Экзосомы в вирусном и поствакцинальном миокардите

Настоящий обзор систематизирует современные данные о многогранной роли экзосом в определении, развитии и тяжести воспаления миокарда, вызванного вирусной инфекцией/ вакцинацией. Миокардит (МК) остается сравнительно трудно диагностируемым сердечно-сосудистым заболеванием, нередко приводящим к осложнениям, причем под угрозой находятся лица молодого и среднего возраста. Чаще остальных МК вызывают вирусы. Пандемия новой коронавирусной инфекции стала причиной развития МК, более того добавились поствакцинальные МК, развившиеся после вакцинации от SARS-CoV2. Внеклеточные везикулы, прежде всего экзосомы, как инструмент межклеточной сигнализации, описаны при развитии, лечении и профилактике разных сердечно-сосудистых заболеваний, однако в отношении МК такие данные носят разрозненный характер. Данный обзор позволяет разносторонне подойти к вопросу роли, функций и молекулярных механизмов различных типов экзосом в вирусном МК. В обзоре представлен новый подход к классификации связанных с вирусными МК экзосом, основанный на их функциональных особенностях и различиях в механизмах действия. Отдельно приведены данные о митохондриальных везикулах, как медиаторах межорганелльной и межклеточной сигнализации при воспалении и вирусной инфекции. Впервые введены термины «маскировочные» и «защитные» экзосомы. Также продемонстрированы антагонистические особенности вирус-индуцируемых и «защитных» экзосом в инфекционном процессе. Сходство биогенеза экзосом и некоторых вирусов открыло путь вирусам для распространения по организму хозяина, а также дало возможность для уклонения от атаки хозяина с помощью «маскировочных» экзосом. Это же сходство открывает исследователям широкие перспективы для поиска путей противовирусной защиты, но также заставляет пересмотреть аспекты безопасности и перспективы использования мРНК-вакцин из-за потенциальных негативных последствий развития МК. 

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