Extracellular Vesicles in Tauopathies: Mechanisms and Applications

Extracellular vesicles (EVs) are nanoscale membrane-enclosed vesicles that mediate intercellular communication and participate in both physiological and pathological signaling processes. Recent studies underscore the critical roles of EVs in the propagation of tau pathology and the diagnostic and therapeutic aspects of tauopathies, a class of neurodegenerative diseases marked by the pathological accumulation of the protein tau, contributing to cognitive decline and neuronal loss. This review aims to explore the many roles of EVs in tauopathies, emphasizing their ability to carry and transmit misfolded tau, modulate immune responses through microglial interactions, and serve as carriers of disease-specific biomarkers. We describe current findings on extravesicular tau, miRNAs, and mRNAs as diagnostic indicators in Alzheimer's disease and related tauopathies and evaluate the therapeutic potential of both endogenous and engineered EVs for delivering therapeutic agents or neuroprotective cargo. Challenges such as isolation standardization, cargo loading efficiency, and biodistribution are also discussed, along with potential strategies to overcome them. Overall, the evidence emphasizes EVs as key players in the pathophysiology, diagnosis, and treatment of tauopathies, offering a strong and compelling platform for precision medicine and clinical applications in the future.