Targeted delivery of apelin using a novel extracellular vesicle platform for pulmonary arterial hypertension treatment

Pulmonary arterial hypertension (PAH) is a severe disease characterized by endothelial dysfunction, vascular remodeling, and pulmonary artery occlusion, culminating in right ventricular hypertrophy and heart failure. While apelin peptides are promising therapeutic candidates due to their critical role in vascular homeostasis, their efficacy as agonists is limited by insufficient lesion-specific targeting and suboptimal in vivo stability. Here, we developed an engineered extracellular vesicle (EV) platform for precise apelin delivery to PAH lesions, maximizing therapeutic impact. Using interferon-induced transmembrane protein 3 (IFITM3), a type II transmembrane protein, we oriented the apelin peptide on the EV surface with its C-terminus fully exposed, preserving the critical binding interface for functional interaction with the apelin receptor. To further enhance targeting specificity, we integrated the PAH-targeting peptide CARSKNKDC (CAR), which selectively binds to heparan sulfate overexpressed on PAH endothelial cells, into the IFITM3-apelin scaffold, creating CAR-Apelin EVs. This dual-engineered EVs demonstrated exceptional targeting and therapeutic efficacy in PAH models. CAR-Apelin EVs significantly reversed pathological vascular remodeling and improved cardiac function, as evidenced by reduced right ventricular systolic pressure and hypertrophy. Our findings establish CAR-Apelin EVs as a transformative therapeutic strategy, providing a targeted and effective approach to meet critical unmet needs in PAH treatment.