The prevalence of central nervous system (CNS) diseases is on the rise as the population ages. The presence of various obstacles, particularly the blood-brain barrier (BBB), poses a challenge for drug delivery to the CNS. An expanding body of study suggests that gut microbiota (GM) plays an important role in CNS diseases. The communication between GM and CNS diseases has received increasing attention. Accumulating evidence indicates that the GM can modulate host signaling pathways to regulate distant organ functions by delivering bioactive substances to host cells via bacterial extracellular vesicles (BEVs). BEVs have emerged as a promising platform for the treatment of CNS diseases due to their nanostructure, ability to penetrate the BBB, as well as their low toxicity, high biocompatibility, ease of modification and large-scale culture. Here, we discuss the biogenesis, internalization mechanism and engineering modification methods of BEVs. We then focus on the use and potential role of BEVs in the treatment of CNS diseases. Finally, we outline the main challenges and future prospects for the application of BEVs in CNS diseases. We hope that the comprehensive understanding of the BEVs-based gut-brain axis will provide new insights into the treatment of CNS diseases.

随着人口老龄化，中枢神经系统（CNS）疾病的患病率不断上升。各种障碍的存在，特别是血脑屏障（BBB），对中枢神经系统的药物输送提出了挑战。越来越多的研究表明肠道微生物群 (GM) 在中枢神经系统疾病中发挥着重要作用。转基因与中枢神经系统疾病之间的交流受到越来越多的关注。越来越多的证据表明，GM 可以通过细菌细胞外囊泡（BEV）向宿主细胞递送生物活性物质，从而调节宿主信号通路，从而调节远端器官功能。 BEVs因其纳米结构、穿透血脑屏障的能力以及低毒性、高生物相容性、易于修饰和大规模培养而成为治疗中枢神经系统疾病的有前景的平台。在这里，我们讨论BEV的生物发生、内化机制和工程改造方法。然后我们重点关注 BEV 在治疗中枢神经系统疾病中的用途和潜在作用。最后，我们概述了 BEV 在中枢神经系统疾病中应用的主要挑战和未来前景。我们希望对基于 BEV 的肠脑轴的全面了解将为中枢神经系统疾病的治疗提供新的见解。