Pathways for Cardioprotection in Perspective: Focus on Remote Conditioning and Extracellular Vesicles

Area of Science:

• Cardiology
• Biomedical Engineering
• Molecular Biology

Background:

• Coronary artery disease (CAD) remains a leading cause of mortality despite advanced treatments.
• Acute ischemia-reperfusion injury (IRI) is a critical factor in CAD, with limited clinical translation of cardioprotective strategies like remote ischemic conditioning (RIC).
• The mechanisms underlying cardioprotection, particularly cross-species transmission, have been poorly understood.

Purpose of the Study:

• To review the evolution of knowledge on myocardial IRI and cardioprotective strategies over 37 years.
• To elucidate the role of extracellular vesicles (EVs) in cardiovascular diseases (CVDs).
• To explore the potential of EVs as prognostic biomarkers, diagnostic tools, and therapeutic agents in cardiac treatment.

Main Methods:

• Literature review of myocardial IRI and cardioprotective strategies.
• Analysis of recent findings on extracellular vesicles (EVs) in cardiovascular research.
• Discussion of EV-based drug delivery and therapeutic applications in cardiac repair.

Main Results:

• Experimental studies demonstrate the efficacy of preconditioning and postconditioning techniques, including RIC, for cardiac protection.
• Extracellular vesicles (EVs) are identified as crucial mediators of signal transduction in cardiac IRI and RIC.
• EVs show significant potential as biomarkers and therapeutic agents for cardiovascular diseases.

Conclusions:

• Remote ischemic conditioning (RIC) is a promising strategy for heart repair, with EVs mediating its protective effects.
• Extracellular vesicles (EVs) represent a novel frontier in understanding and treating cardiovascular diseases.
• Harnessing EVs offers a new paradigm for cardiac drug delivery and therapeutic interventions, potentially overcoming previous limitations.