Extracellular vesicle-mediated immune remodeling in cutaneous wound repair.

Extracellular vesicles (EVs) are emerging cell-free therapeutic platforms for cutaneous wound repair that regulate diverse cellular processes, including intercellular communication, inflammation, angiogenesis, extracellular matrix remodeling, and tissue repair. Recent advances in parental cell preconditioning, EV engineering, smart EV design, and biomaterial-assisted delivery have further enhanced the therapeutic potential of EV-based approaches. These advances have stimulated growing interest in applying EVs to skin wound repair, where EVs act on resident skin cells and immune cells to promote regenerative healing. In particular, macrophage reprogramming is well characterized, whereas EV-mediated regulation of other immune-cell populations remains less clearly defined. Standardized EV production, reliable potency assays, and dynamic in vivo approaches will be essential for defining how EVs coordinate regenerative and immune-regulatory processes. This review discusses EV-mediated cutaneous wound repair with emphasis on temporal and cell-specific immune remodeling, regenerative mechanisms, and translational challenges.