Extracellular vesicles are a double-edged sword in cardiac fibrosis: an epigenetic perspective

Cardiac fibrosis is regarded as a central mechanism by which different cardiovascular diseases react to a range of pathophysiological stimuli. The key features of cardiac fibrosis include the activation of fibroblasts, abnormal cellular proliferation, excessive extracellular matrix deposition, and an altered distribution of matrix components. As research on cardiac fibrosis advances, it has become increasingly clear that extracellular signals play a crucial role in regulating its initiation and progression. Hence, extracellular vesicles serve as pivotal mediators in intercellular communication, facilitating the transmission of a multitude of epigenetic signals and the conveyance of specific gene expression regulatory factors, thereby exerting a modulating influence on the development of cardiac fibrosis. Extracellular vesicles exhibit a dual role in cardiac fibrosis progression, as they can either promote or inhibit the fibrotic process. This review thoroughly explores the epigenetic regulatory mechanisms of extracellular vesicles (EVs) in mediating the process of cardiac fibrosis, and analyzes potential therapeutic intervention strategies. The research results indicate that extracellular vesicles have significant potential for treating cardiac fibrosis through epigenetic regulation, providing an important theoretical basis for the treatment and clinical application of related diseases.