Extracellular vesicles and cardiovascular disease therapy

Abstract

Cardiovascular disease (CVD) constitutes one of the leading causes of mortality worldwide, therefore representing a major public health concern. Despite recent advances in the treatment of patients with acute myocardial infarction (AMI), such as bypass surgery or percutaneous coronary intervention, pathological cardiac remodeling often predisposes survivors to fatal heart failure. In this context, the proven efficacy of stem cell-regenerative therapies constitutes a promising therapeutic perspective with is nevertheless slow down by safety and ethical concerns. Recent studies have underscored the capacity of stem cell-derived extracellular vesicles (EV) to recapitulate the regenerative properties of their parental cells therefore offering a therapeutic alternative to cell therapy in cardiovascular regenerative medicine. In this article, we review the functional relevance of using stem cell-derived EV as therapeutically agents and detail the identified molecular pathways that they used to exert their effects. We also discuss the advantages of using such an acellular regenerative therapy, in regard with parental stem cells, and address the limitations, which would need to be resolved, before their clinical translation.

Keywords: Extracellular vesicles (EV); cardiovascular disease (CVD); stem cell.

Figure 1

Schematic representation of molecular mechanisms underlying the therapeutic potential of stem cell-derived EV in regenerative cardiovascular therapies. EV, extracellular vesicles; Shh, sonic hedgehog; TF, tissue factor; CD, cluster of differentiation; AMP, adenosine monophosphate; MMP, matrix metalloproteinases.

Figure 2

Comparison of advantages and limitations between the use of stem cells and the use of stem cell-derived EV in cardiac regenerative therapies. EV, extracellular vesicles; ESC, embryonic stem cells.