Combinatorial Effect of Biomaterials and Extracellular Vesicle Therapy for Heart Failure with Reduced Ejection Fraction: A Systematic Review of Preclinical Studies

Abstract

Heart failure, a pervasive global health burden, necessitates innovative therapeutic strategies. Extracellular vesicles (EVs) have emerged as promising contenders for cardiac repair, owing to their profound influence on fibrosis and inflammation. Merging EVs with biomaterials holds the potential for a synergistic leap in therapeutic efficacy. In this review, we scrutinized the impact of combining EVs with biomaterials in preclinical heart failure models. Fifteen studies, predominantly employing mesenchymal stromal cell‐derived EVs along with hyaluronic acid or peptides in coronary ligation models, met our stringent criteria. The amalgamation of EVs and biomaterials consistently enhanced cardiac ejection fraction (1.39; 95% CI: 0.68, 2.11; p = 0.0001) and fractional shortening (1.46, 95% CI: 0.70, 2.22; p = 0.0002) compared to EV monotherapy. Secondary outcomes similarly showcased improvement in the combined treatment group. Although the number of studies analyzed was modest, no indications of publication bias surfaced. In summary, combination therapy with EVs and biomaterials enhanced therapeutic benefit in preclinical heart failure models. The consistent improvement observed across diverse EV sources, biomaterials, and animal models underscores the exciting potential of this synergistic approach.This article is protected by copyright. All rights reserved