Exosomes in Glioma: Integrating Molecular Mechanisms with Diagnostic and Therapeutic Potential

Glioma, a lethal intracranial malignancy with limited therapeutic options, represents one of oncology's most persistent challenges. Entering a new era of molecular oncology, exosomes-nanoscale extracellular vesicles-have emerged as master regulators of intercellular communication, dynamically sculpting the glioma tumor microenvironment (TME) and orchestrating hallmarks of malignancy, including immune evasion, angiogenesis, and therapeutic resistance. These versatile vesicles transport bioactive cargo (e.g., miRNAs, lncRNAs, proteins) to reprogram stromal, neuronal, and immune cells, creating a permissive niche for tumor progression. Recent breakthroughs now position exosomes at the forefront of translational medicine, serving dual roles as minimally invasive biomarkers and engineered nanovectors for precision therapy. This review systematically deciphers how exosomes fuel glioma pathogenesis-from driving macrophage polarization and T-cell suppression to facilitating blood-brain barrier disruption and chemoresistance. Beyond mechanistic insights, we spotlight pioneering strategies harnessing exosomes for drug delivery, immunotherapy, and nanotechnology-driven interventions. By bridging foundational discoveries with clinical applications, this work heralds a new era in glioma management, where exosome-based tools promise to revolutionize personalized diagnosis, prognostication, and therapeutic innovation.