Recent studies using exosomes as a therapeutic platform for the treatment of vascular diseases have led to very encouraging responses.1–3 To date, exosomes secreted by stem and progenitor cells in the myocardium have shown promising therapeutic benefits, although their precise cellular origin and mechanism(s) of action remain poorly characterized. In this issue of Molecular Therapy, Beltrami et al.4 report that exosomes present in the pericardial fluid (PF) of patients undergoing aortic valve replacement (AVR) are enriched with microRNAs (miRNAs) co-expressed in patients’ myocardium and vasculature.