MOLECULAR MECHANISMS OF STEM CELL-DERIVED EXOSOMES IN MYOCARDIAL REGENERATION AND CARDIAC REMODELLING IN HEART FAILURE

Heart failure (HF) remains the terminal manifestation of diverse cardiovascular pathologies, including ischemic cardiomyopathy, hypertensive remodelling, diabetic cardiomyopathy, inflammatory myocarditis, and inherited dilated cardiomyopathies, and continues to impose a substantial global health burden. Despite major advances in guideline directed pharmacotherapy targeting maladaptive neurohormonal activation-such as angiotensin receptor-neprilysin inhibition,mineralocorticoid receptor antagonism, B-adrenergic blockade, and sodium-glucose cotransporter-2 inhibition- current treatments do not restore lost cardiomyocytes or re verse established structural remodelling. The intrinsic regenerative incapacity of the adult mammalian myocardium therefore remains the central biological obstacle to curative therapy. In this context, stem cell–derived exosomes (SC-Exos) have emerged as a highly promising, cell-free regenerative platform capable of orchestrating multidimensional reparative signalling within the injured and failing heart.