Unlocking the therapeutic potential of exosomes for ischemic stroke

Ischemic stroke, a leading cause of global mortality and disability, faces therapeutic limitations due to the narrow time window and restricted efficacy of current interventions such as thrombolysis and thrombectomy. Recent advancements highlight exosomes-nanoscale extracellular vesicles-as promising therapeutic agents owing to their ability to cross the blood-brain barrier (BBB) and mediate intercellular communication. This review summarizes the biological characteristics of exosomes, their roles in neuroprotection, neuroregeneration, and angiogenesis following ischemic stroke, and emerging strategies utilizing engineered exosome-based nanoparticles for targeted therapy. Despite exosomes showing significant advantages in the treatment of ischemic stroke, their clinical transformation still faces challenges, including the standardized production of exosomes, the clarification of biological distribution mechanisms, and the assessment of immunogenicity and safety. Overcoming these challenges, exosomes are expected to become a safe and efficient therapeutic means for ischemic stroke.