Exosomes, the cell-derived small extracellular vehicles, play a vital role in intracellular communication by reciprocally transporting DNA, RNA, bioactive protein, chains of glucose, and metabolites. With great potential to be developed as targeted drug carriers, cancer vaccines and noninvasive biomarkers for diagnosis, treatment response evaluation, prognosis prediction, exosomes show extensive advantages of relatively high drug loading capacity, adjustable therapeutic agents release, enhanced permeation and retention effect, striking biodegradability, excellent biocompatibility, low toxicity, etc. With the rapid progression of basic exosome research, exosome-based therapeutics are gaining increasing attention in recent years. Glioma, the standard primary central nervous system (CNS) tumor, is still up against significant challenges as current traditional therapies of surgery resection combined with radiotherapy and chemotherapy and numerous efforts into new drugs showed little clinical curative effect. The emerging immunotherapy strategy presents convincing results in many tumors and is driving researchers to exert its potential in glioma. As the crucial component of the glioma microenvironment, tumor-associated macrophages (TAMs) significantly contribute to the immunosuppressive microenvironment and strongly influence glioma progression via various signaling molecules, simultaneously providing new insight into therapeutic strategies. Exosomes would substantially assist the TAMs-centered treatment as drug delivery vehicles and liquid biopsy biomarkers. Here we review the current potential exosome-mediated immunotherapeutics targeting TAMs in glioma and conclude the recent investigation on the fundamental mechanisms of diversiform molecular signaling events by TAMs that promote glioma progression.

外泌体是细胞衍生的小型细胞外载体，通过相互运输 DNA、RNA、生物活性蛋白、葡萄糖链和代谢物，在细胞内通讯中起着至关重要的作用。外泌体具有作为靶向药物载体、癌症疫苗和用于诊断、治疗反应评估、预后预测的非侵入性生物标志物开发的巨大潜力，具有较高的载药量、可调节治疗药物释放、增强的渗透和保留效果、显着的生物降解性等广泛优势、优良的生物相容性、低毒性等。随着外泌体基础研究的快速进展，基于外泌体的治疗方法近年来受到越来越多的关注。神经胶质瘤，标准的原发性中枢神经系统 (CNS) 肿瘤，目前手术切除联合放化疗等传统疗法和大量新药研发的临床疗效甚微，仍面临重大挑战。新兴的免疫治疗策略在许多肿瘤中取得了令人信服的结果，并促使研究人员在神经胶质瘤中发挥其潜力。作为神经胶质瘤微环境的重要组成部分，肿瘤相关巨噬细胞 (TAM) 显着促进免疫抑制微环境并强烈影响神经胶质瘤的进展通过各种信号分子，同时提供对治疗策略的新见解。外泌体作为药物输送载体和液体活检生物标志物将极大地协助以 TAM 为中心的治疗。在这里，我们回顾了目前潜在的靶向神经胶质瘤中 TAM 的外泌体介导的免疫疗法，并总结了最近对 TAM 促进神经胶质瘤进展的多种分子信号事件的基本机制的研究。