Application of Extracellular Vesicles in the Diagnosis and Treatment of Cardiovascular Diseases

Paracrine signalling is considered an important mechanism underlying the therapeutic effects of cell-based therapies in cardiovascular diseases. Consequently, research in regenerative medicine has increasingly shifted its focus beyond conventional cell-based therapeutic strategies toward cell-derived and cell-free therapeutic approaches. Among these, extracellular vesicles (EVs) have emerged as important mediators of intercellular communication, delivering a diverse cargo of bioactive molecules, including microRNAs, proteins, lipids, and cytokines. EVs have been implicated in several biological processes such as inflammation, angiogenesis, and the response to ischaemic tissue injury. Preclinical studies have demonstrated promising regenerative effects of EV-based therapies in ischaemic cardiovascular diseases, particularly myocardial infarction and chronic limb-threatening ischaemia. However, substantial methodological and translational challenges remain, and robust evidence from prospective randomised clinical trials is required to facilitate their translation into routine clinical practice. In addition to their therapeutic potential, the presence of EVs in biological fluids makes them promising candidates for non-invasive diagnostic and prognostic applications in cardiovascular medicine. This review summarises current evidence on EVs in cardiovascular disease, highlights their potential as diagnostic and prognostic biomarkers, and discusses emerging therapeutic strategies and the challenges associated with their clinical translation.