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Second, VEGF changes the activation of endothelial cells, and induces the expression of a series of endothelial cell genes from different sources under hypoxic conditions (40), including the expression of procoagulant factor, plasminogen activator inhibitor-1 (PAI-1), matrix metalloproteinase (MMP), interstitial collagenase and tissue factor, to degrade the extracellular matrix around blood vessels (41) to promote the release of pro-angiogenic factors stored in the extracellular matrix (42) thus inducing vascularization

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Exosomal surfaces have also been nongenetically modified using lipid-based membrane anchors, electrostatic interactions, and ligandreceptor interactions