Exosomal <scp>LncRNAs</scp> in Myocardial Ischemia: From Diagnostic Advantage to Therapeutic Targets

Myocardial ischemia (MI), which is a key form of ischemic heart disease, is still the most common cause of morbidity and mortality in the world. While reperfusion therapy has changed clinical management, many of the unmet needs for the early diagnosis and treatment of MI remain. Two rapid advances, namely, extracellular vesicle biology and the field of non-coding RNA genomics, have combined to identify a class of potent signaling molecules, exosomal long non-coding RNAs (lncRNAs). In this review, we characterize the specific functions of prominent exosomal lncRNAs in the core biological pathophysiological elements of MI, including apoptosis, inflammation, angiogenesis, autophagy, and fibrosis. Exosomal lncRNAs can either be involved in damaging - transmitting signals of injury-or restorative-driving repair and regeneration-and often play such roles based on their source and recipient. In addition to their therapeutic advantage, exosomal lncRNAs have enormous diagnostic capacity as stable, sensitive, and early-stage "liquid biopsy" diagnostics. By integrating core biology into clinical possibilities, we hope this review represents the field's current viewpoint and where it is heading to change the diagnosis and treatment of myocardial ischemia.