Primary cilia disruption reprograms extracellular vesicle signaling in endothelial dysfunction and cardiovascular disease

Primary cilia disruption profoundly alters vascular integrity. Extracellular vesicles (EVs) released during ciliary decapitation have emerged as potential mediators of these effects, yet their functional contribution remains unclear. Here, we investigated the effects of extracellular vesicles (EVs) released by deciliated endothelial cells on endothelial responses and evaluated their clinical relevance. EVs released by HUVECs and circulating EVs isolated from patients with obstructive sleep apnea syndrome (OSAS) were collected by differential centrifugation. The presence of ciliary markers was then assessed by Western blot analysis. Pharmacological ablation of primary cilia in HUVECs induced the release of EVs enriched in ciliary markers. EVs from deciliated cells did not alter nitric oxide bioavailability but triggered a significant and sustained increase in cytosolic reactive oxygen species, independent of xanthine oxidase and NADPH oxidase activity. By contrast, EVs from intact cilia exerted protective effects, enhancing endothelial migration and preserving barrier integrity during TNF-α-induced hyperpermeability. Loss of cilia abolished these protective actions, revealing a functional dichotomy determined by EV origin. Circulating EVs from OSAS patients with endothelial dysfunction showed a trend toward increased acetylated α-tubulin expression, suggesting that cilia EV signatures may represent emerging biomarkers of vascular impairment in OSAS. These findings reveal EVs from deciliated endothelial cells as previously unrecognized modulators of endothelial behavior, capable of directing vascular responses toward protection or oxidative damage according to ciliary status. Our study uncovers a mechanistic connection between cilia dynamics, EV signaling, and endothelial dysfunction. • Primary cilia disruption in endothelial cells (EC) alters endothelial function • Extracellular vesicles (EV) from cilia-intact cells protect EC • EV from deciliated EC are rich in ciliary markers and lose the protective function • Endothelial dysfunction in patients associates with high levels of cilia marker + -EV