Extracellular vesicles as biomarkers prognosis, diagnosis, and treatment in chagas disease.

Extracellular vesicles (EVs) play a central role in the host-parasite interplay during Trypanosoma cruzi infection and the progression of Chagas disease. Released by both parasite and host cells, EVs modulate immune responses, promote parasite persistence, and sustain inflammation through their diverse cargo, including proteins, lipids, and RNAs. Parasite-derived components such as MASP, trans-sialidases, and TESA, as well as small non-coding RNAs, have been identified within EVs and are increasingly explored as diagnostic and prognostic biomarkers. Their stability in biological fluids and parasite-specific content offer advantages over conventional serology, particularly for chronic disease stages. Experimental models further demonstrate that EVs influence cytokine profiles, enhance parasitemia, and affect complement resistance, highlighting their dual role in immune modulation and disease outcome. Beyond pathogenesis, EVs hold promise as antigen sources for serological assays, as non-invasive biomarkers for disease monitoring, and as innovative platforms for vaccine and therapeutic development. Together, these findings underscore the translational potential of EVs in advancing diagnosis, prognosis, and treatment strategies for Chagas disease.