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.
Highlights
About 16.5 million people die of cardiovascular disease every year and is still the leading cause of death according to the Global Burden of Disease (GBD) study [1]
extracellular vesicles (EVs) contain a variety of proteins, nucleic acids, and lipids, as carriers of intercellular material and information, they can play an important role in influencing the course of disease by regulating interactions between heterogeneous cell microenvironments
EV cargo is effected by disease states, which give circulating EVs the potential as a diagnostic biomarker, which earlier and more accurately reflect the clinical progress of certain diseases, treatment response and prognosis judgement
Summary
About 16.5 million people die of cardiovascular disease every year and is still the leading cause of death according to the Global Burden of Disease (GBD) study [1]. More and more evidences have shown that paracrine factors play an important role in the process of myocardial infarction, the changes of microRNAs (miRs) in circulation can accurately reflect the myocardial injury in vivo [4], and the nearby living myocardium can protect myocardial cells from hypertrophy by capturing EVs. Circulating miRs released by the damaged myocardium after acute myocardial infarction (AMI) can be transferred to distal organs through circulation via exosomes and affect the biological activity of recipient cells functionally. Cardioprotective Effects of Embryonic Stem Cells (ESC), Induced Pluripotent Stem Cells (iPSC), and Their Derrivatives Khan et al [49] found that ESC exosomes enhanced angiogenesis, cardiac progenitor cells (CPC) survival, proliferation and cardiac repair after myocardial infarction, and participated in anti-inflammatory effects, enhanced cardiac function and reduced fibrosis.
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