Year: 2025
Type: article
Abstract: Myocardial infarction (MI) and age-related cardiac remodeling remain major causes of morbidity and mortality worldwide. Because the adult heart has only limited regenerative capacity, extracellular vesicles (EVs) have emerged as promising acellular mediators of tissue repair, with the potential to mitigate both ischemic injury and age-associated decline. Preclinical studies demonstrate that EVs derived from stem and progenitor cells exert anti-apoptotic, anti-fibrotic, anti-inflammatory, and pro-angiogenic effects. In aged hearts, EVs can help restore metabolic homeostasis, attenuate pro-senescent signaling, and improve functional resilience. Early-phase clinical trials suggest that EV-based or EV-enriched products are feasible and safe, although evidence of efficacy remains limited. This review synthesizes current mechanistic insights into EV-mediated regulation of inflammation, fibrosis, angiogenesis, oxidative and ferroptotic stress, and cellular senescence, underscoring the therapeutic potential of EVs in cardiac regeneration - particularly in older patients with impaired endogenous repair. Importantly, it uniquely integrates the dual roles of EVs in both myocardial infarction repair and cardiac aging, thereby addressing a critical gap in the literature. By linking mechanisms of post-infarction regeneration with age-related cardiac decline, we outline the translational challenges and opportunities of EV-based therapies. Further advances in EV engineering, targeting, dosing, potency assays, and standardization will be essential for successful clinical translation.
DOI: 10.20517/jca.2025.30
Language: English
Subfield: Molecular Biology
Domain: Life Sciences
Open Access status: hybrid
OpenAlex ID: W4415781483