Small extracellular vesicles as liquid biopsy targets and precision therapeutics for metabolic dysfunction-associated steatotic liver disease

Figure 3 Conceptual schematic of therapeutic roles and engineering strategies of small extracellular vesicles relevant to metabolic dysfunction-associated steatotic liver disease. The upper panels summarize metabolic dysfunction-associated steatotic liver disease (MASLD)-related evidence for native therapeutic small extracellular vesicles and pathogenic small extracellular vesicle-associated targets. The lower panels summarize general or transferable extracellular vesicle-engineering approaches, including cargo loading and surface engineering. Electroporation, sonication, freeze-thaw cycling, passive incubation, and extrusion represent general cargo-loading methods and should not be interpreted as established MASLD-specific therapeutic strategies unless validated directly in nonalcoholic fatty liver disease/MASLD/metabolic dysfunction-associated steatohepatitis models. Evidence categories and disease-model relevance for representative therapeutic studies are detailed in Table 2. sEV: Small extracellular vesicle; MASLD: Metabolic dysfunction-associated steatotic liver disease.