Plasma Exosomes in Cardiac Surgery: Opportunityfor Precision Perioperative Cardioprotection?

Perioperative cardioprotection aims to timely minimize the consequences of myocardial ischemia-reperfusion injury. Despite elective cardiac surgery is safer today than in the past, improvement of perioperative outcome in older patients with co-morbidities and co-medications remains a debated issue.1 Exosomes, smallest extracellular nanovesicles (30-150 nm in diameter), are increasingly being exploited for their unique cardioprotective role mediated by cargo components (i.e.: microRNAs, proteins, metabolites) and surface pro-survival proteins (i.e. heat shock protein 70, pregnancy-associated plasma protein- A). Previous studies have demonstrated that plasma exosomes during cardiac surgery play anti-inflammatory role by specific microRNAs. Moreover, we found that plasma exosomes change protein cargo in older patients undergoing different types of on-pump cardiac surgery.2 Our data ara in accord with recent findings demonstrating change of exosomal protein cargo by external factors (i.e. drugs, hypoxia, free radicals).3 In particular, 22 and 12 anti-apoptotic exosomal proteins were detected early after aortic unclamping during heart valve surgery and coronary artery bypass graft (CABG), respectively. Interestingly, in CABG patients anti-apoptotic plasma exosomes further increased at 72 h after aortic unclamping (P < 0.01) whereas troponin levels decreased.2 In conclusion, plasma exosomes represent tantalizing theranostic tool for prompt clinical applications in critical scenario for inducing and monitoring effective perioperative cardioprotection early after cardiac surgery.