Lazar Erzsebet, Benedek Theodora, Korodi Szilamer, Rat Nora, Lo Jocelyn, Benedek Imre
Department of Internal Medicine, Clinic of Haematology and Bone Marrow Transplantation, University of Medicine and Pharmacy Tirgu Mures, Tirgu Mures 540042, Romania.
Department of Internal Medicine, Clinic of Cardiology, University of Medicine and Pharmacy Tirgu Mures, Tirgu Mures 540136, Romania.
World J Stem Cells. 2018 Aug 26;10(8):106-115. doi: 10.4252/wjsc.v10.i8.106.
Cardiovascular diseases (CVDs) continue to represent the number one cause of death and disability in industrialized countries. The most severe form of CVD is acute myocardial infarction (AMI), a devastating disease associated with high mortality and disability. In a substantial proportion of patients who survive AMI, loss of functional cardiomyocytes as a result of ischaemic injury leads to ventricular failure, resulting in significant alteration to quality of life and increased mortality. Therefore, many attempts have been made in recent years to identify new tools for the regeneration of functional cardiomyocytes. Regenerative therapy currently represents the ultimate goal for restoring the function of damaged myocardium by stimulating the regeneration of the infarcted tissue or by providing cells that can generate new myocardial tissue to replace the damaged tissue. Stem cells (SCs) have been proposed as a viable therapy option in these cases. However, despite the great enthusiasm at the beginning of the SC era, justified by promising initial results, this therapy has failed to demonstrate a significant benefit in large clinical trials. One interesting finding of SC studies is that exosomes released by mesenchymal SCs (MSCs) are able to enhance the viability of cardiomyocytes after ischaemia/reperfusion injury, suggesting that the beneficial effects of MSCs in the recovery of functional myocardium could be related to their capacity to secrete exosomes. Ten years ago, it was discovered that exosomes have the unique property of transferring miRNA between cells, acting as miRNA nanocarriers. Therefore, exosome-based therapy has recently been proposed as an emerging tool for cardiac regeneration as an alternative to SC therapy in the post-infarction period. This review aims to discuss the emerging role of exosomes in developing innovative therapies for cardiac regeneration as well as their potential role as candidate biomarkers or for developing new diagnostic tools.
心血管疾病（CVDs）仍然是工业化国家死亡和残疾的首要原因。CVD最严重的形式是急性心肌梗死（AMI），这是一种与高死亡率和残疾相关的毁灭性疾病。在相当一部分AMI存活患者中，缺血性损伤导致功能性心肌细胞丧失，进而引发心室衰竭，导致生活质量显著下降和死亡率增加。因此，近年来人们进行了许多尝试，以寻找用于功能性心肌细胞再生的新工具。目前，再生疗法是通过刺激梗死组织再生或提供能够生成新心肌组织以替代受损组织来恢复受损心肌功能的最终目标。在这些情况下，干细胞（SCs）已被提议作为一种可行的治疗选择。然而，尽管在干细胞时代初期，由于初步结果令人鼓舞而引发了极大的热情，但这种疗法在大型临床试验中未能证明有显著益处。干细胞研究的一个有趣发现是，间充质干细胞（MSCs）释放的外泌体能够提高缺血/再灌注损伤后心肌细胞的活力，这表明MSCs在功能性心肌恢复中的有益作用可能与其分泌外泌体的能力有关。十年前，人们发现外泌体具有在细胞间传递miRNA的独特特性，可作为miRNA纳米载体。因此，基于外泌体的疗法最近被提议作为心肌梗死后心脏再生的一种新兴工具，以替代干细胞疗法。本综述旨在讨论外泌体在开发心脏再生创新疗法中的新兴作用，以及它们作为候选生物标志物或开发新诊断工具的潜在作用。
