Extracellular vesicles: new perspectives on infection pathology, diagnosis and therapy_West China Medical Journal

Authors：

YE Yihong ¹ , XU Yihan ¹ , LIN Ziyi ² , CHEN Minmin ¹ ,  CAO Yingping ¹

1. Department of Clinical Laboratory, Fujian Medical University Union Hospital, Fuzhou, Fujian 350001, P. R. China;
2. Department of Nuclear Medicine, Fuzhou University Affiliated Provincial Hospital, Fuzhou, Fujian 350001, P. R. China;

Corresponding?author：

CAO Yingping, Email: caoyingping@aliyun.com

Keywords：

Extracellular vesicles; bacterial infections; viral infections; immune regulation; clinical translation

DOI：

10.7507/1002-0179.202607077

Video：

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Abstract Full text Figures/Tables Video References Cited by

Bacterial and viral infections pose persistent threats to global public health. As core mediators of host-pathogen interactions, extracellular vesicles (EVs) exert bidirectional regulation over infectious progression by mediating immune defense and pathogenic injury. This review systematically elaborates the biological characteristics of host-derived, bacterium-secreted and virus-hijacked EVs, discusses their offensive-defensive crosstalk during infection, and summarizes their translational potential in non-invasive diagnosis, targeted therapy and vaccine development. Meanwhile, major obstacles restricting clinical translation, including the absence of standardized preparation protocols, suboptimal targeting performance and insufficient data on long-term biosafety, are critically assessed. Deciphering the bidirectional regulatory mechanisms of EVs holds the potential to overcome the limitations of traditional anti-infection regimens and provide novel insights for the precision medicine in infectious diseases.

Citation： YE Yihong, XU Yihan, LIN Ziyi, CHEN Minmin, CAO Yingping. Extracellular vesicles: new perspectives on infection pathology, diagnosis and therapy. West China Medical Journal, 2026, 41(8): 1355-1360. doi: 10.7507/1002-0179.202607077 Copy

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54.	Micoli F, Adamo R, Nakakana U. Outer membrane vesicle vaccine platforms[J]. BioDrugs, 2024, 38(1): 47-59.
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59.	G?rgens A, Corso G, Hagey DW, et al. Identification of storage conditions stabilizing extracellular vesicles preparations[J]. J Extracell Vesiclesm, 2022, 11(6): e12238.
60.	Li G, Chen T, Dahlman J, et al. Current challenges and future directions for engineering extracellular vesicles for heart, lung, blood and sleep diseases[J]. J Extracell Vesicles, 2023, 12(2): e12305.
61.	Takakura Y, Hanayama R, Akiyoshi K, et al. Quality and safety considerations for therapeutic products based on extracellular vesicles[J]. Pharm Res, 2024, 41(8): 1573-1594.
62.	Van Delen M, Derdelinckx J, Wouters K, et al. A systematic review and meta-analysis of clinical trials assessing safety and efficacy of human extracellular vesicle-based therapy[J]. J Extracell Vesicles, 2024, 13(7): e12458.

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41. Zhao F, Xu Y, Liu N, et al. Extracellular vesicles from Zika virus-infected cells display viral E protein that binds ZIKV-neutralizing antibodies to prevent infection enhancement[J]. EMBO J, 2023, 42(6): e112096.
42. Hu X, Liao S, Bai H, et al. Integrating exosomal microRNAs and electronic health data improved tuberculosis diagnosis[J]. EBioMedicine, 2019, 40: 564-573.
43.
44. Krishnamachary B, Cook C, Kumar A, et al. Extracellular vesicle-mediated endothelial apoptosis and EV-associated proteins correlate with COVID-19 disease severity[J]. J Extracell Vesicles, 2021, 10(9): e12117.
45.
46.
47.
48.
49.
50.
51.
52.
53. Zamanian MH, Norooznezhad AH, Hosseinkhani Z, et al. Human placental mesenchymal stromal cell-derived small extracellular vesicles as a treatment for severe COVID-19: a double-blind randomized controlled clinical trial[J]. J Extracell Vesicles, 2024, 13(7): e12492.
54. Micoli F, Adamo R, Nakakana U. Outer membrane vesicle vaccine platforms[J]. BioDrugs, 2024, 38(1): 47-59.
55. Ouyang Y, Mouillet JF, Sorkin A, et al. Trophoblastic extracellular vesicles and viruses: friends or foes?[J]. Am J Reprod Immunol, 2021, 85(2): e13345.
56. Cocozza F, Martin-Jaular L, Lippens L, et al. Extracellular vesicles and co-isolated endogenous retroviruses from murine cancer cells differentially affect dendritic cells[J]. EMBO J, 2023, 42(24): e113590.
57. Louro AF, Meliciano A, Alves PM, et al. A roadmap towards manufacturing extracellular vesicles for cardiac repair[J]. Trends Biotechnol, 2024, 42(10): 1305-1322.
58. Lowe NM, Mizenko RR, Nguyen BB, et al. Orthogonal analysis reveals inconsistencies in cargo loading of extracellular vesicles[J]. J Extracell Biol, 2024, 3(8): e70003.
59. G?rgens A, Corso G, Hagey DW, et al. Identification of storage conditions stabilizing extracellular vesicles preparations[J]. J Extracell Vesiclesm, 2022, 11(6): e12238.
60. Li G, Chen T, Dahlman J, et al. Current challenges and future directions for engineering extracellular vesicles for heart, lung, blood and sleep diseases[J]. J Extracell Vesicles, 2023, 12(2): e12305.
61. Takakura Y, Hanayama R, Akiyoshi K, et al. Quality and safety considerations for therapeutic products based on extracellular vesicles[J]. Pharm Res, 2024, 41(8): 1573-1594.
62. Van Delen M, Derdelinckx J, Wouters K, et al. A systematic review and meta-analysis of clinical trials assessing safety and efficacy of human extracellular vesicle-based therapy[J]. J Extracell Vesicles, 2024, 13(7): e12458.

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