New Hope for Myocardial Infarction Therapy: Mechanisms of Mesenchymal Stem Cell–Derived Exosomes and Optimization Strategies

Abstract

Myocardial infarction (MI) constitutes a significant cause of heart failure and mortality. Mesenchymal stem cells (MSCs), because of their anti-inflammatory, anti-apoptotic, and pro-angiogenic properties, have been extensively employed in myocardial repair research. However, their low survival rate and limited colonization efficiency within the ischemic microenvironment continue to constrain clinical efficacy. In recent years, MSC-derived exosomes (MSC-Exo), acting as key paracrine effectors, have demonstrated potential in animal studies to reduce infarct dimension, suppress inflammatory responses, and improve cardiac function using the measurement of carrying multiple bioactive molecules. They are considered a safer and more controllable alternative strategy, which provide a critical microenvironment for cell retention and survival. However, clinical research remains in its infancy, such as possible weak clinical effects and variability in outcomes which link to multiple factors such as MSCs infusion routes, time of transplantation, cell sources, and injection dosages. To overcome these limitations, optimization strategies including improved delivery routes, application of biomaterial and pre-treatment or genetic modification of MSCs have shown promising prospects.