Exosomes in Inflammatory Bowel Disease: Mechanisms, Diagnostic Potential, and Engineering Strategies for Precision Therapy.

Inflammatory bowel disease (IBD) is a chronic gastrointestinal disorder characterized by immune dysregulation, epithelial barrier dysfunction, and microbial imbalance. Despite progress in biologic therapies, challenges such as variable efficacy, systemic side effects, and the lack of reliable biomarkers remain significant obstacles in clinical management. Exosomes, key mediators of intercellular communication, play a pivotal role in IBD's pathogenesis by transporting bioactive substances. Increasing evidence links exosomes to critical IBD processes, including Th17/Treg imbalance, inflammasome activation, and host-microbiome interactions. Exosomes also show potential as minimally invasive biomarkers for disease activity and subtype differentiation. Furthermore, advancements in exosome engineering, including surface modification and hybrid nanostructure development, enhance their potential for targeted drug delivery and immune modulation in IBD. This review summarizes the role of exosomes in IBD, their diagnostic potential, and emerging exosome-based therapeutic strategies.