Extracellular Vesicles in COVID-19: Mechanistic insights and emerging therapeutic strategies

The COVID-19 pandemic has profoundly impacted global health, driven in part by the high mutation rate of SARS-CoV-2, which has resulted in the emergence of variants with enhanced transmissibility, virulence, and immune evasion capabilities. This evolving threat highlights the urgent need for innovative therapeutic strategies, as current treatments have shown limited efficacy. In this context, Extracellular Vesicles (EVs) present a promising alternative. EVs play a crucial role in intercellular communication and offer advantages due to their biocompatibility and mechanisms of cellular entry as viruses, making them an important tool against SARS-CoV-2. One of the principal immune evasion strategies employed by SARS-CoV-2 involves the release of EVs capable of transporting viral antigens. Numerous studies have suggested the role of exosomes and microvesicles as carriers of viral components, indicating that EVs can be targets in the progression of infection. Exosomes derived from infected cells could function as biomarkers and as potential drug delivery vehicles. Furthermore, EVs play a regulatory role in immune responses, facilitating cytokine production and antigen presentation. This review aims to elucidate the molecular mechanisms underlying the involvement of EVs in SARS-CoV-2 infection, examine their implications for biomarker development and explore their potential therapeutic applications in COVID-19.