Epigenetic messengers: extracellular vesicles at the interface of cancer communication

Extracellular vesicles (EVs) have emerged as potent conveyors of epigenetic information, reshaping our understanding of intercellular communication in both health and disease. Beyond their established roles in transferring proteins and nucleic acids, EVs carry DNA methyltransferases and methylated DNA and RNA species, providing a dynamic mechanism for remodelling the methylome of recipient cells. In normal physiology, this exchange fine-tunes gene expression, development, and tissue homeostasis. However, under pathological conditions, particularly in cancer, EV-mediated transfer of methylation machinery becomes dysregulated, driving epigenetic reprogramming of the tumour microenvironment and promoting malignant progression. Tumour-derived EVs mirror the methylation landscape of their parent cells, positioning them as promising non-invasive biomarkers for early detection and disease monitoring. Despite this potential, significant variability in EV isolation, characterisation, and functional assessment continues to obscure mechanistic insights. Clarifying how specific EV cargo drives targeted methylation changes will be essential to harness their diagnostic and therapeutic utility. This review highlights the emerging concept of EVs as mobile epigenetic regulators, underscoring the need for standardisation and translational integration to fully exploit their promise in precision cancer medicine.