Cardiac therapy is entering a delivery-first era.
Many advanced therapies for cardiovascular disease already exist—small molecules, biologics, siRNA, mRNA, CRISPR systems, extracellular vesicles, AAV gene therapy, and nanoparticles.
But the bottleneck is simple:
How do we get the therapy to the heart, and not the liver/spleen?
A new European Heart Journal state-of-the-art review summarizes the emerging toolkit for cardiac-targeted delivery.
Core strategies:
Intracoronary delivery
Direct catheter-based delivery can raise local myocardial exposure, especially during PCI, but it remains invasive and difficult to repeat.
Cardiotropic AAV vectors
AAV9/SERCA2a, AAV-LAMP2B, MOG1, SOCS3, VEGF/Ang1, and CRISPR-based approaches show promise, but translation is limited by immune responses, liver uptake, dose toxicity, and packaging constraints.
Extracellular vesicles
EVs can be engineered with cardiac-homing peptides or membrane cloaking to increase uptake in cardiomyocytes, fibroblasts, and ischemic myocardium.
Microbubbles ultrasound
Ultrasound-targeted microbubble destruction enables local release of genes, drugs, or cells with spatial control.
Nanoparticles
Lipid, polymeric, metallic, inorganic, and nanomotor platforms are being designed for mRNA/siRNA delivery, anti-fibrotic therapy, anti-inflammatory targeting, and cardiac repair.
The key insight:
Cardiac targeting is not just “organ delivery.”
It requires three levels of precision:
heart accumulation → disease-region localization → cell-type-specific delivery
The future of cardiovascular therapeutics may depend less on discovering one more drug, and more on engineering the right delivery system:
right payload,
right cardiac compartment,
right cell type,
right timing.
Reference:
Liu et al. “Cardiac-targeted delivery of advanced medical therapies for heart disease.” European Heart Journal 2026. DOI: 10.1093/eurheartj/ehag432.