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Exosomes are membrane\u2010bound vesicles released from almost all cells and are crucially involved in cell\u2013cell communication. Interestingly, COVID\u201019 viral particles produce exosomes that moderate communication between infected and uninfected cells. Hence, there is growing evidence highlighting the crucial implications of exosomes in COVID\u201019 infection, transmission, intercellular spread, and reinfection. On the other hand, clinical trials have demonstrated mesenchymal stem cell\u2010derived exosomes as a promising therapeutic strategy for severely affected COVID\u201019 patients. Also, convalescent plasma\u2010derived exosomes have been proposed for multiple efficacies in COVID\u201019 patients. Furthermore, messenger RNAs (mRNA)\u2010loaded exosomes were superior to mRNA\u2010loaded lipid nanoparticles as a delivery system. Hence, exosomes can be used to safely induce SARS\u2010CoV\u20102 immunity via their loading with mRNAs encoding immunogenic forms of SARS\u2010CoV\u20102 spike and nucleocapsid proteins. Moreover, exosomes can be used as a nano\u2010delivery system for microRNA to alleviate cytokine storm and prevent the progression of organ failure in COVID\u201019 patients. The present review summarizes state of the art concerning the role of exosomes in COVID\u201019 infection and accompanying organ complications as well as the potential use of exosomes in COVID\u201019 diagnosis, treatment, drug delivery, and vaccination. The review also sheds the light on the common biogenic pathway between the SARS\u2010CoV\u20102 virus and exosomes. Additionally, the latest and current clinical trials using exosomes for COVID\u201019 infection are summarized.<\/jats:p>","DOI":"10.1002\/cbin.12014","type":"journal-article","created":{"date-parts":[[2023,3,19]],"date-time":"2023-03-19T14:38:21Z","timestamp":1679236701000},"page":"1049-1067","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Exosomes in COVID\u201019 infection: Focus on role in diagnosis, pathogenesis, immunity, and clinical trials"],"prefix":"10.1002","volume":"47","author":[{"given":"Alhanouf","family":"Aljuhani","sequence":"first","affiliation":[{"name":"Pharm D Program, Faculty of Pharmacy University of Tabuk  Tabuk Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omniah","family":"Albalawi","sequence":"additional","affiliation":[{"name":"Pharm D Program, Faculty of Pharmacy University of Tabuk  Tabuk Saudi 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