Microfluidic sensing technologies for exosome-based isolation, detection and therapy in panvascular diseases

Panvascular diseases (PVDs) comprise systemic vascular disorders predominantly driven by atherosclerosis, resulting in widespread vascular injury across multiple organ systems. Large population-based imaging studies have shown that atherosclerotic lesions are highly prevalent even in asymptomatic populations and frequently involve multiple vascular beds, highlighting the systemic burden of vascular pathology and the need for improved strategies for early detection and intervention. In this context, mammalian cell-derived exosomes have emerged as promising circulating biomarkers and nanoscale delivery vehicles in vascular diseases. However, their practical application is hindered by low abundance in blood, vesicle heterogeneity, and the analytical complexity of clinically relevant samples. This review provides a comprehensive overview of microfluidic biosensor platforms for exosome isolation, detection, and therapeutic engineering in PVDs. Microfluidic strategies based on size-exclusion, immunoaffinity capture, and integrated electrochemical or optical transduction enable enhanced analytical sensitivity, reduced sample consumption, high-throughput processing, and improved reproducibility. In addition, microfluidic-enabled cargo loading and surface functionalization approaches offer precise control over exosome modification compared with conventional bulk methods. Collectively, these technologies establish scalable and integrative microfluidic frameworks that advance exosome-based diagnostics and therapeutic engineering, while highlighting remaining challenges in standardization, multiplexing capability, and clinical translation.