From Adipose Tissue to Cardiac Repair: Extracellular Vesicles in Cardiovascular Regeneration.

Adipose-derived extracellular vesicles (ADEVs) secreted by adipose tissue have gained increasing attention due to their regenerative and immunomodulatory properties in cardiovascular diseases. They carry proteins, lipids, and nucleic acids that mediate intercellular communication and influence cardiac pathophysiology. In atherosclerosis, ADEVs promote vascular regeneration, protect endothelial integrity, modulate macrophage polarization, foam cell formation, and regulate lipid homeostasis. In myocardial infarction, they limit apoptosis, reduce fibrosis, stimulate angiogenesis, and regulate inflammation through miRNA-dependent paracrine mechanisms. While preclinical studies support their therapeutic relevance, clinical translation remains at an early stage due to fragmented evidence and lack of standardization in isolation methods, dosing, and safety assessment. This review synthesizes current pathophysiological and translational evidence on the role of ADEVs in cardiovascular repair and provides a structured perspective to guide the development of ADEV-based therapies toward clinical application.