Extracellular vesicle therapeutics: the issue of one size fits all

Extracellular vesicles (EV) are mediators of intercellular communication locally in tissue microenvironments and enable distal across organ communication between cells of the same origin and those from different sources. EV surface proteins and lipids enable interaction with particular cells, whereas their internal payload of RNA, transcription factors, DNA, enzymes and metabolites functionally alters recipient cells. EV-interactions and uptake induce changes in cellular proliferation, differentiation, cell movement, as well as transcriptional and epigenetic regulation. These unique properties of EV poise them as attractive therapeutics in a broad range of pathologies, but questions remain in translating EV discoveries to effective therapies. Here, I briefly discuss the need for more stringent considerations for EV-therapeutic effects with a focus on EV biodistribution profiles in appropriate disease models and routes of EV administration with a particular focus on the vasculature.