Exosomes in organ transplantation: roles in immunomodulation, ferroptosis and mitophagy

Exosomes are extracellular vesicles (EVs) with a lipid bilayer structure, ranging from 30 to 150 nm in diameter, that are secreted by cells. As key carriers of biological information, they play pivotal roles in diverse physiological and pathological processes, such as immune response, apoptosis, angiogenesis, and inflammation. Advancing research has revealed that exosomes transport immunomodulatory cargo relevant to transplantation, demonstrating their capacity to directly modulate immune rejection and tolerance, beyond merely serving as biomarkers for assessing graft function and acceptance. Consequently, exosomes present significant therapeutic potential in transplant immunology. Furthermore, ferroptosis and mitophagy, two burgeoning fields of research, are increasingly recognized to interact closely with exosomes and participate in coordinated pathophysiological processes. This review aims to summarize the characteristics of exosomes and elaborate on their roles, alongside ferroptosis and mitophagy, in organ transplantation, with a focus on their collective therapeutic implications.