Extracellular Vesicles as Therapeutic Strategy for Ischemic Stroke

Ischemic stroke remains one of the leading causes of death and long-term disability worldwide, with current treatments limited by narrow therapeutic windows and the risk of hemorrhagic transformation. In this context, extracellular vesicles (EVs) have emerged as a promising cell-free therapeutic strategy due to their ability to modulate inflammation and support neuroregeneration. This review explores recent advances in the application of EVs in ischemic stroke therapy, highlighting their mechanisms of action, including the delivery of neuroprotective molecules such as microRNAs and proteins that promote angiogenesis, neurogenesis, and anti-apoptotic pathways. We summarize findings from preclinical models demonstrating the regenerative potential of EVs derived from mesenchymal stem cells, microglia, neural progenitor cells, and other cell types, as well as advances in bioengineered EVs for targeted delivery. Despite encouraging results, the clinical translation of EV-based therapies faces challenges, including large-scale production, content variability, and targeted delivery efficiency. Future efforts should focus on optimizing EV characterization and manufacturing processes to ensure therapeutic consistency and safety.