Extracellular vesicles for heart repair: origins, functions, bioengineering strategies, and therapeutic potential

Heart disease has become a major threat to global health. In recent years, extracellular vesicles (EVs) have become a research hotspot in heart regeneration and repair due to their unique intercellular communication function and advantages in cell-free therapy. This paper systematically summarizes the sources, characteristics, engineering, and clinical applications of EVs in heart regeneration. Cardiac therapy-related EVs significantly reduce cardiac fibrosis, regulate inflammation and immunity, improve the myocardial microenvironment, and promote angiogenesis by delivering biologically active molecules such as proteins, lipids, and microRNAs. In addition, bioengineering techniques (such as targeted peptide modification and hydrogel delivery systems) have further improved the cardiac targeting and long-lasting efficacy of specific EVs. The above methods have shown high repair potential in disease models such as cardiac ischemia-reperfusion injury, myocardial infarction, heart failure, and structural heart diseases. However, the clinical application of EVs still faces some challenges that need to be urgently addressed. Future research needs to focus on standardized and scaled production processes, long-lasting storage capacity, and precise and specific mechanisms of action of EVs to facilitate the translation of EVs from basic research to the clinic.