Research progress on mesenchymal stem cell-derived exosomes in cardiovascular diseases

With population aging and lifestyle changes, cardiovascular diseases, as one of the leading causes of death and disability, continue to show a rising incidence rate. Despite ongoing advancements in existing pharmacological treatments, interventional procedures, and surgical procedures, there remains a lack of effective curative methods for end-stage cardiovascular diseases in clinical practice, highlighting an urgent need for innovative therapeutic approaches. Mesenchymal stem cells are considered promising therapies due to their regenerative and paracrine potential, but their application is limited by challenges such as immune rejection and potential tumorigenicity. In recent years, research focus has shifted toward their secreted exosomes. Mesenchymal stem cell-derived exosomes, as a cell-free therapeutic strategy, offer advantages such as good circulatory stability, high biocompatibility, and low immunogenicity. By carrying various bioactive substances, including proteins, lipids, and microRNAs, they demonstrate multiple protective effects, such as anti-apoptosis, anti-inflammation, promotion of angiogenesis, and inhibition of cardiac remodeling, in cardiovascular disease models like myocardial infarction, heart failure, and atherosclerosis. They also exhibit significant therapeutic potential in various cardiovascular disease models, making them a promising cell-free therapeutic strategy. This narrative review comprehensively synthesizes the biological characteristics of mesenchymal stem cell-derived exosomes (MSC-Exos), their cardioprotective mechanisms, disease-specific preclinical evidence, engineering and delivery strategies, and the major barriers to clinical translation.