The Effect of Exosome-Related Therapy in Cardiac Revascularization Procedures: A Systematic Review Publisher Pubmed



Shojaei S ; Mirhosseini SA ; Mousavi A ; Zooravar D ; Ranjbar M ; Aghajani S ; Attar A
Source: BMC Cardiovascular Disorders Published:2025

Abstract

Background: Cardiovascular diseases (CVDs) remain the leading global cause of mortality despite advances in revascularization strategies like coronary artery bypass grafting (CABG) and percutaneous interventions. Exosomes have emerged as dual-function agents, acting both as paracrine mediators of vascular repair and as drug-delivery vehicles. This systematic review evaluates the therapeutic efficacy of exosome-based therapies in cardiac revascularization procedures. Methods: A comprehensive search of Embase, PubMed, Scopus, and Web of Science was conducted from inception to January 2025. We included experimental studies, evaluating animal subjects undergoing revascularizations. Risk of bias was assessed using SYRCLE’s tool. Study characteristics, population characteristics, intervention details, various outcomes, and limitations of each study were extracted from each included study. Results: Eight preclinical studies met our inclusion criteria. We observed that exosome therapies demonstrated significant benefits. Sirolimus-loaded exosomes (SIR-EXO) reduced stenosis to 5% vs. 59% in controls. Exosome-coated stents (ACC-Exo-REDV) suppressed neointimal hyperplasia by 60% compared to bare stents. Brown adipose tissue-derived exosomes increased left ventricular ejection fraction, while CABG + exosome patches restored diastolic function. Exosome-eluting stents reduced pro-inflammatory cytokines (IL-1β, TNF-α) by 93% and promoted M2 macrophage polarization. Exosome-enhanced stents improved endothelial cell proliferation by 40% and reduced platelet adhesion by 70%. Conclusion: Exosome-based therapies show promise in enhancing vascular repair, mitigating restenosis, and modulating post-revascularization inflammation. © 2025 Elsevier B.V., All rights reserved.