Exosomes and Extracellular vesicles, potential tools in the effective management of tuberculosis infection

Extracellular vesicles (EVs) are nano-sized, lipid bilayer-enclosed structures secreted by cells to mediate intercellular communication, with exosomes originating from the endosomal pathway constituting a distinct subclass that plays a key role in immune modulation and cellular signaling. EVs and exosomes demonstrate significant potential in Mycobacterium tuberculosis ( M.tb ) pathogenesis, diagnostics, and therapeutics. This review examines the pivotal role of EVs in M.tb infection and their potential therapeutic applications. EVs, including exosomes, facilitate intercellular communication by transporting various molecular cargos, including proteins, lipids, and nucleic acids. Host-derived EVs demonstrate critical functions in immune modulation and granuloma formation, while M.tb -derived EVs, containing immunologically active components, influence host-pathogen interactions. Although isolation and characterisation challenges persist, EVs show promise as diagnostic biomarkers due to their stability and specific cargo profiles recent advances in EV engineering present opportunities for targeted drug delivery and vaccine development. The review also highlights emerging EV isolation and analysis technologies, emphasizing their potential in TB diagnostics and therapeutics. While technical hurdles remain, ongoing research suggests EVs could revolutionize TB management through improved diagnosis, drug delivery, and immunotherapy strategies. • EVs from Mycobacterium tuberculosis (M.tb) and host cells offer low immunogenicity, biocompatibility, and barrier-crossing abilities, making them effective drug delivery vehicles. • Engineered EVs enable targeted TB therapy by delivering immunostimulatory molecules, enhancing immunity, and transporting genetic or antimicrobial cargo. • Advanced isolation techniques, such as microfluidics and magnetic precipitation, improve EV characterization and clinical applicability. • EV-based vaccines demonstrate potential, with membrane-bound antigens eliciting stronger immune responses than traditional vaccines. • Major challenges include standardizing EV preparation, ensuring purity, and advancing clinical translation.