The Role and Therapeutic Potential of Gut Microbiota and Their Extracellular Vesicles in Neurological, Cardiovascular, and Metabolic Diseases

Gut microbiota-derived extracellular vesicles (EVs) have emerged as important mediators of host-microbiota communication, influencing physiological and pathological processes across multiple organ systems through gut-organ axes. These nanoscale vesicles can exert either protective or pathogenic effects depending on their microbial origin, molecular cargo, and host context. Increasing evidence suggests that microbiota-derived EVs contribute to the pathogenesis of neurological, cardiovascular, and metabolic disorders by modulating immune, inflammatory, and metabolic pathways. In addition, their stability, accessibility in biological fluids, and capacity for targeted delivery have generated interest in their use as diagnostic biomarkers and therapeutic platforms. In this narrative review, we summarize current evidence regarding the role of gut microbiota-derived EVs in representative neurological, cardiovascular, and metabolic diseases, highlighting both their detrimental and beneficial effects. We further discuss their translational potential, current challenges in clinical application, and emerging strategies for EV-based diagnostics and therapeutics. Collectively, this review provides a conceptual and translational framework for advancing microbiota-derived EV research toward clinical practice.