Abstract
<jats:p>The аim – to systematize and critically analyze the role of exosomes as mediators of epigenetic regulation and intercellular communication in post-infarction myocardial remodeling, and to justify the use of vesicle-based engineering nanoplatforms to stimulate angiogenesis and suppress fibrosis.Materials and methods. The methodology is based on a systematic analysis of scientific literature published between 2020 and 2025. This interval was selected due to the emergence of new data on epigenetic mechanisms involved in myocardial infarction pathogenesis and advances in the development of biomimetic nanoplatforms for therapeutic cargo delivery.Results. The analysis of contemporary data (2020–2025) shows that exosomes represent a specific subpopulation of extracellular vesicles (30–150 nm) that function as critical mediators of intercellular communication and myocardial infarction pathogenesis. Their biogenesis and molecular composition — in particular tetraspanins CD9, CD81 and MVB-associated proteins — ensure stable transport of bioactive cargo even under ischemic stress. A key mechanism of exosomal action in post-infarction remodeling is epigenetic modulation. The involvement of specific non-coding RNAs (miR-1, miR-152-5p, miR-193a-5p) and proteomic hubs (ITGB3, GP9) has been identified; these molecules serve not only as precise biomarkers for differentiating STEMI from NSTEMI but also directly regulate gene expression in recipient cells. Exosomal «programming» operates through DNA methylation changes (CpG sites of ZNF438 and F2RL3 genes) and histone modifications, modulating the intensity of inflammation and cardiomyocyte apoptosis. Particular attention is given to the therapeutic potential of mesenchymal stem cell-derived exosomes. Through the transfer of VEGF-A and regulatory microRNAs (miR-146a, miR-133), these vesicles stimulate targeted angiogenesis and simultaneously suppress TGF-β-mediated fibrosis, preventing pathological scar replacement of myocardial tissue. The final stage of the analysis substantiates the advantages of engineered exosomes. Methods of surface modification (PEGylation, CXCR4 receptor expression) and biomimetic nanoplatforms significantly increase targeting of vesicles to ischemic zones. This approach enables the transformation of natural exosomes into controllable therapeutic systems capable of precision epigenetic correction, opening new avenues in cell-free regenerative cardiology.Conclusions. Epigenetic regulation mediated by exosomes affects the course of myocardial infarction and post-infarction remodeling. Exosomal cargo modulates cell death, inflammation, angiogenesis and anti-fibrotic responses, and may serve as sensitive biomarkers of myocardial status. Engineered exosomes represent a promising strategy for regenerative treatment of cardiac tissue.</jats:p>