Therapeutic Applications of Extracellular Vesicles for Myocardial Repair

Abstract

Cardiovascular disease is the leading cause of human death worldwide. Drug thrombolysis, percutaneous coronary intervention, coronary artery bypass grafting and other methods are used to restore blood perfusion for coronary artery stenosis and blockage. The treatments listed prolong lifespan, however, rate of mortality ultimately remains the same. This is due to the irreversible damage sustained by myocardium, in which millions of heart cells are lost during myocardial infarction. The lack of pragmatic methods of myocardial restoration remains the greatest challenge for effective treatment. Exosomes are small extracellular vesicles (EVs) actively secreted by all cell types that act as effective transmitters of biological signals which contribute to both reparative and pathological processes within the heart. Exosomes have become the focus of many researchers as a novel drug delivery system due to the advantages of low toxicity, little immunogenicity and good permeability. In this review, we discuss the progress and challenges of EVs in myocardial repair, and review the recent development of extracellular vesicle-loading systems based on their unique nanostructures and physiological functions, as well as the application of engineering modifications in the diagnosis and treatment of myocardial repair.

Mesenchymal Stromal/Stem Cells and Their Extracellular Vesicles Application in Acute and Chronic Inflammatory Liver Diseases: Emphasizing on the Anti-Fibrotic and Immunomodulatory Mechanisms

“…Although there are numerous clinical trials on the use of MSCs in the treatment of liver disease, to date, no clinical trials have been performed on the use of MSC-EVs despite their benefits. However, it has been used to treat many disorders, including orthopaedic disease ( 151 ), neurodegenerative disease ( 183 ), myocardial disease ( 184 ), renal disease, graft versus host disease (GvHD), pancreatic cancer and type 1 diabetes and has shown promising results ( 185 ). Despite the therapeutic potential of MSC-EVs and their beneficial effects in preclinical studies, several issues related to the clinical use of these vesicles remain unresolved.…”

Nucleic acid functionalized extracellular vesicles as promising therapeutic systems for nanomedicine

“…The EVs summarized in this paper mainly refer to small EVs, including exosomes and microvesicles. Due to their good biocompatibility, low immunogenicity, excellent extensibility, and unique biological regulatory function, EVs have attracted wide attention in the field of nanomedicine and are considered as a new star in nanomedicine [7][8][9] .…”

“…EVs have been developed as a delivery carrier of drugs or contrast agents, showing great application potential in the field of disease diagnosis and treatment [5,8,9] . However, native EVs have difficulty meeting the functional requirements of the complex physiological environment; therefore, necessary engineering design and modification can significantly improve the performance of EVs as a therapeutic system.…”

Designer Functional Nanomedicine for Myocardial Repair by Regulating the Inflammatory Microenvironment

“…The mechanism of heart failure after AMI is closely related to the process of ventricular remodeling [6], and the degree of reconstruction depends on the size of the infarction focus and the quality of cardiac repair [3]. Inflammatory signals play an important role in dilation and fibrosis remodeling of infarcted hearts and are key events driving postinfarct heart failure [7,8]. The traditional treatment methods for myocardial injury include antibiotics, antioxidants, and surgery, but the purpose of clinical treatment is only to delay the progression of myocardial injury due to a lack of more effective treatment measures.…”