REVIEW article
Front. Cardiovasc. Med.
Sec. Atherosclerosis and Vascular Medicine
Exosome-delivered bioactive molecules regulate macrophage polarization in atherosclerosis and myocardial infarction: mechanisms and therapeutic potential
Yuanlin Zhou 1
Guang He Ran 2
Hua Guo 1
1. Department of Cardiology Dandong Central Hospital,118000 Liaoning, China, Liaoning, China
2. Chongqing Changshou Traditional Chinese Medicine Hospital, Chongqing, China
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Abstract
Exosomes, by carrying biologically active molecules, constitute the core network of inter-cell communication and play an important role in the regulation of macrophage polarization. The dynamic balance of macrophage polarization is a key determinant of atherosclerosis plaque stability and cardiac repair after myocardial infarction. This review systematically summarizes the molecular mechanisms by which exosomes and their specific molecules accurately regulate M1/M2 polarization of macrophages. We also focused on the mechanism of action by which exosomes play a dual role in promoting or inhibiting the physiological and pathological environment of AS and MI. In addition, the clinical transformation potential and current challenges of new biomarkers and treatment strategies (such as engineered exosomes, drug carriers) are also discussed, which is expected to bring new treatment strategies to the treatment of cardiovascular diseases.
Summary
Keywords
Atherosclerosis, exosome, macrophage, Myocardial Infarction, polarization
Received
05 November 2025
Accepted
26 January 2026
Copyright
© 2026 Zhou, Ran and Guo. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Guang He Ran; Hua Guo
Disclaimer
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.