Extracellular vesicle-based drug delivery in pediatric immune thrombocytopenia
- 1Department of Woman, Child and General and Specialist Surgery, University of Campania “Luigi Vanvitelli”
- 2Department of Life Sciences, Health and Health Professions, Link Campus University
Abstract
Pediatric immune thrombocytopenia (ITP) is an acquired immune-mediated disorder triggered by autoantibody production directed against glycoproteins on the platelet surface, leading to platelet destruction in the spleen and impaired megakaryopoiesis in the bone marrow. The immune response is further compromised by a dysregulated inflammatory environment involving T-cell proliferation, pro-inflammatory macrophage polarization and defective immunomodulatory function of mesenchymal stromal cells (MSCs). Although first-line therapies such as intravenous immunoglobulin G and corticosteroids remain beneficial, they are also associated with relevant toxicities and do not fully address the systemic nature of the disease in pediatric patients. Extracellular vesicles (EVs) as cellular mediators secreted by all kinds of cells are currently under investigation as promising therapeutic nanocarriers. MSC-derived extracellular vesicles (MSC-EVs) in particular, have emerged as therapeutic candidates due to their low immunogenicity, high biocompatibility, and intrinsic ability to transport cargo capable of modulating the immune response. MSC-EVs may simultaneously regulate T-cell balance, influence macrophage polarization, support megakaryopoiesis, and deliver regulatory molecules to specific targets. Bioengineering strategies involving cargo loading and surface functionalization may further improve their therapeutic potential and homing capabilities. Although key barriers to clinical translation remain, MSC-EVs represent a promising platform for a precision and cell-free approach in pediatric ITP. Although direct pediatric-specific evidence remains limited, in this review we provide a comprehensive overview of the biological properties, immunomodulatory mechanisms, and translational challenges of MSC-EVs, comparing their advantages against conventional pharmacological approaches and other available synthetic nanocarriers.
Related
- Feed-based delivery of plasmid DNA using milk-derived extracellular vesicle-polyethylenimine complexes enables hepatic transgene expression in goldfish
- Microfluidic Profiling of an Immune Cell‐Associated Extracellular Vesicle Signature for Active Tuberculosis Diagnosis and Treatment Monitoring
- Extracellular vesicle-mediated immune remodeling in cutaneous wound repair
- The Use of TF-Ag-α to Selectively Capture Tumor-Derived Extracellular Vesicles and Enhance the Predictive Performance of Extracellular Vesicle PD-L1 for Response to Immune Checkpoint Inhibitors
- Toward objective brain monitoring of cancer-related cognitive impairment: an extracellular vesicle–based conceptual framework
BibTeX
@article{domenico2026extracellular,
title = {{Extracellular vesicle-based drug delivery in pediatric immune thrombocytopenia}},
author = {Oriana Di Domenico and Maria Maddalena Marrapodi and Giuseppe Di Feo and Lucia Argenziano and Francesca Rossi and Alessandra Di Paola},
journal = {Frontiers in Immunology},
year = {2026},
month = oct,
doi = {10.3389/fimmu.2026.1951209},
url = {https://www.frontiersin.org/articles/10.3389/fimmu.2026.1951209/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Extracellular vesicle-based drug delivery in pediatric immune thrombocytopenia
AU - Oriana Di Domenico
AU - Maria Maddalena Marrapodi
AU - Giuseppe Di Feo
AU - Lucia Argenziano
AU - Francesca Rossi
AU - Alessandra Di Paola
PY - 2026
DA - 2026/10/23
JO - Frontiers in Immunology
DO - 10.3389/fimmu.2026.1951209
UR - https://www.frontiersin.org/articles/10.3389/fimmu.2026.1951209/full
AB - Pediatric immune thrombocytopenia (ITP) is an acquired immune-mediated disorder triggered by autoantibody production directed against glycoproteins on the platelet surface, leading to platelet destruction in the spleen and impaired megakaryopoiesis in the bone marrow. The immune response is further compromised by a dysregulated inflammatory environment involving T-cell proliferation, pro-inflammatory macrophage polarization and defective immunomodulatory function of mesenchymal stromal cells (MSCs). Although first-line therapies such as intravenous immunoglobulin G and corticosteroids remain beneficial, they are also associated with relevant toxicities and do not fully address the systemic nature of the disease in pediatric patients. Extracellular vesicles (EVs) as cellular mediators secreted by all kinds of cells are currently under investigation as promising therapeutic nanocarriers. MSC-derived extracellular vesicles (MSC-EVs) in particular, have emerged as therapeutic candidates due to their low immunogenicity, high biocompatibility, and intrinsic ability to transport cargo capable of modulating the immune response. MSC-EVs may simultaneously regulate T-cell balance, influence macrophage polarization, support megakaryopoiesis, and deliver regulatory molecules to specific targets. Bioengineering strategies involving cargo loading and surface functionalization may further improve their therapeutic potential and homing capabilities. Although key barriers to clinical translation remain, MSC-EVs represent a promising platform for a precision and cell-free approach in pediatric ITP. Although direct pediatric-specific evidence remains limited, in this review we provide a comprehensive overview of the biological properties, immunomodulatory mechanisms, and translational challenges of MSC-EVs, comparing their advantages against conventional pharmacological approaches and other available synthetic nanocarriers.
SN - 1664-3224
ER -