Extracellular vesicles cargo orchestration in colorectal cancer: immune evasion, stromal remodeling, and therapeutic frontiers

Extracellular vesicles (EVs), as pivotal "messengers" in intercellular communication within the tumor microenvironment (TME), play multifaceted regulatory roles in the initiation, progression, and therapeutic response of colorectal cancer (CRC). This review focuses on the roles of EVs in CRC progression, including the creation of an immunosuppressive microenvironment and the modulation of other cells within the TME. Additionally, the article briefly discusses the potential biomarker value of EVs for early diagnosis and metastasis prediction. Furthermore, several therapeutic strategies employing EVs for CRC treatment are introduced, such as adjuvant immunotherapy, the use of stem cell-derived EVs, and engineered EVs. In this context, we emphasize the limitations and challenges of EV-based research and explore the future prospects of this field, aiming towards the realization of its practical application in the precise diagnosis and treatment of CRC.