Small vesicles, big potential: A review of innovative exosome delivery and molecular mechanisms in preclinical myocardial infarction models

Exosomes have emerged as promising therapeutic carriers, with over 40 000 scientific publications reflecting their exponential growth in biomedical research. Cardiovascular diseases (CVDs) are the leading cause of mortality worldwide. Among these, myocardial infarction (MI) represents the most prevalent and devastating form, contributing significantly to global morbidity and mortality. Reducing the mortality and long-term complications associated with MI is therefore both necessary and urgent. Exosomes, naturally occurring extracellular vesicles, offer a promising cell-free alternative for drug delivery and cardiac repair and regeneration after ischemic injury due to their ability to transport bioactive proteins, lipids, and RNA. This narrative review summarizes recent advancements in exosome-based therapeutics for ischemic heart disease, focusing on the efficacy of various animal models. Various approaches are being studied to optimize exosome-based therapies, including methods to enhance their stability, targeting ability, and bioavailability in the cardiovascular system, highlighting the potential of exosomes not only as drug delivery vehicles but also as regenerative mediators capable of promoting myocardial repair and reducing MI. With continued advances in exosome technology and a deeper understanding of their biological functions, there is growing optimism that these vesicles could pave the way for more effective and less invasive treatments for cardiovascular diseases in the near future.