Injury minimization after myocardial infarction: focus on extracellular vesicles.
Lucio BarileEduardo MarbánPublished in: European heart journal (2024)
Despite improvements in clinical outcomes following acute myocardial infarction, mortality remains high, especially in patients with severely reduced left ventricular ejection fraction (LVEF <30%), emphasizing the need for effective cardioprotective strategies adjunctive to recanalization. Traditional cell therapy has shown equivocal success, shifting the focus to innovative cardioactive biologicals and cell mimetic therapies, particularly extracellular vesicles (EVs). EVs, as carriers of non-coding RNAs and other essential biomolecules, influence neighbouring and remote cell function in a paracrine manner. Compared to cell therapy, EVs possess several clinically advantageous traits, including stability, ease of storage (enabling off-the-shelf clinical readiness), and decreased immunogenicity. Allogeneic EVs from mesenchymal and/or cardiac stromal progenitor cells demonstrate safety and potential efficacy in preclinical settings. This review delves into the translational potential of EV-based therapeutic approaches, specifically highlighting findings from large-animal studies, and offers a synopsis of ongoing early-stage clinical trials in this domain.
Keyphrases
- cell therapy
- left ventricular
- ejection fraction
- acute myocardial infarction
- stem cells
- bone marrow
- early stage
- aortic stenosis
- mesenchymal stem cells
- clinical trial
- stem cell transplantation
- percutaneous coronary intervention
- heart failure
- randomized controlled trial
- hypertrophic cardiomyopathy
- risk factors
- mitral valve
- radiation therapy
- transcatheter aortic valve replacement
- squamous cell carcinoma
- middle cerebral artery
- open label
- cardiac resynchronization therapy
- cardiovascular disease
- dna methylation
- coronary artery disease
- phase ii
- case control
- left atrial
- double blind