Exosomal biomarkers and therapeutic strategies for stroke: A focused review

Abstract: Stroke remains a major global contributor to mortality and long-term disability, imposing substantial burdens on both individuals and societal systems. Current therapeutic interventions remain limited despite extensive scientific exploration. Small extracellular vesicles termed exosomes have emerged as a focal point in cerebrovascular research, owing to their distinctive biological properties including blood–brain barrier permeability, minimal immunogenic responses, and intercellular signaling capabilities. This comprehensive analysis synthesizes contemporary understanding of exosomal roles in stroke pathophysiology, encompassing diagnostic biomarker potential, therapeutic applications, and mechanistic insights. Through systematic database interrogation and critical evaluation of multidisciplinary studies, we identify the exosome-mediated transport of protein complexes, regulatory microRNAs, long noncoding RNAs, and circular RNAs as critical modulators of inflammatory cascades, vascular remodeling, neural regeneration, and programmed cell death pathways. Diagnostic applications demonstrate that exosomal signatures may enable stroke subtype discrimination and prognostic stratification. Therapeutically, preclinical evidence highlights neuroprotective outcomes from mesenchymal, neural progenitor, and astrocyte-derived exosome administration. Translational challenges persist regarding isolation protocol standardization, targeted delivery optimization, and comprehensive safety profiling. While exosomal technologies hold transformative potential for stroke management, realization requires coordinated multidisciplinary investigation to overcome existing technical and biological barriers.