Outer membrane vesicles as novel therapeutics for heart repair

Ischemic heart disease is the leading cause of global morbidity and mortality. Amending an injured heart remains a major challenge in both clinics and basic research. Cardiac regenerative medicine that utilizes stem cells for heart repair and regeneration has transitioned into extracellular vesicles. Despite advancements in extracellular vesicle treatment for heart disease, the selection of parental cells and the transplantation pattern—whether autologous or allogeneic—remains a topic of ongoing debate due to immunological and therapeutic variability. Outer membrane vesicles (OMVs) offer an alternative option due to their unique properties, including large-scale production, and highly efficient drug loading/eluting, as well as proven modulation of pathological conditions in various diseases. Additionally, engineering strategies, including surface modification, cargo encapsulation, and microbiome modulation, enhance the specificity and safety of OMVs. At the joint of microbial engineering and cardiac regenerative medicine, OMVs represent a novel platform to develop precise therapeutics for heart disease treatment. This review underscores OMVs as innovative nanotherapeutic tools, bridging microbial-host interactions and cardiovascular health, with transformative potential for patient care.