The Dual Role of Extracellular Vesicles in Aging and Age-Related Diseases: Pathophysiology and Therapeutic Potential

Aging is a complex biological process characterized by progressive loss of physiological integrityand represents the primary risk factor for numerous chronic disorders, including neurodegenerative diseases, diabetes mellitus, cardiovascular disease, and stroke. Increasing evidence indicates that chronic low-grade inflammation ("inflammaging"), genomic instability, mitochondrial dysfunction, deregulated nutrient sensing, cellular senescence, and impaired intercellular communication collectively drive aging and age-related pathologies. Extracellular vesicles (EVs), a heterogeneous population of lipid bilayer-enclosed nanoparticles released by nearly all cell types, have emerged as critical regulators of these processes by mediating intercellular transfer of proteins, lipids, metabolites, and nucleic acids. In this review, we systematically synthesize current advances in EV biology within the context of aging and major age-related diseases, emphasizing their double-edged roles in disease pathogenesis and therapy. We discuss how senescent or diseased cell-derived EVs propagate inflammation, oxidative stress, genomic damage, mitochondrial dysfunction, and maladaptive immune responses, thereby accelerating tissue degeneration. Conversely, EVs derived from stem cells or young, healthy tissues exert therapeutic and rejuvenating effects by restoring redox balance, modulating immune polarization, enhancing mitochondrial function, regulating nutrient-sensing pathways, and promoting tissue repair and regeneration. Finally, we highlight the therapeutic potential of native and engineered EVs as diagnostic biomarkers and treatment modalities for aging and age-related diseases, while discussing key limitations, including rapid systemic clearance and targeting efficiency. Collectively, this review provides a comprehensive and therapy-oriented framework for understanding EVs as both drivers of aging-associated pathology and promising tools for anti-aging and regenerative medicine.