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Background <p>Extracellular vesicles (EVs), including exosomes, play pivotal roles in the pathogenesis, diagnosis, and treatment of endometriosis. These nanosized vesicles carry bioactive molecules such as microRNAs (miRNAs), long noncoding RNAs (lncRNAs), proteins, and lipids, facilitating intercellular communication and modulating the mechanisms that drive disease progression. This systematic review aims to synthesize the current evidence on the role of EVs in the pathophysiology of endometriosis, their potential as diagnostic biomarkers, and their therapeutic applications.</p> Methods <p>A comprehensive systematic review was conducted following the PRISMA guidelines. A systematic search of PubMed, Web of Science, Embase, and Scopus was performed for studies published between 2019 and 2024. The search terms included “extracellular vesicles” AND “endometriosis”, “pathogenesis” AND “diagnostic biomarkers” AND “therapeutic potential” AND “targeted therapy”. After screening 327 records, 269 unique studies were assessed. Following a full-text review of the remaining articles, 43 studies were included in the qualitative synthesis.</p> Results <p>Our review identified critical roles of EVs in immune modulation, epithelial-mesenchymal transition (EMT), and fertility impairment, all of which contribute to the progression of endometriosis. EVs carry molecular cargo that mirrors disease pathophysiology, highlighting their potential as noninvasive biomarkers for early diagnosis and disease monitoring. Additionally, engineered EVs offer novel therapeutic strategies for targeting disease-specific pathways.</p> Conclusions <p>This review highlights the multifaceted roles of EVs in endometriosis. EV-derived biomarkers, particularly miRNAs and proteins, show promise for noninvasive diagnosis and disease monitoring, while engineered EVs hold potential for targeted therapeutic interventions. These findings highlight the transformative potential of EVs in the diagnosis, prognosis, and treatment of endometriosis.</p> Graphical abstract <p>Schematic representation of the systematic review methodology and key findings on the role of extracellular vesicles in endometriosis. Fifty-two studies were ultimately included through databases such as Web of Science, Scopus, PubMed, and Embase, following PRISMA guidelines. The figure highlights the involvement of EVs in endometriosis pathogenesis (e.g., epithelial‒mesenchymal transition, inflammation, and fertility disruption), their potential as diagnostic biomarkers, and their therapeutic applications, including engineered EVs for targeted therapy and immune modulation.</p>

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The role of extracellular vesicles in endometriosis: A systematic review of pathogenesis, diagnostic biomarkers, and therapeutic potential

  • 期刊论文

  • 发表日期：

    2026年3月3日

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  • Mohsen Sheykhhasan,
  • Saeedeh Zare Jalise,
  • Hourieh Kalhor,
  • Tahereh Komeili Movahed,
  • Fatemeh Javaheri Tehrani,
  • Hamed Afkhami

摘要

Background

Extracellular vesicles (EVs), including exosomes, play pivotal roles in the pathogenesis, diagnosis, and treatment of endometriosis. These nanosized vesicles carry bioactive molecules such as microRNAs (miRNAs), long noncoding RNAs (lncRNAs), proteins, and lipids, facilitating intercellular communication and modulating the mechanisms that drive disease progression. This systematic review aims to synthesize the current evidence on the role of EVs in the pathophysiology of endometriosis, their potential as diagnostic biomarkers, and their therapeutic applications.

Methods

A comprehensive systematic review was conducted following the PRISMA guidelines. A systematic search of PubMed, Web of Science, Embase, and Scopus was performed for studies published between 2019 and 2024. The search terms included “extracellular vesicles” AND “endometriosis”, “pathogenesis” AND “diagnostic biomarkers” AND “therapeutic potential” AND “targeted therapy”. After screening 327 records, 269 unique studies were assessed. Following a full-text review of the remaining articles, 43 studies were included in the qualitative synthesis.

Results

Our review identified critical roles of EVs in immune modulation, epithelial-mesenchymal transition (EMT), and fertility impairment, all of which contribute to the progression of endometriosis. EVs carry molecular cargo that mirrors disease pathophysiology, highlighting their potential as noninvasive biomarkers for early diagnosis and disease monitoring. Additionally, engineered EVs offer novel therapeutic strategies for targeting disease-specific pathways.

Conclusions

This review highlights the multifaceted roles of EVs in endometriosis. EV-derived biomarkers, particularly miRNAs and proteins, show promise for noninvasive diagnosis and disease monitoring, while engineered EVs hold potential for targeted therapeutic interventions. These findings highlight the transformative potential of EVs in the diagnosis, prognosis, and treatment of endometriosis.

Graphical abstract

Schematic representation of the systematic review methodology and key findings on the role of extracellular vesicles in endometriosis. Fifty-two studies were ultimately included through databases such as Web of Science, Scopus, PubMed, and Embase, following PRISMA guidelines. The figure highlights the involvement of EVs in endometriosis pathogenesis (e.g., epithelial‒mesenchymal transition, inflammation, and fertility disruption), their potential as diagnostic biomarkers, and their therapeutic applications, including engineered EVs for targeted therapy and immune modulation.