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. 2023 Sep 28;147(2):372–389. doi: 10.1093/brain/awad332

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© The Author(s) 2023. Published by Oxford University Press on behalf of the Guarantors of Brain.

This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

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Cartoon summarizing major modes of actions of extracellular vesicles that are therapeutically administered via different routes in diverse disease conditions including stroke, multiple sclerosis or neurodegenerative diseases. The different modes of action, which comprise immune modulation, nuclear signalling, metabolic reprogramming and promotion of neuronal plasticity, synergistically contribute to the recovery-promoting effects of extracellular vesicles (EVs). For therapeutic purposes, unmodified EVs are currently evaluated, as well as EVs that have genetically been modified enabling prolonged EV circulation in the blood, enhanced brain uptake or enhanced signalling action, respectively.