Extracellular vesicle therapy for spinal cord injury: engineering-enhanced strategies and combination therapies

Spinal cord injury (SCI) is a highly disabling central nervous system disease. The prognosis of traditional treatment methods is poor at present, which is closely related to the poor regenerative ability of the nervous system. Extracellular vesicles (EVs) have shown excellent therapeutic potential because they restore immune homeostasis in the injured area, promoting axonal regeneration and angiogenesis. However, there are still many deficiencies in the use of extracellular vesicles alone. Researchers have significantly improved the therapeutic effect through many methods, such as engineering amplification strategies, intelligent delivery systems, and combined treatment with vesicle materials. In view of this, We conducted a search in the PubMed and Web of Science databases for articles published up to January 2026, and this article systematically reviews the research progress, mechanism of action, and frontier technology development of EVs in SCI, providing a theoretical basis and technical reference for regenerative medicine.