Exosomes as Modulators of Atherosclerosis: Pathogenetic Insights and Therapeutic Potential

Abstract

Atherosclerosis remains a leading cause of cardiovascular morbidity and mortality worldwide. It is driven by a cascade of pathogenetic events, including chronic endothelial dysfunction and lipid accumulation, culminating in critical complications such as plaque instability, thrombus formation, and thromboembolism. Current treatment strategies, including statin therapy and drug-eluting stents, primarily act by slowing disease progression or mechanically restoring vessel patency rather than actively regenerating damaged endothelium. In recent years, exosomes - nanoscale extracellular vesicles derived from endothelial, mesenchymal, and immune cells—have emerged as potent mediators of intercellular communication, capable of modulating inflammation, promoting endothelial repair, inhibiting foam cell formation, and stabilizing vulnerable plaques through their cargo of microRNAs, proteins, and lipids. These findings introduce the transformative concept of exosome-based vascular therapeutics that can restore endothelial integrity. Furthermore, the integration of exosomes into scaffold- based delivery systems has generated considerable interest in developing biological stent models that harness endogenous regenerative pathways, rather than relying solely on metallic structures. This review synthesizes current pathogenetic insights of atherosclerosis and treatment strategies, evaluates translational progress from the bench to the bedside, and proposes exosome-driven vascular repair as a novel conceptual framework for treating atherosclerosis, ultimately facilitating the development of advanced, regenerative biological stent technologies.