{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T10:09:25Z","timestamp":1790071765320,"version":"4.0.1"},"reference-count":162,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:p>Ischemic stroke (IS) accounts for over 80% of all stroke cases, featuring high disability, mortality, and recurrence rates. Conventional intravenous thrombolysis and mechanical thrombectomy are limited by narrow therapeutic windows, reperfusion injury, and the blood\u2013brain barrier (BBB), which impedes the entry of neuroprotective agents into the brain parenchyma. Exosomes (Exos) are cell-secreted nanoscale extracellular vesicles (EVs) that carry miRNAs, proteins, and lipids, with low immunogenicity, BBB permeability, and ease of genetic modification, making them promising cell-free therapeutic agents for central nervous system (CNS) disorders. Exos alleviate cerebral ischemia-reperfusion injury by suppressing multiple forms of programmed cell death, oxidative stress, and neuroinflammation, repairing the BBB, and facilitating angiogenesis and neurogenesis. Genetic engineering, surface peptide modification, and drug loading further enhance brain-targeted exosomal enrichment. This review systematically summarises Exos biogenesis, multi-pathway neural repair mechanisms mediated by exosomal miRNAs, engineered delivery strategies, translational bottlenecks, and future research directions, aiming to provide theoretical support for the clinical transformation of Exos therapy for IS.<\/jats:p>","DOI":"10.3389\/fphar.2026.1930673","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T09:35:57Z","timestamp":1790069757000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Recent advances in research on novel therapeutic mechanisms and strategies for exosome-based treatment of ischemic stroke"],"prefix":"10.3389","volume":"17","author":[{"given":"Tairan","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Cell Biology, Third Military Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanlin","family":"Cao","sequence":"additional","affiliation":[{"name":"Department of Cell Biology, Third Military Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xi","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Neurology, Southwest Hospital, Third Military Medical University (Army Medical University)","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaxin","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Cell Biology, Third Military Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiao","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Pain and Rehabilitation, Xinqiao Hospital, Army Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingze","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Cell Biology, Third Military Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen","family":"Zeng","sequence":"additional","affiliation":[{"name":"Department of Cell Biology, Third Military Medical University","place":["Chongqing, China"]},{"name":"Jinfeng Laboratory","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Su","sequence":"additional","affiliation":[{"name":"Jinfeng Laboratory","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,22]]},"reference":[{"key":"B1","article-title":"Insights into exo transport through the blood-brain barrier and the potential therapeutical applications in brain diseases","volume":"16","author":"Abdelsalam","year":"2023","journal-title":"Pharm. 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