Exosome-delivered bioactive molecules regulate macrophage polarization in atherosclerosis and myocardial infarction: mechanisms and therapeutic potential

Exosomes, by carrying biologically active molecules, constitute the core network of inter-cell communication and play an important role in the regulation of macrophage polarization. The dynamic balance of macrophage polarization is a key determinant of atherosclerosis plaque stability and cardiac repair after myocardial infarction. This review systematically summarizes the molecular mechanisms by which exosomes and their specific molecules accurately regulate M1/M2 polarization of macrophages. We also focused on the mechanism of action by which exosomes play a dual role in promoting or inhibiting the physiological and pathological environment of AS and MI. In addition, the clinical transformation potential and current challenges of new biomarkers and treatment strategies (such as engineered exosomes, drug carriers) are also discussed, which is expected to bring new treatment strategies to the treatment of cardiovascular diseases.