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Review article
Extracellular vesicles in atherosclerosis: Current and forthcoming impact?
Vesículas extracelulares en aterosclerosis: impacto actual y futuro
José A. Páramoa,b,c,d, Ana Cenarrod,e,f, Fernando Civeirad,e,f, Carmen Roncalb,c,d,
Corresponding author
croncalm@unav.es

Corresponding author.
a Hematology Service, Clínica Universidad de Navarra, Pamplona, Spain
b Laboratory of Atherothrombosis, Cima Universidad de Navarra, Pamplona, Spain
c IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
d CIBERCV, ISCIII, Madrid, Spain
e Hospital Universitario Miguel Servet, Zaragoza, Spain
f Instituto de Investigación Sanitaria Aragón (IIS Aragón), Universidad de Zaragoza, Zaragoza, Spain
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age&#44; and&#47;or exposure to risk factors&#44; including&#44; dyslipidemia&#44; hypertension&#44; diabetes mellitus&#44; kidney diseases or smoking&#46;<a class="elsevierStyleCrossRefs" href="#bib0505"><span class="elsevierStyleSup">3&#8211;5</span></a> It can be latent and symptomless&#44; but in advanced stages atherosclerosis may trigger symptoms of acute coronary syndrome&#44; heart failure&#44; stroke or peripheral vascular disease &#40;PAD&#41;&#44; that are the most common consequences of atherosclerosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0495"><span class="elsevierStyleSup">1&#44;6</span></a> The identification of atherogenesis as an active process&#44; rather than the passive cholesterol storage disease&#44; has highlighted important inflammatory&#44; molecular and cellular pathways underlying its pathophysiology&#44; leading to a better characterization of these patients&#46; Despite these advances&#44; CVDs still remain the leading cause of morbidity and mortality worldwide&#46;<a class="elsevierStyleCrossRef" href="#bib0525"><span class="elsevierStyleSup">7</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Pathophysiology of atherosclerosis</span><p id="par0010" class="elsevierStylePara elsevierViewall">The vascular endothelium&#44; as an integral component of the CV system&#44; plays a crucial role in maintaining systemic homeostasis&#44; by regulating vascular muscle contraction&#44; relaxation&#44; smooth muscle proliferation&#44; and the expression of adhesion molecules or chemotactic factors&#46;<a class="elsevierStyleCrossRef" href="#bib0530"><span class="elsevierStyleSup">8</span></a> By producing vasoactive&#44; anti-inflammatory&#44; antithrombotic and cytostatic substances&#44; the endothelium maintains the vascular tone&#44; and prevents the adhesion of inflammatory cells and platelets&#44; keeping at bay the coagulation and the fibrinolytic systems&#46; This balance can be broken under conditions of oxidative stress&#44; hyperlipidemia&#44; hypertension&#44; diabetes or smoking&#44; which induce endothelial activation&#46;<a class="elsevierStyleCrossRefs" href="#bib0535"><span class="elsevierStyleSup">9&#44;10</span></a> The disruption of these haemostatic processes underpins the mechanism of atherosclerosis&#44; activating prothrombotic and proinflammatory pathways&#44; that result in lipid&#44; protein and nucleic acid oxidation&#44; and in the production of reactive oxygen species &#40;ROS&#41;&#44; chemokines&#44; cytokines and adhesion molecules&#44; that enable leucocyte and platelet adhesion&#44; and thrombus formation&#46;<a class="elsevierStyleCrossRefs" href="#bib0535"><span class="elsevierStyleSup">9&#44;10</span></a> A characteristic feature of the initial stages of atherosclerosis is the local accumulation of monocytes and lymphocytes in the dysfunctional inner membrane of the vessel wall&#46;<a class="elsevierStyleCrossRef" href="#bib0545"><span class="elsevierStyleSup">11</span></a> Recruited monocytes differentiate into macrophages and transform into foam cells through the uptake of extracellularly modified lipoproteins&#44; mainly oxidized low-density lipoproteins &#40;ox-LDL&#41;&#46; If the atherogenic stimulus continues&#44; the accumulation of ox-LDLs in the subendothelial space&#44; coupled with inflammatory cell infiltration and vascular smooth muscle cell &#40;VSMC&#41; migration and proliferation from the media to the intima&#44; can lead to atherosclerotic lesion formation&#46; All the evidences support an active crosstalk between the cellular components of the vessel wall and the circulation&#44; that might be in part facilitated by the extracellular vesicles &#40;EVs&#41; released during the atherogenic process&#46;<a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">12</span></a> As such&#44; the study of EVs phenotype&#44; content&#44; and biological activity emerge as an opportunity to gain insight in the pathophysiology of CVDs &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0555"><span class="elsevierStyleSup">13&#44;14</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Extracellular vesicle discovery</span><p id="par0015" class="elsevierStylePara elsevierViewall">More than 70 years ago&#44; Chargaff and West hypothesize that platelets might not be the only source of prothrombotic material&#44; and demonstrated that blood samples depleted of platelets were able to induce clotting&#46; In addition&#44; high-speed centrifugated plasma presented reduced thrombin generation capacity&#44; whereas the recovered pellet was able to induce clotting <span class="elsevierStyleItalic">in vitro</span>&#44; suggesting the presence of prothrombotic acellular particles in that sedimented fraction&#46;<a class="elsevierStyleCrossRef" href="#bib0565"><span class="elsevierStyleSup">15</span></a> Despite the technical limitations at that time&#44; they even anticipated a possible role of these subcellular components in the modulation of physiological and pathological processes&#46;<a class="elsevierStyleCrossRef" href="#bib0565"><span class="elsevierStyleSup">15</span></a> In 1955&#44; Hougie reported that the coagulant activity of citrated plasma increased during storage of some hours&#46;<a class="elsevierStyleCrossRef" href="#bib0570"><span class="elsevierStyleSup">16</span></a> Further on&#44; in the late 1960s&#44; Wolf identified platelet derived phospholipids-rich procoagulant subcellular elements in both plasma and serum&#44; and was able to resolve them by electron microscopy&#44; observing particles between 20 and 50<span class="elsevierStyleHsp" style=""></span>nm&#46; He called this particle subfraction platelet dust&#46;<a class="elsevierStyleCrossRef" href="#bib0575"><span class="elsevierStyleSup">17</span></a> From that moment on&#44; the interest in EVs has grown exponentially&#44; from being considered mere cellular waste disposal systems&#44; to be pinpointed as important mediators of intercellular communication processes among a bunch of target cells and tissues&#46;<a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">12</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">EVs biology and function</span><p id="par0020" class="elsevierStylePara elsevierViewall">In spite of current technical developments for nanoscale particle analysis&#44; EVs size and their scarce biological content represent a huge limitation for their characterization&#44; and hamper a consensus on their nomenclature or classification&#46; Initially&#44; these particle subpopulations were classified according to their size and biogenesis into&#58; exosomes with diameters between 30 and 150<span class="elsevierStyleHsp" style=""></span>nm&#44; generated by the inward budding of the endosomal membrane<a class="elsevierStyleCrossRef" href="#bib0580"><span class="elsevierStyleSup">18</span></a>&#59; microparticles&#44; microvesicles or ectosomes referring to vesicles with 100&#8211;1000<span class="elsevierStyleHsp" style=""></span>nm of diameter&#44; directly shed from the plasma membrane and polydisperse in size&#59; and finally&#44; apoptotic bodies&#44; the biggest subpopulation &#40;1&#8211;5<span class="elsevierStyleHsp" style=""></span>&#956;m of diameter&#41; generated during the apoptotic process that can even contain cellular organelles&#46;<a class="elsevierStyleCrossRefs" href="#bib0585"><span class="elsevierStyleSup">19&#8211;23</span></a> Due to the considerable overlap in size and composition between exosomes and microvesicles&#44; and the lack of specific separation methods for each particle fraction&#44; later recommendations and guidelines encourage the use of the general term EVs in the absence of accurate information about their subcellular origin&#46;<a class="elsevierStyleCrossRefs" href="#bib0605"><span class="elsevierStyleSup">23&#44;24</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">EVs are spherical lipid bilayers containing cytoplasmic material that are released to the blood stream and other biological fluids &#40;<span class="elsevierStyleItalic">e&#46;g&#46;</span>&#58; saliva&#44; urine&#41; by most cells and tissues under certain physiological and pathological circumstances&#46; The number of EVs and their content varies according to the cellular activation status and the stimulus triggering their formation and release&#44; increasing under stress conditions&#46; Likewise&#44; EVs have been postulated as small reservoirs of proteins&#44; lipids&#44; metabolites and nucleic acids regulated by specific pathophysiological processes&#46;<a class="elsevierStyleCrossRef" href="#bib0615"><span class="elsevierStyleSup">25</span></a> Interestingly&#44; their cargo is protected by the lipid bilayer from the activity of endogenous DNases&#44; RNases or proteinases&#44; as well as from adverse physicochemical conditions related to sample processing&#44; such as prolonged storage&#44; multiple freeze&#47;thaw cycles or extreme pHs&#46;<a class="elsevierStyleCrossRef" href="#bib0620"><span class="elsevierStyleSup">26</span></a> These features&#44; together with their ability to hold markers of the parental cell&#44; have postulated EVs as an attractive component of the liquid biopsy&#46; In this line&#44; the analysis of their cargo might be useful to understand the pathophysiological condition behind their generation&#44; leading to the identification of novel diagnostic and prognostic biomarkers&#44; and therapeutic targets&#46;<a class="elsevierStyleCrossRefs" href="#bib0605"><span class="elsevierStyleSup">23&#44;27</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">EVs biological activity in neighbour or distant cells is displayed by different mechanism related to their content and their lipidic nature&#46;<a class="elsevierStyleCrossRef" href="#bib0600"><span class="elsevierStyleSup">22</span></a> EVs rich in bioactive molecules in their surface will be able to interact directly with target proteins or extracellular matrix components changing their activity or composition&#46;<a class="elsevierStyleCrossRef" href="#bib0630"><span class="elsevierStyleSup">28</span></a> EVs can also activate signalling pathways in host cells through different mechanisms&#44; including receptor&#8211;ligand interactions&#44; transference of their cargo to the cytoplasm by fusion with the plasma membrane&#44; or through endocytosis&#44; phagocytosis or micropinocytosis&#44; regulating among other processes&#44; vascular homeostasis and atherosclerosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0555"><span class="elsevierStyleSup">13&#44;29</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Separation and characterization of extracellular vesicles</span><p id="par0035" class="elsevierStylePara elsevierViewall">The absence of specific methods for EVs separation requires a careful experimental design according to the downstream application and the biological sample of origin&#46; In this section we will give a short overview of the most widely used methods for EVs isolation and characterization&#46; For more detailed and extensive information readers can consults the latest update of the International Society of EVs<a class="elsevierStyleCrossRef" href="#bib0605"><span class="elsevierStyleSup">23</span></a> and other recent reviews and articles&#46;<a class="elsevierStyleCrossRefs" href="#bib0640"><span class="elsevierStyleSup">30&#8211;32</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">When working with blood samples&#44; it is important to consider not only the analytical&#44; but also the preanalytical conditions starting from blood withdrawal &#40;<span class="elsevierStyleItalic">e&#46;g&#46;</span>&#58; citrated <span class="elsevierStyleItalic">vs</span> EDTA plasma&#44; gauge diameter&#44; <span class="elsevierStyleItalic">etc&#46;</span>&#41;&#44; posterior blood processing &#40;centrifugation speed&#44; temperature&#44; <span class="elsevierStyleItalic">etc&#46;</span>&#41; or plasma storage&#44;<a class="elsevierStyleCrossRefs" href="#bib0655"><span class="elsevierStyleSup">33&#8211;35</span></a> since this will predetermine ulterior EVs separation technique&#44; favouring yield against purity or <span class="elsevierStyleItalic">vice versa</span> based on the final purpose of the study&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Ultracentrifugation &#40;UC&#41; is the most widely used technique for EVs separation&#44;<a class="elsevierStyleCrossRefs" href="#bib0650"><span class="elsevierStyleSup">32&#44;36</span></a> but requires high amount of starting material and contaminating protein aggregates &#40;<span class="elsevierStyleItalic">e&#46;g&#46;</span>&#58; HDL&#44; LDL&#44; VLDL&#44; or chylomicrons&#41; are pelleted together with EVs&#46;<a class="elsevierStyleCrossRefs" href="#bib0605"><span class="elsevierStyleSup">23&#44;37</span></a> This can improve combined with density gradient &#40;commonly with sucrose&#41; that notably diminishes contaminants&#44; but can compromise EVs yield&#46; Moreover&#44; either UC alone or UC<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>density gradient are time-consuming and low-throughput methods&#44; limiting their applicability in clinical scenario&#46; Size exclusion chromatography &#40;SEC&#41; is a faster isolation method &#40;&#8764;15<span class="elsevierStyleHsp" style=""></span>min&#41; that efficiently enriches and separates EVs from contaminants&#46; Its yield can be increased combined with ultrafiltration&#44; although abundant proteins as albumin might obstruct the nanopores&#44; compromising both concentration and purity&#46;<a class="elsevierStyleCrossRef" href="#bib0680"><span class="elsevierStyleSup">38</span></a> Polymer-based precipitation methods&#44; either hand-made or commercial&#44; are effective for concentrating EVs but not for removing protein aggregates&#44; and affinity-based techniques&#44; using antibodies or proteins against specific EVs surface markers or receptors&#44; are also commonly used for isolating particular EV subpopulations&#46;<a class="elsevierStyleCrossRef" href="#bib0685"><span class="elsevierStyleSup">39</span></a> Novel EVs separation methods including microfluidic-based devices&#44; flow field-flow fractionation&#44; or high-resolution flow cytometry are promising alternatives for EVs separation&#46;<a class="elsevierStyleCrossRefs" href="#bib0690"><span class="elsevierStyleSup">40&#8211;43</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Once separated&#44; EVs should be characterized by different methods&#46;<a class="elsevierStyleCrossRef" href="#bib0605"><span class="elsevierStyleSup">23</span></a> Western blot is recommended to test the presence of specific EVs markers and common co-precipitated contaminants&#44; nanoparticle tracking analysis &#40;NTA&#41; is useful to determine size and concentration of single particles&#44;<a class="elsevierStyleCrossRef" href="#bib0710"><span class="elsevierStyleSup">44</span></a> high-resolution flow cytometry with specific EV surface markers or labelled with nonfluorescent pro-dyes is used to test EVs markers and cellular origins&#44;<a class="elsevierStyleCrossRefs" href="#bib0700"><span class="elsevierStyleSup">42&#44;45</span></a> and conventional transmission electron microscopy &#40;TEM&#41; or cryo-TEM for EVs morphology and size assessment&#46;<a class="elsevierStyleCrossRef" href="#bib0720"><span class="elsevierStyleSup">46</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">These evidences highlight the need of a careful experimental design when EVs studies are performed&#44; as well as a thorough description of the methods used for the separation and characterization to enable reproducibility&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Extracellular vesicles potential biomarkers in atherosclerosis</span><p id="par0060" class="elsevierStylePara elsevierViewall">Compelling evidences point towards an important role of EVs in all the stages of atherosclerosis and its associated complications&#46;<a class="elsevierStyleCrossRefs" href="#bib0550"><span class="elsevierStyleSup">12&#44;47</span></a> Indeed&#44; all blood and vascular cells are capable of releasing EVs to the circulation&#44; and elevated levels of platelet&#44; endothelial&#44; erythrocyte or leucocyte derived EVs have been associated with the presence of traditional CV risk factors&#44; including diabetes&#44;<a class="elsevierStyleCrossRefs" href="#bib0730"><span class="elsevierStyleSup">48&#44;49</span></a> hypertension&#44;<a class="elsevierStyleCrossRef" href="#bib0740"><span class="elsevierStyleSup">50</span></a> hypercholesterolemia<a class="elsevierStyleCrossRefs" href="#bib0745"><span class="elsevierStyleSup">51&#44;52</span></a> and smoking&#44;<a class="elsevierStyleCrossRef" href="#bib0755"><span class="elsevierStyleSup">53</span></a> as well as with subclinical and clinical atherosclerosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0760"><span class="elsevierStyleSup">54&#8211;57</span></a> In this regard&#44; it has been reported a correlation of blood EVs and inflammation&#44; and thrombotic risk in patients with coronary disease&#46; Specifically&#44; in coronary heart disease &#40;CHD&#41;&#44; endothelial and platelet derived EVs have been correlated with the inflammatory markers interleukin-6 &#40;IL-6&#41; and C-reactive protein &#40;CRP&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0780"><span class="elsevierStyleSup">58</span></a> and displayed procoagulant activity <span class="elsevierStyleItalic">in vitro</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0785"><span class="elsevierStyleSup">59</span></a> The levels of EVs have also been studied as possible markers of plaque instability&#46; In fact&#44; EVs of different cellular origins&#44; <span class="elsevierStyleItalic">e&#46;g&#46;</span>&#58; platelet&#44; endothelial&#44; leucocyte and erythrocyte derived&#44; were increased in patients with myocardial infarction compared with patients with unstable and stable angina&#44; and a relationship between procoagulant EVs&#44; assessed by their content in tissue factor or annexin V&#44; and CHD presentation was equally demonstrated&#46;<a class="elsevierStyleCrossRefs" href="#bib0780"><span class="elsevierStyleSup">58&#8211;63</span></a> From a prognosis perspective&#44; endothelial and erythrocyte EVs were associated with worse vascular function and CV events in coronary patients&#44;<a class="elsevierStyleCrossRefs" href="#bib0810"><span class="elsevierStyleSup">64&#8211;69</span></a> and with poor outcome in stroke&#46;<a class="elsevierStyleCrossRefs" href="#bib0840"><span class="elsevierStyleSup">70&#8211;72</span></a> Similarly&#44; platelet and endothelial derived EVs have been found elevated in PAD and correlated with disease severity&#44;<a class="elsevierStyleCrossRefs" href="#bib0855"><span class="elsevierStyleSup">73&#8211;76</span></a> although the role of EVs in PAD should be reconsidered according to their cargo&#46; For instance&#44; Crawford et al&#46; found an elevation of monomeric CRP<span class="elsevierStyleSup">&#43;</span> endothelial EVs in PAD&#44; and suggested their contribution to subclinical inflammation&#44;<a class="elsevierStyleCrossRef" href="#bib0870"><span class="elsevierStyleSup">76</span></a> while Giarretta et al&#46; proposed that Sonic hedgehog morphogen positive endothelial EVs could participate in angiogenic processes in skeletal muscle&#46;<a class="elsevierStyleCrossRef" href="#bib0875"><span class="elsevierStyleSup">77</span></a> In this regard&#44; the transcriptomic study of EVs led us to identify calprotectin and lipocalin-2 as potential biomarkers of worse prognosis in PAD&#44;<a class="elsevierStyleCrossRefs" href="#bib0765"><span class="elsevierStyleSup">55&#44;78</span></a> and the proteomic analysis of circulating and arterial EVs in abdominal aortic aneurysm &#40;AAA&#41; revealed their enriched in proteins related to oxidative stress&#44; inflammation and thrombosis&#44; key processes underlaying AAA pathophysiology&#46;<a class="elsevierStyleCrossRefs" href="#bib0885"><span class="elsevierStyleSup">79&#8211;81</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Extracellular vesicles as active players in atherosclerosis</span><p id="par0065" class="elsevierStylePara elsevierViewall">Besides their possible utility as CV risk biomarkers&#44; EVs emerge as active players in the processes leading to atherosclerosis&#44; including endothelial dysfunction&#44; inflammation&#44; vascular remodelling or apoptosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0615"><span class="elsevierStyleSup">25&#44;82</span></a> In fact&#44; circulating EVs from patients with CHD and metabolic syndrome reduced ECs viability and proliferation&#44;<a class="elsevierStyleCrossRef" href="#bib0905"><span class="elsevierStyleSup">83</span></a> while increasing endothelial permeability and trans-endothelial migration&#44;<a class="elsevierStyleCrossRef" href="#bib0910"><span class="elsevierStyleSup">84</span></a> and promoted VSMC dedifferentiation <span class="elsevierStyleItalic">in vitro</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0910"><span class="elsevierStyleSup">84</span></a> These data support a crosstalk between the cellular components of the aortic wall and the circulating EVs&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Studies with <span class="elsevierStyleItalic">in vitro</span> and <span class="elsevierStyleItalic">in vivo</span> models of atherosclerosis &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41; suggest that the activity of EVs in vascular remodelling&#44; being beneficial or detrimental&#44; depends not only on their cellular origin&#44; but also on their cargo&#44; which varies according to stimulus&#47;stimuli triggering their release&#46; For instance&#44; endothelial EVs obtained after ox-LDL stimulation &#40;ox-LDL-EC-EVs&#41;&#44; induced endothelial death or pyroptosis <span class="elsevierStyleItalic">in vitro</span> in a mechanism dependent on the long non-coding &#40;lnc&#41;RNA HIF1A-AS2&#44; that inhibited miR-455-5p enabling the expression of its target gene ESRRG and the activation of caspase-1 and NLRP3 &#40;NLR family pyrin domain containing 3&#41;&#44; and <span class="elsevierStyleItalic">in vivo</span> ox-LDL-EC-EVs increased lesion size and induced apoptosis in arterial ECs of Apoe&#8722;&#47;&#8722; mice&#46;<a class="elsevierStyleCrossRef" href="#bib0915"><span class="elsevierStyleSup">85</span></a> In this line&#44; other authors reported a switch towards a proinflammatory &#40;M1&#41; phenotype of macrophages upon ox-LDL-EC-EVs exposure <span class="elsevierStyleItalic">in vitro</span>&#44; through the overexpression of miR-155&#44; that was prevented when ox-LDL EC-EVs were enriched in the lncRNA Kruppel-like factor 2 &#40;KLF2&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0920"><span class="elsevierStyleSup">86</span></a> Indeed&#44; Apoe&#8722;&#47;&#8722; mice receiving KLF2<span class="elsevierStyleSup">&#43;</span>-EC-EVs presented smaller arterial lesion size and proinflammatory &#40;M1&#41; macrophages&#44; while increasing the number of M2 anti-inflammatory cells supporting the protective effect of this specific EC-EVs subpopulation&#46;<a class="elsevierStyleCrossRef" href="#bib0920"><span class="elsevierStyleSup">86</span></a> In this line&#44; it has been reported a reduction in VSMCs migration and proliferation <span class="elsevierStyleItalic">in vitro</span>&#44; and neointima formation in a model of carotid artery injury by EC-EVs in a mechanism dependent on low-density lipoprotein receptor-related protein 6 &#40;LRP6&#41; and miR-126-3p&#46;<a class="elsevierStyleCrossRef" href="#bib0925"><span class="elsevierStyleSup">87</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">This dual role has also been observed for macrophage derived EVs &#40;M-EVs&#41;&#46; As such&#44; the administration of M-EVs to Apoe&#8722;&#47;&#8722; mice reduced atherosclerotic plaque size and serum inflammatory markers compared with untreated mice&#44; and with mice receiving ox-LDL-M-EVs&#44; suggesting that ox-LDL exposure might avert the beneficial effect of M-EVs in atherosclerosis&#46;<a class="elsevierStyleCrossRef" href="#bib0930"><span class="elsevierStyleSup">88</span></a> These authors described a reduction of the antiapoptotic miR-199-5p in ox-LDL-M-EVs&#44; that when replenished&#44; reduced EC pyroptosis <span class="elsevierStyleItalic">in vitro</span><span class="elsevierStyleItalic">via</span> the regulation of the SMARCA4&#47;PODXL&#47;NF-&#954;B axis&#44;<a class="elsevierStyleCrossRef" href="#bib0930"><span class="elsevierStyleSup">88</span></a> and <span class="elsevierStyleItalic">in vivo</span> reduced lesion size and serum inflammatory markers&#44; as well as caspase-1 and IL-1&#946; expression in aortic endothelial cells&#46;<a class="elsevierStyleCrossRef" href="#bib0930"><span class="elsevierStyleSup">88</span></a> The proapoptotic activity of ox-LDL-M-EVs on ECs <span class="elsevierStyleItalic">in vitro</span> was further corroborated by other group&#44; identifying the lncRNA GAS5 as a possible mediator&#46;<a class="elsevierStyleCrossRef" href="#bib0935"><span class="elsevierStyleSup">89</span></a> Besides ECs&#44; M-EVs can also interact with surrounding macrophages and VSMCs&#46; The exposure of na&#239;ve macrophages to ox-LDL-M-EVs inhibited migration to a greater extent than control-M-EVs in a mechanism involving miR-146a&#44; and the reduction of its target genes IGF2BP1 &#40;insulin-like growth factor 2 mRNA-binding protein 1&#41; and HuR &#40;human antigen R or ELAV-like RNA-binding protein 1&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0940"><span class="elsevierStyleSup">90</span></a> Additionally&#44; <span class="elsevierStyleItalic">in vitro</span>&#44; miR-19b-3p enriched ox-LDL-M-EVs increased VSMCs proliferation and migration through the decrease of its downstream gene&#44; zinc finger gene 1 &#40;JAZF1&#41;&#44; while <span class="elsevierStyleItalic">in vivo</span>&#44; aggravated atherosclerosis lesions in Apoe&#8722;&#47;&#8722; mice&#46;<a class="elsevierStyleCrossRef" href="#bib0945"><span class="elsevierStyleSup">91</span></a> A worsening of the atherosclerotic phenotype was also observed in Apoe&#8722;&#47;&#8722; mice injected with M-EVs obtained after M1 differentiation &#40;M1-M-EVs&#41;&#44; that resulted in increased blood levels of cholesterol&#44; oxidative stress and inflammatory markers&#44; and locally in bigger atherosclerotic plaques&#46; This phenotype was further aggravated when M1-M-EVs overexpressed miR-185-3p and induced the downregulation of its target gene Smad7&#46;<a class="elsevierStyleCrossRef" href="#bib0950"><span class="elsevierStyleSup">92</span></a> Similarly&#44; ox-LDL-M-EVs rich in miR-503-5p and poor in smad7&#44; smurf1&#44; and smurf2 impaired angiogenesis&#44; and activated apoptosis and inflammation in ECs <span class="elsevierStyleItalic">in vitro</span>&#44; while inducing proliferation and migration in VSMCs&#46;<a class="elsevierStyleCrossRef" href="#bib0955"><span class="elsevierStyleSup">93</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Experiment performed stimulating ECs with KLF5&#43;VSMC-EVs or ox-LDL-VSMCs-EVs&#44; resulted into the transfer of miR-155 to the endothelial monolayer&#44; pointing towards a potential role of this miRNA in atherosclerosis&#46;<a class="elsevierStyleCrossRef" href="#bib0960"><span class="elsevierStyleSup">94</span></a> As such&#44; the injection of miR-155<span class="elsevierStyleSup">&#43;</span>VSMC-EVs to Apoe&#8722;&#47;&#8722; mice increased lesion size&#44; and promoted the disruption of endothelial integrity by decreasing the endothelial expression of tight junction proteins&#44; suggesting a potential role of KLF5&#43;VSMC-EVs in endothelial injury&#46;<a class="elsevierStyleCrossRef" href="#bib0960"><span class="elsevierStyleSup">94</span></a> Similarly&#44; VSMC-EVs derived from diabetic donors increased the endothelial expression of the proinflammatory molecule ICAM-1 &#40;intercellular adhesion molecule&#41; and monocyte adhesion compared to non-diabetic-VSMC-EVs&#44; and promoted M1 polarization of human monocytes in a miR-221&#47;222 dependent manner&#46; Finally&#44; the intravenous administration of diabetic-VSMC-EVs&#44; resulted in a significant increase of atherosclerotic plaque size in Apoe&#8722;&#47;&#8722; mice as compared with non-diabetic-VSMC-EVs&#46;<a class="elsevierStyleCrossRef" href="#bib0965"><span class="elsevierStyleSup">95</span></a> These results suggest a detrimental effect of activated VSMC derived EVs on endothelial function&#44; and the potential utility of EVs for novel biomarker and therapeutic target discovery in atherosclerosis&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The contribution of EVs from other sources&#44; <span class="elsevierStyleItalic">e&#46;g&#46;</span>&#58; blood cells&#44; or other organs&#44; to the atherosclerotic phenotype has also been investigated&#46; For instance&#44; <span class="elsevierStyleItalic">in vitro</span>&#44; the stimulation of macrophages with red blood cells derived EVs &#40;RBC-EVs&#41; resulted in the upregulation of the athero-protective genes heme oxygenase-1 &#40;HO-1&#41; and the ATP binding cassette transporter-1 &#40;ABCG1&#41;&#44; and the polarization of macrophages towards a reparative phenotype&#46;<a class="elsevierStyleCrossRef" href="#bib0970"><span class="elsevierStyleSup">96</span></a> Moreover&#44; RBC-EVs-primed macrophages showed reduced Oil Red O staining after ox-LDL challenge&#44; suggesting that RBC-EVs protect macrophages against foam cell formation and atherosclerosis&#46; <span class="elsevierStyleItalic">In vivo</span>&#44; Apoe&#8722;&#47;&#8722; mice treated with RBC-EVs showed a decrease in total aortic lesions with a concomitant increase in macrophage HO-1 expression&#46;<a class="elsevierStyleCrossRef" href="#bib0970"><span class="elsevierStyleSup">96</span></a> Similarly&#44; platelet derived EVs &#40;PLT-EVs&#41; were athero-protective by reducing circulating total cholesterol and triglycerides&#44; and arterial lesion size and inflammatory markers in Apoe&#8722;&#47;&#8722; mice&#44; in a mechanism mediated by the transfer of miR-34c-5p to target cells and the decrease of PODXL &#40;podocalyxin like&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0975"><span class="elsevierStyleSup">97</span></a> A possible crosstalk facilitated by EVs between perivascular adipose tissue &#40;PVAT&#41; and macrophages has also been reported&#46;<a class="elsevierStyleCrossRef" href="#bib0980"><span class="elsevierStyleSup">98</span></a> Indeed&#44; the pre-treatment of murine macrophages with PVAT-EVs reduced ox-LDL uptake <span class="elsevierStyleItalic">in vitro</span>&#44; and induced cholesterol efflux in a mechanism involving the athero-protective miR-382-5p&#46; PVAT-EVs increased macrophage expression of the cholesterol efflux transporters ABCA1 and ABCG1&#44; and the peroxisome proliferator-activated receptor gamma &#40;PPAR&#947;&#41;&#44; and reduced the mRNA levels of bone morphogenetic protein-4 &#40;BMP4&#41; and macrophage scavenger receptor-A &#40;SR-A&#41;&#44; that was reversed in the presence of a miR-382-5p inhibitor&#46;<a class="elsevierStyleCrossRef" href="#bib0980"><span class="elsevierStyleSup">98</span></a> These evidences point towards a beneficial effect of EVs derived from cells of non-vascular origin in atherosclerosis&#44; although this should be corroborated with broader studies&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclusions</span><p id="par0090" class="elsevierStylePara elsevierViewall">Overall&#44; EVs emerge as important mediators of cellular communication in atherogenesis&#44; being detrimental or beneficial according to their cellular origin&#44; the stimuli triggering their release&#44; and their cargo&#46; This dual capacity holds promise for the discovery of novel diagnosis and prognosis biomarkers&#44; as well as for the identification of new therapeutic targets in CVDs by the study and characterization of EVs&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Funding</span><p id="par0095" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleGrantSponsor" id="gs1">Foundation for Applied Medical Research&#44; Universidad de Navarra &#40;Spain&#41;</span>&#59; the <span class="elsevierStyleGrantSponsor" id="gs2">Ministry of Science and Innovation&#44; Institute of Health Carlos III</span>&#44; co-funded by the <span class="elsevierStyleGrantSponsor" id="gs3">European Fund for Economic and Regional Development &#40;FEDER&#41;</span> &#91;<span class="elsevierStyleGrantNumber" refid="gs3">PI21&#47;00622</span>&#44; <span class="elsevierStyleGrantNumber" refid="gs3">Gobierno de Navarra 8-2021</span>&#93;&#46; The 8-2021 project has received 50&#37; co-financed aid from the European Regional Development Fund through the ERDF 2014-2020 Operational Program of Navarra&#46; This research was supported by CIBER &#8211; Consorcio Centro de Investigaci&#243;n Biom&#233;dica en Red &#8211; Cardiovascular &#40;CB16&#47;11&#47;00483 and CB16&#47;11&#47;00451&#41;&#44; Instituto de Salud Carlos III&#44; Ministerio de Ciencia e Innovaci&#243;n&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Authors&#8217; contributions</span><p id="par0100" class="elsevierStylePara elsevierViewall">Conceptualization&#58; CR&#59; writing&#58; JAP and CR&#59; review and editing&#58; JAP&#44; AC&#44; FC&#44; and CR&#46; All authors have read and agreed to the published version of the manuscript&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conflict of interests</span><p id="par0105" class="elsevierStylePara elsevierViewall">None to declare&#46;</p></span></span>"
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          "titulo" => "Introduction"
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          "titulo" => "Pathophysiology of atherosclerosis"
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        14 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "Authors&#8217; contributions"
        ]
        15 => array:2 [
          "identificador" => "sec0055"
          "titulo" => "Conflict of interests"
        ]
        16 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2023-12-12"
    "fechaAceptado" => "2024-03-27"
    "PalabrasClave" => array:2 [
      "en" => array:2 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1817040"
          "palabras" => array:4 [
            0 => "Atherosclerosis"
            1 => "Extracellular vesicles"
            2 => "Intercellular communication"
            3 => "Biomarker"
          ]
        ]
        1 => array:4 [
          "clase" => "abr"
          "titulo" => "Abbreviations"
          "identificador" => "xpalclavsec1817038"
          "palabras" => array:39 [
            0 => "AAA"
            1 => "ABCA1"
            2 => "ABCG1"
            3 => "BMP4"
            4 => "CHD"
            5 => "CVD"
            6 => "CRP"
            7 => "ECs"
            8 => "ESRRG"
            9 => "EVs"
            10 => "GAS5"
            11 => "HO-1"
            12 => "HIF1A-AS2"
            13 => "HuR"
            14 => "IL-6"
            15 => "IGF2BP1"
            16 => "ICAM-1"
            17 => "JAZF1"
            18 => "KLF"
            19 => "LRP6"
            20 => "&#40;Ox&#41;-LDL"
            21 => "NLRP3"
            22 => "NF-&#954;B"
            23 => "PAD"
            24 => "PVAT"
            25 => "PPAR&#947;"
            26 => "PODXL"
            27 => "NTA"
            28 => "lncRNA"
            29 => "SR-A"
            30 => "RBC"
            31 => "ROS"
            32 => "SEC"
            33 => "SMARCA4"
            34 => "smad7"
            35 => "smurf"
            36 => "TEM"
            37 => "UC"
            38 => "VSMC"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1817039"
          "palabras" => array:4 [
            0 => "Arteriosclerosis"
            1 => "Ves&#237;culas extracelulares"
            2 => "Comunicaci&#243;n intercelular"
            3 => "Biomarcador"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Atherosclerosis is the main pathogenic substrate for cardiovascular diseases &#40;CVDs&#41;&#46; Initially categorized as a passive cholesterol storage disease&#44; nowadays&#44; it is considered an active process&#44; identifying inflammation among the key players for its initiation and progression&#46; Despite these advances&#44; patients with CVDs are still at high risk of thrombotic events and death&#44; urging to deepen into the molecular mechanisms underlying atherogenesis&#44; and to identify novel diagnosis and prognosis biomarkers for their stratification&#46; In this context&#44; extracellular vesicles &#40;EVs&#41; have been postulated as an alternative in search of novel biomarkers in atherosclerotic diseases&#44; as well as to investigate the crosstalk between the cells participating in the processes leading to arterial remodelling&#46; EVs are nanosized lipidic particles released by most cell types in physiological and pathological conditions&#44; that enclose lipids&#44; proteins&#44; and nucleic acids from parental cells reflecting their activation status&#46; First considered cellular waste disposal systems&#44; at present&#44; EVs have been recognized as active effectors in a myriad of cellular processes&#44; and as potential diagnosis and prognosis biomarkers also in CVDs&#46; This review summarizes the role of EVs as potential biomarkers of CVDs&#44; and their involvement into the processes leading to atherosclerosis&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La aterosclerosis es el principal sustrato patog&#233;nico de las enfermedades cardiovasculares &#40;ECV&#41;&#46; Considerada inicialmente como un dep&#243;sito pasivo de colesterol&#44; hoy se asume que es un proceso activo&#44; donde la inflamaci&#243;n juega un papel clave en su inicio y progresi&#243;n&#46; A pesar de los avances realizados&#44; los pacientes con ECV presentan alto riesgo de episodios tromb&#243;ticos y elevada mortalidad&#44; por lo que sigue siendo necesario profundizar en los mecanismos de la aterog&#233;nesis e identificar nuevos biomarcadores diagn&#243;sticos y pron&#243;sticos para estratificar el riesgo&#46; En este sentido&#44; se ha postulado que las ves&#237;culas extracelulares &#40;EV&#41; podr&#237;an representar nuevos biomarcadores de la enfermedad ateroscler&#243;tica&#44; siendo de inter&#233;s investigar su participaci&#243;n en la comunicaci&#243;n intercelular que favorece el remodelado arterial&#46; Las EV son part&#237;culas lip&#237;dicas liberadas por numerosas c&#233;lulas en condiciones fisiol&#243;gicas y patol&#243;gicas&#44; que contienen l&#237;pidos&#44; prote&#237;nas y &#225;cidos nucleicos procedentes de las c&#233;lulas parentales&#46; Consideradas inicialmente como material de desecho&#44; hoy se sabe que son efectores activos de numerosos procesos celulares&#44; constituyendo biomarcadores potenciales con significado diagn&#243;stico y pron&#243;stico en la ECV&#46; En esta revisi&#243;n se sintetiza el papel de las EV como biomarcadores potenciales de las ECV y su participaci&#243;n en procesos que favorecen la aterosclerosis&#46;</p></span>"
      ]
    ]
    "multimedia" => array:2 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1088
            "Ancho" => 2925
            "Tamanyo" => 260629
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">EVs in vascular inflammation and atherosclerosis&#46; EVs are released by all cellular components of the vascular wall and blood and participate in all steps of atherosclerosis&#59; initiation &#40;fatty streak formation&#41;&#44; development &#40;stable plaque&#47;fibroatheroma&#41;&#44; and progression and rupture &#40;vulnerable plaque&#47;thrombus formation&#41;&#46; VSMC&#58; smooth muscle cells&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">ABCA1&#58; ATP binding cassette subfamily A member 1&#59; ABCG1&#58; ATP binding cassette transporter-1&#59; BMP4&#58; bone morphogenetic protein-4&#59; ECs&#58; endothelial cells&#59; EVs&#58; extracellular vesicles&#59; GAS5&#58; growth arrest specific 5&#59; HO-1&#58; heme oxygenase-1&#59; HAECs&#58; human aortic endothelial cells&#59; HASMC&#58; human aortic smooth muscle cells&#59; HCAECs&#58; human coronary artery endothelial cells&#59; HCASMCs&#58; human coronary artery vascular smooth muscle cells&#59; HuR&#58; human antigen R or ELAV-like RNA-binding protein 1&#59; IGF2BP1&#58; insulin-like growth factor 2 mRNA-binding protein 1&#59; JAZF1&#58; zinc finger gene 1&#59; KLF2-5&#58; Kruppel-like factor&#59; MetS&#58; metabolic syndrome&#59; NF-&#954;B&#58; nuclear factor kappa B&#59; LPR6&#58; low-density lipoprotein receptor-related-protein 6&#59; ox-LDL&#58; oxidized low-density lipoprotein&#59; PVAT&#58; perivascular adipose tissue&#59; PPAR&#947;&#58; peroxisome proliferator-activated receptor gamma&#59; PLT&#58; platelets&#59; PODXL&#58; podocalyxin like&#59; RBC&#58; red blood cells&#59; SMARCA4&#58; SWI&#47;SNF related&#44; matrix associated&#44; actin dependent regulator of chromatin&#44; subfamily A&#44; member 4&#59; SR-A&#58; macrophage scavenger receptor-A&#59; Smurf&#58; SMAD specific E3 ubiquitin protein ligase&#59; ZO-1&#58; zonula occludens-1&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">EVs type and source&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Study type&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Biological effect&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EVs from CHD patients <span class="elsevierStyleItalic">vs</span> control EVs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">In vitro</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CHD-EVs reduced HUVECs viability and proliferation&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bib0905">83</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Plasma EVs from metabolic syndrome &#40;MetS-EVs&#41; <span class="elsevierStyleItalic">vs</span> non-MetS patients &#40;nMETS-EVs&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">In vitro</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MetS-EVs increased HAECs permeability&#44; and HASMC migration&#44; proliferation and inflammation in a mechanism related to Rap1 activity&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bib0910">84</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ox-LDL-EC-EVs from HUVECs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">In vitro</span> and <span class="elsevierStyleItalic">in vivo</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">In vitro</span>&#44; ox-LDL-EC-EVs rich in the LncRNA HIF1A-AS2 induced apoptosis in HUVECs&#44; inhibiting miR-455-5p&#44; and upregulating ESRRD and caspase-1 activity&#46;Ox-LDL-EC-EVs increased atherosclerotic lesion size and ECs apoptosis in Apoe&#8722;&#47;&#8722; mice&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bib0915">85</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ox-LDL-EC-EVs from HUVECs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">In vitro</span> and <span class="elsevierStyleItalic">in vivo</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ox-LDL-EC-EVs induced M1 polarization on THP-1 monocytes depending on miR-155&#44; that was prevented when EVs were enriched in KLF2&#46;KLF2<span class="elsevierStyleSup">&#43;</span>-EC-EVs reduced lesion size and proinflammatory macrophages in Apoe&#8722;&#47;&#8722; mice&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bib0920">86</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EC-EVs from HCAECs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">In vitro</span> and <span class="elsevierStyleItalic">in vivo</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EC-EVs reduced VSMC migration and proliferation by transferring miR-126 to target cells&#44; reducing LRP6&#46;<span class="elsevierStyleItalic">In vivo</span>&#44; EC-EVs decreased neointima formation in a model of carotid artery injury in WT mice&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bib0925">87</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M-EVs and ox-LDL-M-EVs from differentiated THP-1 macrophages&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">In vitro</span> and <span class="elsevierStyleItalic">in vivo</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ox-LDL-M-EVs poor in miR-199-5p induce HAECs apoptosis through the regulation of the SMARCA4&#47;PODXL&#47;NF-&#954;B axis&#46;M-EVs treated Apoe&#8722;&#47;&#8722; mice presented reduced lesion size and blood inflammatory markers&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bib0930">88</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ox-LDL-M-EVs from THP-1 cells&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">In vitro</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ox-LDL-M-EVs induced HUVECs apoptosis in a mechanism mediated by the LncRNA GAS5&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bib0935">89</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M-EVs and ox-LDL-M-EVs from primary cultures or RAW264&#46;7 cells&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">In vitro</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ox-LDL-M-EVs reduced macrophage migration in mechanism involving miR-146a and the reduction in IGF2BP1 and HuR&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bib0940">90</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ox-LDL-M-EVs from RAW264&#46;7 macrophages&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">In vitro</span> and <span class="elsevierStyleItalic">in vivo</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">In vitro</span>&#44; miR-19b-3p enriched ox-LDL-M-EVs increased VSMCs proliferation and migration&#44; and decreased JAZF1 expression&#46;<span class="elsevierStyleItalic">In vivo</span>&#44; ox-LDL-M-EVs aggravated atherosclerosis lesions in Apoe&#8722;&#47;&#8722; mice&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bib0945">91</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M1-M-EVs from M1 polarized THP-1 cells&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">In vitro</span> and <span class="elsevierStyleItalic">in vivo</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M1-M-EVs increased blood levels of cholesterol&#44; oxidative stress and inflammatory markers in Apoe&#8722;&#47;&#8722; mice&#44; presenting bigger atherosclerotic plaques&#46;miR-185-3p enriched M1-M-EVs aggravated this phenotype through Smad7 downregulation&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bib0950">92</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ox-LDL-M-EVs from THP-1 and RAW264&#46;7 macrophages&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">In vitro</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">In vitro</span>&#44; ox-LDL-M-EVs rich in miR-503-5p and poor in smad7&#44; smurf1&#44; and smurf2 impaired angiogenesis&#44; and activated apoptosis and inflammation in HCAECs and induced HCASMCs proliferation and migration&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bib0955">93</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">miR-155<span class="elsevierStyleSup">&#43;</span>VSMC-EVs from HASMCs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">In vitro</span> and <span class="elsevierStyleItalic">in vivo</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">In vivo</span>&#44; miR-155<span class="elsevierStyleSup">&#43;</span>VSMC-EVs from KLF5&#8722; transfected cells increased lesion size&#44; and disrupted endothelial integrity in Apoe&#8722;&#47;&#8722; mice&#46;miR-155<span class="elsevierStyleSup">&#43;</span>VSMC-EVs decreased the endothelial expression of ZO-1&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bib0960">94</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">VSMC-EVs from diabetic and non-diabetic HCASMCs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">In vitro</span> and <span class="elsevierStyleItalic">in vivo</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">In vitro</span>&#44; diabetic-VSMC-EVs increased ECs expression of ICAM-1 and monocyte adhesion&#44; and induced monocyte M1 polarization in a miR-221&#47;222 dependent manner&#46;In Apoe&#8722;&#47;&#8722; mice&#44; diabetic-VSMC-EVs increased plaque size&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bib0965">95</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RBC-EVs from RBCs of healthy volunteers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">In vitro</span> and <span class="elsevierStyleItalic">in vivo</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RBC-EVs upregulated the expression of HO-1 and ABCG1&#44; and induced the polarization of macrophages towards M2 <span class="elsevierStyleItalic">in vitro</span>&#46;<span class="elsevierStyleItalic">In vivo</span>&#44; RBC-EVs decreased aortic lesions&#44; and increased macrophage HO-1 expression in Apoe&#8722;&#47;&#8722; mice&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bib0970">96</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PLT-EVs from mouse platelets&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">In vitro</span> and <span class="elsevierStyleItalic">in vivo</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PLT-EVs reduced circulating total cholesterol and triglycerides&#44; and lesion size and inflammatory markers in arterial tissue of Apoe&#8722;&#47;&#8722; mice&#44; transferring miR-34c-5p to target cells&#44; and decreasing PODXL&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bib0975">97</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PVAT-EVs from WT mice&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">In vitro</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The pre-treatment of RAW264&#46;7 macrophages with PVAT-EVs reduced ox-LDL uptake&#44; and induced cholesterol efflux in a mechanism involving miR-382-5p&#46; PVAT-EVs increased macrophage expression of the cholesterol efflux transporters ABCA1 and ABCG1&#44; and the PPAR&#947;&#44; and reduced the levels of BMP4 and SR-A&#44; that was reversed in presence of a miR-382-5p inhibitor&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bib0980">98</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Summary of studies investigating the biological activity of EVs from different origins <span class="elsevierStyleItalic">in vitro</span> and <span class="elsevierStyleItalic">in vivo</span>&#46;</p>"
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                      "titulo" => "Comparing cancer and cardiovascular disease trends in 20 middle- or high-income countries 2000-19&#58; a pointer to national trajectories towards achieving sustainable development goal target 3&#46;4"
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                      "titulo" => "The changing landscape of atherosclerosis"
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                      "titulo" => "SEA 2022 standards for global control of cardiovascular risk"
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                      "titulo" => "European Society of Cardiology&#58; cardiovascular disease statistics 2021"
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                      "titulo" => "Heart disease and stroke statistics &#8211; 2023 update&#58; a report from the American Heart Associatio"
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                    0 => array:2 [
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The quiescent endothelium&#58; signalling pathways regulating organ-specific endothelial normalcy"
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              "etiqueta" => "9"
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                  "contribucion" => array:1 [
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                      "titulo" => "Endothelial cell dysfunction and the pathobiology of atherosclerosis"
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dysfunctional vascular endothelium as a driver of atherosclerosis&#58; emerging insights into pathogenesis and treatment"
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            10 => array:3 [
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Atherosclerosis&#58; recent developments"
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                        "volumen" => "185"
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                          0 => array:2 [ …2]
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Original language: English
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