Extracellular vesicle-mediated mechanisms and therapeutic potential in acute lung injury

Acute lung injury (ALI) is a severe inflammatory lung disorder characterized by disruption of the alveolar-capillary barrier and impaired gas exchange, often progressing to acute respiratory distress syndrome and respiratory failure. Current treatments are largely supportive with limited efficacy, underscoring the need for novel therapeutic strategies.

This review summarizes current evidence on extracellular vesicles (EVs) in ALI and evaluates their potential as therapeutic agents and biomarkers.

A comprehensive literature review was conducted focusing on the biological functions, mechanisms of action, and translational potential of EVs in ALI.

EVs are key mediators of intercellular communication in ALI. They exert anti-inflammatory, antioxidant, and pro-regenerative effects through transfer of bioactive cargo, thereby modulating immune responses, preserving endothelial and epithelial barrier integrity, and promoting tissue repair. EVs derived from mesenchymal stem cells and endothelial progenitor cells demonstrate protective effects against lung injury and vascular dysfunction in preclinical studies. In addition, EVs hold promise as natural drug delivery systems due to their low immunogenicity and ability to cross biological barriers, as well as potential biomarkers for ALI.

EVs represent a promising cell-free therapeutic platform for ALI, with applications in immunomodulation, tissue repair, drug delivery, and diagnosis. However, further mechanistic studies and rigorous translational validation are required to support clinical application.