Exosomes in Cardiovascular Disease: Emerging Roles, Therapeutic Potential and Translational Challenges

Cardiovascular diseases (CVDs) remain a leading global cause of mortality, necessitating novel therapeutic strategies to address myocardial injury, adverse remodelling and impaired cardiomyocyte regeneration. Exosomes, nanoscale extracellular vesicles secreted by nearly all cell types, have emerged as pivotal mediators of intercellular communication, influencing cardiac physiology and pathology through their cargo of nucleic acids, proteins and lipids. These vesicles participate actively in processes such as cytoprotection, angiogenesis, apoptosis regulation and immune modulation, which are critical for cardiac repair and regeneration. Recent preclinical and clinical studies highlight the promising regenerative capabilities of exosomes, especially those derived from stem cells and immune cells, positioning them as innovative therapeutic tools and diagnostic biomarkers in CVD management. Despite their potential advantages over traditional cell therapies, including lower immunogenicity and enhanced targeting, several hurdles remain before exosomes can be routinely applied in clinical practice. Challenges include the lack of standardized isolation and characterization protocols, heterogeneity of exosome populations, inefficient cargo loading methods, off-target biodistribution and safety concerns related to immune response and infectious risk. Ongoing research aims to overcome these obstacles to realize exosomes' full potential in cardiovascular regenerative medicine, with diagnostic applications currently representing a nearer-term goal.