Cardiovascular Theranostics, Istituto Cardiocentro Ticino, Laboratories for Translational Research, Ente Ospedaliero Cantonale, CH-6500, Bellinzona, Switzerland.
Euler Institute, Faculty of Biomedical Sciences, Università della Svizzera italiana, CH-6900 Lugano, Switzerland.
Eur Heart J. 2024 May 13;45(18):1602-1609. doi: 10.1093/eurheartj/ehae089.
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.
尽管急性心肌梗死后临床结局有所改善，但死亡率仍然很高，特别是在左心室射血分数严重降低（LVEF <30%）的患者中，这强调了需要除再灌注治疗以外的有效心脏保护策略。传统的细胞疗法效果不一，因此研究重点转向创新的心脏活性生物制剂和细胞模拟疗法，特别是细胞外囊泡（EVs）。EVs 作为非编码 RNA 和其他重要生物分子的载体，以旁分泌的方式影响邻近和远程细胞的功能。与细胞疗法相比，EVs 具有一些临床优势，包括稳定性、易于储存（实现现货临床准备）和降低免疫原性。间充质和/或心脏基质祖细胞的同种异体 EV 在临床前研究中显示出安全性和潜在疗效。本综述深入探讨了基于 EV 的治疗方法的转化潜力，特别强调了大型动物研究的发现，并概述了该领域正在进行的早期临床试验。
