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  • Review Article
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Extracellular vesicles in cardiovascular homeostasis and disease: potential role in diagnosis and therapy

Nature Reviews Cardiology volume 22, pages 883–895 (2025)Cite this article

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Abstract

Communication between multicellular organs is essential to propagate signals and coordinate their function. Over the past decade, the role of extracellular vesicles in the molecular communication between cells in both physiological and pathological settings has received much attention. Extracellular vesicles can shuttle proteins, lipids and nucleic acids (such as RNA) between cells, thus inducing an array of functional changes in the recipient cells. In this Review, we describe the different extracellular vesicle subclasses and their heterogeneous nature, provide insights into extracellular vesicle-mediated signalling in the cardiovascular system, and highlight how extracellular vesicles can be used as diagnostic and prognostic biomarkers for a variety of pathological conditions. Finally, we also discuss the potential therapeutic applications of extracellular vesicles.

Key points

  • Extracellular vesicles (EVs) are effective mediators of cellular communication by transporting nucleic acids, proteins and lipids.

  • EVs are a heterogeneous population of vesicles that vary in size, cargo content, surface characteristics and intracellular origin, with differing pathways of biogenesis.

  • EVs or EV-linked molecules can be used to predict the progression and severity of numerous cardiovascular diseases.

  • Numerous techniques to isolate EVs have been employed for research, but they require careful validation for different applications given the differences in EV populations or profiles depending on the technique used.

  • A better understanding of the unique characteristics of EVs for intercellular communication will provide insights into how they can be used for diagnostic and therapeutic applications and will facilitate the design of better vehicles for drug delivery to reduce off-target effects.

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Fig. 1: Techniques to isolate, visualize, characterize or quantify extracellular vesicles or their cargo.
Fig. 2: Role of extracellular vesicles in intracellular communication in the heart in physiological and pathological circumstances.

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Acknowledgements

The authors’ work was supported by grants from the National Natural Science Foundation of China (82225005 and 82020108002 to J.X.) and the Science and Technology Commission of Shanghai Municipality (23410750100, 20DZ2255400 and 21XD1421300 to J.X.). J.P.G.S. is supported by H2020-EVICARE (#725229) and TOP-EVICARE (#101138069) of the European Research Council, and by ZonMw Psider-Heart (10250022110004) and NWO-TTP HARVEY (2021/TTW/01038252), Health-Holland 2022TKI2306 EV-PROTECT and ERA for Health Cardinnov (RESCUE- 2024/KIC/01627794).

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Authors and Affiliations

  1. Institute of Cardiovascular Sciences, Shanghai Engineering Research Center of Organ Repair, Joint International Research Laboratory of Biomaterials and Biotechnology in Organ Repair (Ministry of Education), School of Life Science, Shanghai University, Shanghai, China

    Junjie Xiao

  2. Cardiac Regeneration and Ageing Lab, Institute of Geriatrics (Shanghai University), Affiliated Nantong Hospital of Shanghai University (The Sixth People’s Hospital of Nantong), School of Medicine, Shanghai University, Nantong, China

    Junjie Xiao

  3. Department of Cardiology, Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, Netherlands

    Joost P. G. Sluijter

  4. UMC Utrecht Regenerative Medicine Center, Circulatory Health Research Center, University Medical Center, Utrecht University, Utrecht, Netherlands

    Joost P. G. Sluijter

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Xiao, J., Sluijter, J.P.G. Extracellular vesicles in cardiovascular homeostasis and disease: potential role in diagnosis and therapy. Nat Rev Cardiol 22, 883–895 (2025). https://doi.org/10.1038/s41569-025-01141-2

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