Exosomes as Molecular Mediators of Reproductive Health: From Infertility to HPV-Related Disease

This review provides a comprehensive overview of the biological roles of exosomes in reproductive physiology, examines their involvement in mechanisms associated with female and male infertility, and discusses their emerging role in human papillomavirus (HPV)-related reproductive disease. Exosomes are small extracellular vesicles that mediate intercellular communication by transporting proteins, lipids, DNA, messenger RNAs (mRNAs), microRNAs (miRNAs), long non-coding RNAs (lncRNAs), circular RNAs (circRNAs), and other bioactive molecules, thereby regulating the biological functions of recipient cells. Particular emphasis is placed on the roles of exosomes in folliculogenesis, gametogenesis, fertilization, embryo implantation, and spermatogenesis. Alterations in exosomal cargo and function have been reported in several female and male reproductive disorders. In parallel, emerging evidence suggests that exosomes may participate in HPV-associated disease through mechanisms involving viral persistence, modulation of immune and inflammatory responses, and transfer of viral and host-derived molecules between cells. Exosomes are also being investigated as potential non-invasive biomarkers and therapeutic delivery platforms; however, these applications remain largely investigational. Importantly, substantial heterogeneity in extracellular vesicle isolation, purification, and characterization methods limits cross-study comparability and remains a major barrier to clinical translation. Overall, current evidence supports exosome-mediated communication as a biologically relevant mechanism across reproductive physiology, infertility-related disorders, and HPV-associated disease, while further standardized and clinically validated studies are required to establish their diagnostic and therapeutic utility.