Regulatory mechanisms of deer antler extracellular vesicles in multilevel tissue repair: a state-of-the-art review

Extracellular vesicles (EVs) are defined as key nanoscale messengers that mediate intercellular communication, demonstrating immense potential in tissue repair and regenerative medicine. As the only organ in mammals capable of complete, cyclical regeneration, deer antlers provide EVs with exceptional regenerative bioactivity. This paper systematically reviews and prospectively discusses the research field of deer antler-derived EVs. We first outline their isolation strategies and characteristic functional subtypes, then focus on elucidating their multi-level molecular mechanisms driving tissue repair: at the cellular level, they directly regulate stem cell proliferation and lineage differentiation; at the microenvironmental level, they effectively remodel the immune ecology of injured areas by reprogramming immune cells and coordinating cytokine networks, thereby creating favorable conditions for regeneration. At the molecular level, they precisely regulate core signaling pathways, including the Wnt/β-catenin, NF-κB, miR-21-5p/STAT3, and TGF-β pathways. Finally, this paper prospectively explores cutting-edge developments in the field, including enhancing vesicle targeting and drug-loading capacity through engineering strategies, constructing controlled-release delivery systems based on smart materials, and developing precision therapies tailored to specific pathological microenvironments. This review aims to elucidate the biomedical potential of deer antler extracellular vesicles as regenerative nanomedicines for promoting tissue repair.