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Extracellular vesicles (EVs) form a heterogeneous group of membrane-enclosed structures secreted by all cell types. EVs export encapsulated materials composed of proteins, lipids, and nucleic acids, making them a key mediator in cell–cell communication. In the context of the neurovascular unit (NVU), a tightly interacting multicellular brain complex, EVs play a role in intercellular communication and in maintaining NVU functionality. In addition, NVU-derived EVs can also impact peripheral tissues by crossing the blood–brain barrier (BBB) to reach the blood stream. As such, EVs have been shown to be involved in the physiopathology of numerous neurological diseases.
The Neurovascular Unit (NVU) is a relatively new concept describing the relationship between brain cells with their environment and blood vessels. Knowing the NVU structure is essential to better understand brain physiopathology. The NVU is a multicellular complex composed of vascular cells such as endothelial cells, pericytes, and vascular smooth muscle cells, as well as glial cells including astrocytes, microglia and oligodendrocytes, and lastly neurons. All of these cell types are interdependent and act in concert with various physiological processes of the brain [8][9][10]. Under normal physiological conditions, NVU cells interaction results in a highly efficient barrier, whose main functions are to regulate the brain’s homeostasis, maintain its integrity, and protect it against insults (i.e., infections, trauma, and inflammation) [11]. A pivotal part of this complex cellular unit appears to be its ability to maintain brain integrity through junctional complexes, allowing them to be intimately and reciprocally linked to each other [11].
It has been reported that all cell types of the NVU release EVs [3][25]. An important characteristic of EVs is that they can cross the BBB to reach peripheral blood and later, other organs. EV transport is mostly mediated by a receptor-based mechanism and transcytosis [26][27]. By crossing this determinant barrier, EVs become an attractive tool for the diagnosis, prognosis or treatment of certain diseases. They can be a rich molecular biomarker source, a cell therapy surrogate or a drug delivery vehicle [28]. However, knowledge of the physiological role of EVs in the CNS is still limited [1][29][30].
Neuroinflammation is a biological process by which the innate immune system of the brain is activated after an inflammatory event such as an infection, toxin exposure, a neurodegenerative disease, aging or brain traumas [41][42][43][44]. This triggers an immediate and short activation of the innate immune system, mainly characterized by the release of inflammatory mediators such as cytokines and chemokines, and by increased BBB permeability [45]. However, a prolonged and amplified inflammatory response may have a detrimental impact due to excitotoxicity or oxidative stress, resulting in BBB breakdown [46]. Those processes can cause further damage to the surrounding tissue of the initial neurovascular injury, leading to secondary brain injuries [47][48][49]. Moreover, the pro-inflammatory microenvironment created by activated microglia and astrocytes and their release of cytokines and chemokines can increase tissue injury [50]. Red blood cells lysis and excess thrombin also produce cytotoxicity, enhancing brain damage and BBB disruption [47][48][49].
Thus, when neuroinflammation occurs, particular inflammatory mediators may be transported by EVs, notably by microglia that are regarded as resident immune cells of the CNS, to communicate the current inflammatory state. It has been reported that EVs from microglia had upregulated expressions of miR-146a and miR-125b, involved in the regulation of the NF-κB pathway as well as in microglial activation, revealing EVs as promising modulators by promoting neuroregeneration [51]. In parallel, the study of Kumar et al. demonstrated that after a trauma, EVs released from microglia, which were initially loaded with proinflammatory molecules, were able to activate other microglia. This contributes to the ongoing neuroinflammatory reply in the injured brain and to the activation of immune responses [52].
Although, under multiple stimuli, EVs transport immune response elements, they are also able to propagate inflammatory mediators during diseases or disorders. Indeed, TLR-4 expression in EVs was already shown to be increased, enhancing cytokines and ROS production in EVs from microglia and astrocytes. This increase resulted in a transmission of inflammation via EVs, which provides evidence in using EVs as biomarker cargos [53][54].
Moreover, it is widely recognized that coagulopathy is an important factor for secondary brain injury in trauma patients, which is related to poor outcome and may be associated with neuroinflammation and enhanced BBB permeability [55]. Indeed, there is strong evidence of a reciprocal activation between inflammation and coagulation, mainly mediated by the tissue factor pathway [56]. Regarding EVs, several studies on animals and humans have shown that platelets and cell-derived EVs could have procoagulant action [57][58][59][60], which relies on the exposure of phosphatidylserine (PS) on their surface and/or tissue factors (TF), the primary initiator of coagulation in vivo [57][61][62]. Under pathological conditions, coagulant TF-exposing microparticles can directly initiate coagulation and thrombus formation by being recruited to sites of vascular injury in vivo [62][63]. In addition, EVs, upon exposure to negatively charged phospholipids such as PS, provide a catalytic platform supporting coagulation through the facilitated formation of tenase and prothrombinase complexes [57][64].
Taken together, studies on brain-derived EVs demonstrated that they do not simply mediate the inflammatory response. Indeed, EVs associated with proinflammatory and procoagulant molecules were reported to trigger different biological processes such as the immune response or platelet activation. However, additional investigations are required to better and more completely understand the mechanisms of EVs that are involved in brain inflammatory processes.
Brain diseases can occur in multiple forms: infections (meningitis, encephalitis) [65], seizures (epilepsy) [66], trauma (concussion, traumatic brain injury (TBI)) [67], vascular conditions (stroke [68]), autoimmune conditions (vasculitis, multiple sclerosis (MS)) [69], neurodegenerative conditions (Parkinson’s disease (PD), Alzheimer’s disease (AD) [70], and tumors (glioblastoma, brain tumor) [71]. While some of these brain diseases have diagnosis predictors [71], others still face the lack of effective molecular or biological markers, for example, neurodegenerative diseases (NDs).
Given the role of neurons in trans-synaptic exchanges, it is not surprising that EVs are regarded to be a vector for the dissemination of pathological alterations in the brain. The propagation of well-described pathological proteins contained in EVs such as tau, amyloid-β (Aβ) peptide or α-synuclein has already been depicted [72]. The research conducted by Wang et al. highlighted the release and trans-synaptic transmission of Tau protein by EVs of cultured cortical neurons [73]. EVs were able to mediate the neuron-to-neuron transportation of tau protein via direct transmission, which could contribute to the spreading of tau protein involved in Alzheimer’s disease and other tauopathies [73]. The pathogenesis of Alzheimer’s disease includes another identified hallmark, the Aβ peptide [74].
Astrocyte-derived EVs have also been reported to spread or exacerbate neuropathology. A quantitative proteomics study comparing brain-derived EVs from a nontransgenic (NTg) and a transgenic amyotrophic lateral sclerosis (ALS) animal model indicated that astrocyte- and neuron-derived EVs from ALS animal models carry a misfolded and aggregated pathogenic protein, SOD1 [75]. These findings propose that EVs containing misfolded and pathogenic proteins will be transmitted into recipient cells, thus contributing to the mechanism of disease propagation [75].