the survival of recipient cells undergoing ischemia. In this review, we summarize the functional involvement of exosomes regarding IHD. We also highlight the cardioprotective effects of native and bioengineered exosomes to IHD, as well as the possibility of using exosomes as natural biomarkers of cardiovascular diseases. Lastly, we discuss the opportunities and challenges that need to be addressed before exosomes can be used in clinical applications.

Research Opportunities in Autonomic Neural Mechanisms of Cardiopulmonary Regulation

“…In addition to hard-wired neural pathways between cardiopulmonary regions and the brain, there are novel non-neural communication pathways that can modulate autonomic tone. Extracellular vesicles (EVs) are a prime example of such communication ( 23 ). Transfer of proteins, lipids, nucleotides, and metabolites from one organ to another is mediated by EV cargo, specific to each tissue.…”

Research Progress on Transorgan Regulation of the Cardiovascular and Motor System through Cardiogenic Exosomes

“…With cardiac coronary atherosclerosis as the main underlying disease, plaque rupture in the coronary artery triggers coagulation reaction induces platelet aggregation, and then thrombosis in the vascular lumen and progresses along with the blood flow, ultimately leading to acute ischemic hypoxia necrosis of cardiomyocytes downstream of the blood vessel [ 81 ]. The physiological and pathological mechanisms leading to ischemic injury of heart tissue are diverse, among which metabolic acidosis, Ca 2+ overload and accumulation of ROS are the core elements caused by hypoxia and insufficient supply of essential nutrients for some cells [ 82 ]. A series of physiological and pathological changes induced by AMI can stimulate various heart cells and then affect the EXOs they secrete.…”

New Developments in Exosomal lncRNAs in Cardiovascular Diseases

“…In recent years, treatments for MIRI have included ischemic preconditioning (IPC), ischemic postprocessing (IPost), remote ischemic conditioning (IPC), the use of drugs to prevent myocardial reperfusion injury, therapeutic hyperbaric oxygen (HBO) and hypothermia (77)(78)(79). Recent studies have shown that the cardioprotective effect of IPC is mediated by exosomes (80). For example, exosomes derived from rat fibroblasts can protect cardiomyocytes after ischemia by targeting MIR-423-3p/RAP2C to reduce MIRI (81).…”