Harnessing exosomes for precision diagnostics and therapies in psychiatry disorders

Abstract

Exosomes are nanosized extracellular vesicles enriched with proteins, lipids, and nucleic acids and are emerging as powerful mediators of intercellular communication with transformative potential for psychiatry. Their ability to cross the blood–brain barrier, reflect the molecular state of parent cells, and deliver functional cargo positions them as uniquely suited tools for precision diagnostics and targeted therapeutics in neuropsychiatric disorders. This narrative review synthesizes current advances in exosome biology, isolation technologies, and multi-omics profiling to evaluate their utility as biomarkers for early detection, disease stratification, and treatment monitoring across major psychiatric conditions, including depression, bipolar disorder, schizophrenia, and neurodevelopmental disorders. We further examine innovative therapeutic strategies leveraging engineered exosomes for targeted delivery of small molecules, RNA therapeutics, and gene-editing systems to neural circuits implicated in psychiatric pathophysiology. Key challenges such as standardization of isolation methods, cargo heterogeneity, and translational scalability are critically discussed alongside emerging solutions from nanotechnology and machine learning–driven biomarker discovery. By integrating mechanistic insights with translational applications, this review highlights exosomes as a promising frontier for precision psychiatry and outlines the roadmap needed to advance them toward clinical implementation.