A narrative review on exosomes therapeutics in stroke: advancing neuroprotection and regeneration

The complexities of neuroinflammatory processes and the limited regenerative capacity of neural tissues have made ischemic stroke one of the leading causes of disability in many countries for the long periods after the initial incidence. Extracellular vesicles (EVs), more particularly exosomes, are emerging as promising agents for therapeutic usage, because of their outstanding ability to alter immune response and minimize oxidative stress suffered by neural tissue, and to enhance neuronal repair. The narrative review covers exosome biogenesis, particular cargo components, and mechanistic properties of exosomes in stroke therapy. It evaluates neuroprotection along with neurogenesis in both preclinical and clinical models, amassing their findings in immune modulation. Exosomes mediate neuroprotection through cargo-driven mechanisms involving miRNAs (e.g., miR-124, miR-21), stress-responsive proteins (e.g., HSP70), and bioactive lipids, facilitating neural repair post-ischemia. This review provides an in-depth analysis of exosome biogenesis, their cargo profiles, and the translational potential of exosome-based therapies in ischemic stroke. It discusses some of the advantages of exosome therapies over traditional cell-based therapies, such as greater safety profiles and more prolonged storage stability, based on the latest literature. Notwithstanding the challenges presented by exosome isolation and targeted delivery, their therapeutic possible applications deserve increasing attention. However, current translational efforts focus on optimizing exosome sourcing, improving targeting accuracy, and ensuring safety, positioning this innovative approach as a compelling candidate for next-generation stroke interventions with the potential to improve outcomes and facilitate personalized medicine.