Exosome-mediated neuroprotection in vascular dementia: Mechanisms, molecular pathways, and therapeutic prospects

Exosomes, a specialized class of extracellular vesicles, exhibit significant therapeutic potentials for neurological disorders, in particular for vascular dementia (VaD). VaD is the second most common form of dementia, characterized by cognitive and behavioral impairments. VaD is often linked to hippocampal damage resulting from its vulnerable vascular structure, which disrupts memory formation and retrieval. Secreted by various cell types within the central nervous system, exosomes mediate intercellular communication by transporting bioactive molecules. Growing evidence indicates that exosomes enhance synaptic plasticity, modulate neuroinflammation, inhibit apoptosis, and promote angiogenesis, supporting their therapeutic potentials in VaD. Given the urgent need for effective treatments and the unique ability of exosomes to cross the blood-brain barrier (BBB) and deliver multi-targeted therapies, research in this field is critically important. It offers a viable pathway toward the development of disease-modifying interventions for a condition that is currently managed primarily through symptomatic treatment. This review summarizes current knowledge on the functions of exosomes in the central nervous system, explores recent advances in exosome-based strategies for VaD, and discusses ongoing challenges and future directions for their clinical translation.