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PE hampers the invasion of trophoblasts and disrupts placental function, contributing to inflammation and maternal organ dysfunction. Exosomes are small extracellular vesicles that mediate cell-to-cell communication by transferring proteins, lipids, and nucleic acids. This review highlights their role in immune regulation during pregnancy, especially their altered behavior in PE. Normally, exosomes support communication between the mother and fetus, promoting immune tolerance. In PE, however, exosomal activity and content undergo significant changes, potentially intensifying the inflammatory state. Further investigation into the in vivo immune-modulatory actions of exosomes, especially those from preeclamptic placentas, may provide insights into the pathogenesis of PE and uncover novel therapeutic targets for treatment.<\/jats:p>","DOI":"10.1007\/s00404-025-08013-7","type":"journal-article","created":{"date-parts":[[2025,4,5]],"date-time":"2025-04-05T08:50:24Z","timestamp":1743843024000},"page":"1477-1487","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["The immune-modulatory dynamics of exosomes in preeclampsia"],"prefix":"10.1007","volume":"311","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0688-157X","authenticated-orcid":false,"given":"M.","family":"David","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9210-9913","authenticated-orcid":false,"given":"N.","family":"Maharaj","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,4,3]]},"reference":[{"key":"8013_CR1","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1016\/j.preghy.2021.09.008","volume":"27","author":"LA Magee","year":"2022","unstructured":"Magee LA, Brown MA, Hall DR, Gupte S, Hennessy A, Karumanchi SA et al (2022) The 2021 International Society for the Study of Hypertension in Pregnancy classification, diagnosis & management recommendations for international practice. 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