Immune
regulation therapies are considered promising for treating
classically activated macrophage (M1)-driven viral myocarditis (VM).
Alternatively, activated macrophage (M2)-derived extracellular vesicles
(M2 EVs) have great immunomodulatory potential owing to their ability
to reprogram macrophages, but their therapeutic efficacy is hampered
by insufficient targeting capacity in vivo. Therefore, we developed
cardiac-targeting peptide (CTP) and platelet membrane (PM)-engineered
M2 EVs enriched with viral macrophage inflammatory protein-II (vMIP-II),
termed CTP/PM-M2 EVsvMIP‑II‑Lamp2b, to improve
the delivery of EVs “cargo” to the heart tissues. In
a mouse model of VM, the intravenously injected CTP/PM-M2 EVsvMIP‑II‑Lamp2b could be carried into the myocardium
via CTP, PM, and vMIP-II. In the inflammatory microenvironment, macrophages
differentiated from circulating monocytes and macrophages residing
in the heart showed enhanced endocytosis rates for CTP/PM-M2 EVsvMIP‑II‑Lamp2b. Subsequently, CTP/PM-M2 EVsvMIP‑II‑Lamp2b successfully released functional
M2 EVsvMIP‑II‑Lamp2b into the cytosol, which
facilitated the reprogramming of inflammatory M1 macrophages to reparative
M2 macrophages. vMIP-II not only helps to increase the targeting ability
of M2 EVs but also collaborates with M2 EVs to regulate M1 macrophages
in the inflammatory microenvironment and downregulate the levels of
multiple chemokine receptors. Finally, the cardiac immune microenvironment
was protectively regulated to achieve cardiac repair. Taken together,
our findings suggest that CTP-and-PM-engineered M2 EVsvMIP‑II‑Lamp2b represent an effective means for treating VM and show promise for
clinical applications.