Urine-derived stem cells (USCs) exhibit self-renewal, differentiating, and immunomodulatory properties, making them a valuable alternative to other stem cells, with wide potential in regenerative medicine. USCs exhibit a favorable immune profile through a presence of HLA-ABC and the absence of HLA-DR, which reduces the risk of transplant rejection. Specific importance has been emphasized on mitochondria. Crucial for endothelial and cardiovascular research is specificity of USCs mitochondria, which present young cell phenotype with high metabolic activity. It not only provides low oxidative stress level of the cells, but also exhibit anti-inflammatory influence on surrounding environment. Secretory activity of USCs can regulate apoptosis, angiogenesis, and inflammation, also activating signaling pathways such as NF-κB, STAT3, and Akt in recipient cells. Due to the acellular activity, USCs-Exos contain miRNAs involved in promoting angiogenesis, reducing fibrosis, and regulating apoptosis such as miR-16, miR-216, miR-26a, miR-146a and miR-140. Additionally, USCs can be reprogrammed into induced pluripotent stem cells (iPSCs). This expands opportunities for disease modeling, developing personalized therapies and reconstructions. However, there are still many limitations and clinical challenges, like cell isolation and its characterization, or urinary tract ailments which may impact the cells physiology. Still, USCs and their derivatives are promising tools in modern regenerative medicine, especially in endothelial and cardiovascular tissues. However, further research is needed to optimize their clinical applications and face the challenges.
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