Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), 13353 Berlin, Germany.
Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13353 Berlin, Germany.
Int J Mol Sci. 2023 Jun 22;24(13):10480. doi: 10.3390/ijms241310480.
Heart failure is the leading cause of morbidity and mortality and currently affects more than 60 million people worldwide. A key feature in the pathogenesis of almost all forms of heart failure is cardiac fibrosis, which is characterized by excessive accumulation of extracellular matrix components in the heart. Although cardiac fibrosis is beneficial in the short term after acute myocardial injury to preserve the structural and functional integrity of the heart, persistent cardiac fibrosis contributes to pathological cardiac remodeling, leading to mechanical and electrical dysfunction of the heart. Despite its high prevalence, standard therapies specifically targeting cardiac fibrosis are not yet available. Cell-based approaches have been extensively studied as potential treatments for cardiac fibrosis, but several challenges have been identified during clinical translation. The observation that extracellular vesicles (EVs) derived from stem and progenitor cells exhibit some of the therapeutic effects of the parent cells has paved the way to overcome limitations associated with cell therapy. However, to make EV-based products a reality, standardized methods for EV production, isolation, characterization, and storage must be established, along with concrete evidence of their safety and efficacy in clinical trials. This article discusses EVs as novel therapeutics for cardiac fibrosis from a translational perspective.
心力衰竭是发病率和死亡率的主要原因，目前影响着全球超过 6000 万人。几乎所有形式心力衰竭的发病机制的一个关键特征是心脏纤维化，其特征是心脏中外基质成分的过度积累。虽然心脏纤维化在急性心肌损伤后短期内有利于保持心脏的结构和功能完整性，但持续的心脏纤维化有助于病理性心脏重构，导致心脏的机械和电功能障碍。尽管其发病率很高，但目前还没有专门针对心脏纤维化的标准治疗方法。基于细胞的方法已被广泛研究作为心脏纤维化的潜在治疗方法，但在临床转化过程中已经确定了一些挑战。观察到源自干细胞和祖细胞的细胞外囊泡 (EVs) 表现出亲本细胞的一些治疗效果，为克服细胞治疗相关的局限性铺平了道路。然而，为了使基于 EV 的产品成为现实，必须建立 EV 生产、分离、表征和储存的标准化方法，并在临床试验中提供其安全性和有效性的具体证据。本文从转化医学的角度讨论了 EVs 作为心脏纤维化的新型治疗方法。
