Bioengineering Applications of Chinese Herbal Medicine-Derived Exosomes in Cardiovascular Diseases: Mechanisms and Translational Prospects

Abstract: Cardiovascular disease remains the leading cause of death worldwide, with current therapies facing limitations in efficacy and safety. Chinese Herbal Medicine-Derived Exosomes (CHM-Exos) are nano-sized membrane vesicles secreted by herbal cells, capable of cross-species delivery of bioactive substances. While plant-derived extracellular vesicles have been extensively reviewed, analyses specifically focused on CHM-Exos in cardiovascular contexts remain limited. This review systematically examines the bioengineering applications and therapeutic mechanisms of CHM-Exos in cardiovascular diseases, addressing a critical gap in translational literature. Mechanistically, CHM-Exos show potential to alleviate oxidative stress and modulate vascular cell function, though direct cardiovascular evidence remains preliminary. Key translational barriers—including standardization challenges, scalability constraints, and regulatory uncertainties—are critically discussed, alongside strategies to advance these promising nanocarriers toward clinical application. The infographic titled ’Chinese Herbal Medicine-Derived Exosomes (CHM-Exos): From Source to Cardiovascular Therapy and Clinical Translation Barriers’ is divided into four sections. The first section, ’Source & Advanced Isolation,’ includes Astragalus, Tea and Sophora flavescens, with processes like exosome purification and optimized isolation. The second section, ’Bioengineering & Cargo Loading,’ features endogenous miRNAs, proteins, drug cargo like Simvastatin and drug loading and surface modification. The third section, ’CVD Therapeutic Mechanisms,’ covers vascular endothelium repair and protection, vascular function improvement, miR-223 increase, VSMC stabilization decrease, smooth muscle layer and vascular repair mechanisms. The final section, ’Roadmap to Progress,’ illustrates cardiovascular repair leading to clinical success and future clinical application.Infographic on CHM-Exos for cardiovascular therapy, detailing sources, bioengineering, mechanisms and progress roadmap. Keywords: Chinese herbal medicine-derived exosomes, cardiovascular diseases, bioengineering, engineering modification, targeted delivery