# Mesenchymal stem cell-derived exosomes in myocardial infarction repair: therapeutic potential and scaffold-based delivery strategies

## TL;DR

This paper reviews how exosomes from mesenchymal stem cells can help repair heart tissue after a heart attack and how delivery methods like scaffolds can improve their effectiveness.

## Contribution

The paper provides a comprehensive review of MSC-derived exosomes for myocardial repair and highlights innovative scaffold-based delivery strategies.

## Key findings

- MSC-derived exosomes modulate cardiac repair by enhancing angiogenesis and reducing inflammation.
- Different MSC sources like bone marrow and adipose tissue show distinct therapeutic roles.
- Scaffold-based delivery systems improve exosome stability and therapeutic outcomes.

## Abstract

Myocardial infarction (MI) remains a leading cause of global mortality, with current therapeutic modalities offering limited capacity for complete myocardial tissue regeneration. Advances in regenerative medicine have introduced stem cell-based approaches, among which mesenchymal stem cells (MSCs) have garnered significant scientific curiosity due to their multipotent differentiation potential and favorable safety profile. However, evidence suggests that the primary therapeutic effects of MSCs are mediated through their paracrine secretion of bioactive factors, notably exosomes. These MSC-derived exosomes (MSC-Exos) can modulate key aspects of cardiac repair, such as enhancing angiogenesis, preventing apoptosis, and alleviating inflammation by transferring genetic material such as miRNAs, proteins, and lipids and by activating molecular pathways critical to cardiac repair. Numerous studies as well as preclinical and clinical trials are currently investigating MSC-Exos for tissue regeneration. This review critically examines the biological characteristics and underlying mechanisms of MSC-Exos in myocardial repair, with particular focus on cell sources such as bone marrow-derived MSCs (BMMSCs), adipose-derived MSCs (ADSCs), and human umbilical cord MSCs (HUCMSCs), and evaluates their roles from multiple perspectives. Moreover, this review emphasizes innovative delivery approaches, including hydrogel-based systems, aimed at maximizing therapeutic effectiveness and accelerating translational potential. The integration of scaffold technologies and exosome engineering holds substantial promise for translating this cell-free approach into effective clinical treatments, presenting MSC-Exos as a transformative strategy with the potential to markedly improve outcomes in MI.

Diagram illustrating the sources and applications of mesenchymal stem cells. Main sources include bone marrow, adipose tissue, umbilical cord, amniotic fluid, endometria, and cardiac cells. Visuals show exosome composition like integrins and proteins. Types of scaffolds include hydrogel, ceramic, polymer matrix, and 3D printing. The applications focus on myocardial infarction treatment and include pro-angiogenesis, anti-apoptosis, anti-oxidative stress, anti-inflammation, and anti-fibrosis benefits.