The Roles and Uses of Extracellular Vesicles in Neuroimmunologic Diseases

Neuroimmunology is a field of neurology focused on the diagnosis and treatment of diseases where the immune system causes inflammation or injury to the nervous system. This includes diseases such as multiple sclerosis, myelin oligodendrocyte glycoprotein antibody-associated disease, neuromyelitis optica spectrum disorder, autoimmune encephalitis, autoimmune ataxia, stiff person syndrome spectrum disorder, and neuro-rheumatologic diseases such as neuropsychiatric lupus. Over the past couple decades, there have been significant advancements in the diagnostic methods for several neuroimmunologic diseases. Despite these achievements, major needs remain for additional methods to facilitate earlier diagnosis, monitor disease activity and treatment, and elucidate disease mechanisms to aid in the development of novel or tailored treatment strategies. Currently, there is often a trade-off between the invasiveness of neurodiagnostic testing and the level of detail that can be obtained from the test without causing an iatrogenic injury. Here, we discuss the potential of extracellular vesicles (EVs), especially CNS-derived EVs obtained from peripheral blood, as a promising avenue for advancing research and clinical care in neuroimmunology. This article provides a review of the key clinical features and approaches to care for the most common neuroimmunologic diseases. We identify gaps that remain in our current understanding of these conditions. We then highlight how ongoing research in the EV field may address these existing gaps. Finally, we examine the challenges that must be overcome before EV analysis can be more widely adopted in both research and clinical care in this field.