Extracellular Vesicles in Liver Fibrosis: Pathogenic Messengers, Diagnostic Biomarkers, and Therapeutic Nanovectors

Liver fibrosis (LF) is the final common pathological outcome of various chronic liver diseases. Advanced LF can progress to severe complications, such as cirrhosis, liver failure, and hepatocellular carcinoma (HCC). Currently, liver transplantation remains the main clinical treatment for advanced LF, but its application is limited by donor availability and unavoidable complications. Extracellular vesicles (EVs), nanoscale particles actively released by hepatic cells, including hepatocytes, hepatic stellate cells (HSCs), and macrophages), circulate in bodily fluids carrying cell-specific cargoes (e.g., RNAs, proteins). EVs mediate intercellular communication via their specific cargo profiles and contribute to the progression in LF. Increasing evidence indicates that tracking changes in the quantity and composition of EVs in LF can aid in disease diagnosis and prognosis prediction. This review discusses the pathological role of EVs in LF development and their potential as biomarkers and therapeutic targets, and provides new perspectives for future research and treatment advances.