Extracellular Vesicles: A New Dimension in Nerve Injury Repair

Peripheral and central nerve injuries present significant challenges in clinical practice due to the paucity of effective therapeutic options. Extracellular vesicles (EVs), lipid membrane-encapsulated nanoparticles released from most cell types, are enriched in bioactive molecules capable of mediating intercellular communication. Recently, EVs have shown potential for applications in regenerative medicine, notably as alternatives to cell therapy. A therapeutic paradigm shift is emerging towards the EV-based treatment of nerve injury. Accumulating evidence indicates that EVs promote nerve regeneration and functional recovery, primarily by modulating neural cell function, immune-inflammatory responses, and angiogenesis. Various strategies have been developed to incorporate EVs into nerve grafts or to utilize them as diagnostic and therapeutic vehicles. This review aimed to provide a systematic survey of the available literature on the latest progress in EV-based treatments for peripheral nerve, spinal cord, and brain injuries. Additionally, prospects of EV-based nerve injury repair are discussed in terms of deep mechanistic understanding, technological innovations, and interdisciplinary convergence.