Extracellular vesicles (EVs) are lipid-membrane-enclosed particles released from cells, playing a pivotal role in cellular communication, particularly within the immune system. The fundamental molecular mechanisms through which EVs offer unique functionality for immunotherapeutic benefits are identified and reviewed. The focus is on three essential features, all rooted in the EV lipid membrane: immune receptor–ligand interactions at the EV membrane interface, the shielding of immunogenic cargo within the EVs, and the fusion of EVs with target cell membranes for direct cargo delivery. From this, how these distinct EV attributes, from their initial description and analysis in immune communication, have led to the development of novel immunotherapeutic strategies is traced. This review delves into how these strategies are applied in various immunotherapies, such as cancer immunotherapy, autoimmune diseases, infections, vaccinations, and graft-versus-host diseases, to modulate communication among different cell types for immune regulation. It is concluded by reviewing clinical trials involving EVs in immunotherapy that have effectively harnessed EVs' unique molecular mechanisms in clinical settings. Research and standardization efforts to maximize the potential impact of EVs on immunotherapy are further suggested.

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从理论到治疗：细胞外囊泡在免疫治疗中的进展

细胞外囊泡（EV）是细胞释放的脂质膜包裹的颗粒，在细胞通讯中发挥着关键作用，特别是在免疫系统中。确定并回顾了 EV 提供独特功能以实现免疫治疗益处的基本分子机制。重点是三个基本特征，所有这些特征都植根于 EV 脂质膜：EV 膜界面处的免疫受体-配体相互作用、EV 内免疫原性货物的屏蔽，以及 EV 与目标细胞膜的融合以直接货物输送。由此，可以追溯这些独特的 EV 属性，从它们在免疫通讯中的最初描述和分析，如何导致新型免疫治疗策略的发展。本综述深入探讨了如何将这些策略应用于各种免疫疗法，例如癌症免疫疗法、自身免疫性疾病、感染、疫苗接种和移植物抗宿主疾病，以调节不同细胞类型之间的通讯以进行免疫调节。结论是通过回顾涉及 EV 进行免疫治疗的临床试验，这些试验在临床环境中有效地利用了 EV 独特的分子机制。进一步建议进行研究和标准化工作，以最大限度地发挥 EV 对免疫治疗的潜在影响。