Extracellular Vesicles: Emerging Players in Tumor Progression, Diagnosis, and Therapeutic Applications

Extracellular vesicles (EVs) are emerging as critical players in oncology and also exert vital regulatory effects on exercise-induced muscle injury repair, offering novel insights into tumor biology. Tumor-derived EVs facilitate intercellular communication by carrying bioactive molecules such as proteins and nucleic acids, which reshape the tumor microenvironment and enhance tumor invasion, metastasis, and drug resistance. Conversely, specific subsets of EVs, particularly those derived from dendritic cells or engineered to present tumor antigens, can elicit antitumor immune responses by activating cytotoxic T lymphocytes and facilitating antigen cross-presentation. Clinically, the high stability of EVs in body fluids, coupled with their intrinsic capacity to encapsulate and protect tumor-derived molecular cargo, positions them as robust noninvasive biomarkers for early cancer diagnosis and prognostic stratification, as well as indicators for evaluating muscle recovery status after exercise. Additionally, EVs function as drug delivery carriers, offering advantages like biocompatibility, low immunogenicity, and targeting capabilities. However, challenges remain in EVs isolation, characterization, and scalable production, with inconsistent techniques affecting purity, structure, and biological activity. Moreover, limited understanding of EVs mechanisms, such as their role in immune modulation and drug delivery efficiency, hinders broader clinical translation across oncology and musculoskeletal rehabilitation. Addressing these issues requires advances in standardization, scalable manufacturing, and extensive clinical trials to ensure its safety and efficacy. Despite these challenges, EVs hold immense promise as transformative tools in precision oncology and sports rehabilitation, paving the way for innovative diagnostics, therapies, and improving patient and athletic outcomes in the fight against cancer and exercise-related muscle damage.