# Extracellular vesicles in cardiovascular diseases: pathogenic mediators, diagnostic tools, and therapeutic vectors

## TL;DR

Extracellular vesicles (EVs) play a key role in cardiovascular diseases, acting as both harmful and healing agents, and show promise for diagnosis and treatment.

## Contribution

This review highlights the dual roles of EVs in CVD pathogenesis and their potential as diagnostic and therapeutic tools.

## Key findings

- EVs contribute to both pathology and tissue repair in cardiovascular diseases.
- EVs from stem cells and plant cells show potential for acellular therapy in heart protection and repair.
- EVs in bodily fluids like plasma and urine may serve as biomarkers for diagnosing and predicting CVDs.

## Abstract

Cardiovascular diseases (CVDs), the leading global cause of mortality, underscore an urgent need for innovative diagnostic and therapeutic strategies. Extracellular vesicles (EVs)—lipid-bilayer nanoparticles transporting bioactive cargo (microRNAs, proteins, lipids)—are critical mediators of intercellular communication in CVD pathogenesis. They exhibit functional duality: propagating pathology (inflammation, fibrosis, thrombosis) while facilitating tissue repair. This review synthesizes EV biogenesis mechanisms, isolation methodologies, source-specific functions, and multifaceted roles in atherosclerosis, myocardial infarction, heart failure, and stroke. We further evaluate EV-based diagnostic biomarkers, engineered therapeutic applications, clinical translation challenges, and future directions.

The roles of EVs in CVDs and the potential of acellular therapy. EVs derived from tissues and circulating sources target recipient cells through intercellular communication, influencing their biological functions and thereby impacting the progression of cardiovascular diseases. EVs from plant cells and stem cells carry molecules that promote protection and repair of the heart, significantly alleviating damage caused by cardiovascular diseases, indicating great potential as acellular therapies. EVs from plasma, serum and urine provide a potential avenue for the diagnosis and prognosis of future CVDs.Diagram illustrating cellular components and processes. An exosome with receptors, lipids, DNA, RNA, and proteins is shown, ranging from 35-150 nm. Table compares markers: exosome, microvesicle, apoptotic body. Processes include lysosome interactions, Golgi apparatus, and endoplasmic reticulum involvement. Apoptotic cells release bodies greater than 500 nm. Mitochondria and nucleus are labeled. Arrows indicate movement of cellular materials.

The roles of EVs in CVDs and the potential of acellular therapy. EVs derived from tissues and circulating sources target recipient cells through intercellular communication, influencing their biological functions and thereby impacting the progression of cardiovascular diseases. EVs from plant cells and stem cells carry molecules that promote protection and repair of the heart, significantly alleviating damage caused by cardiovascular diseases, indicating great potential as acellular therapies. EVs from plasma, serum and urine provide a potential avenue for the diagnosis and prognosis of future CVDs.