Abstract
Intercellular metabolic communication is essential for maintaining homeostasis and normal physiological function. Extracellular vesicles (EVs), as key mediators of cell-to-cell communication, are increasingly recognized for their close association with metabolic regulation. EVs encapsulate and transport bioactive molecules-including metabolites, enzymes, nucleic acids, and proteins-that directly influence intracellular pathways such as energy supply, RNA and protein synthesis, and organelle function. Conversely, cellular metabolic states profoundly shape EV biogenesis, cargo composition, and targeting. These bidirectional interactions position EVs as coordinators of metabolism, with dysregulation contributing to diverse diseases. In this review, we focus on the regulatory roles of EVs in metabolic processes, their pathogenic and therapeutic implications across different diseases, and their applications in metabolomics and tissue engineering. By emphasizing the metabolic perspective, this work highlights the novelty of understanding EVs as both regulators and targets of metabolism, providing a holistic view of their mechanisms and offering new insights into the development of targeted therapies.