State-of-the-Art: The Use of Extracellular Vesicles and Preparations Based on Them for Neuroprotection and Stimulation of Brain Tissue Regeneration after Injury

Abstract—Extracellular vesicles are macromolecular complexes produced by virtually all types of eukaryotic and prokaryotic cells. According to modern concepts, they allow cells to exchange information, regulate each other’s activity and coordinate their actions during the complex processes of development, maintaining homeostasis, tissue regeneration, etc. Extracellular vesicles have a number of unique properties: the ability to accumulate certain types of proteins and nucleic acids, protect them from degradation and ensure their delivery to target cells, which can be used to create biomimetic approaches to the therapy of a wide range of diseases. The composition of vesicles, the preference for docking with a particular cell type, and ultimately their therapeutic potential are very flexible parameters and are highly dependent on the type and properties of the producer cell culture, as well as cultivation conditions. This review gives an idea of the state and prospects of the therapeutic strategies based on the application of extracellular vesicles for neuroprotection and stimulation of brain tissue regeneration after injury, and also considers existing clinical studies which use extracellular vesicles in the field of neurology and neurosurgery. Particular attention in the review is given to new promising approaches to increasing the production of extracellular vesicles, manipulating their contents, and increasing the efficiency of targeted docking in order to increase their therapeutic activity and specificity.