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Natural killer cell-derived extracellular vesicles (NKEVs) are nanosized, cell-free particles secreted by natural killer (NK) cells that function as mediators of intercellular communication and immune effector activity. These vesicles carry a cargo of cytotoxic proteins, including perforin and granzymes, as well as various nucleic acids and membrane markers (e.g., CD56) that allow them to target and induce apoptosis in malignant cells. NKEVs are being explored as an off-the-shelf immunotherapy for hematological malignancies, such as leukemia and lymphoma, and for inflammatory conditions like acute-on-chronic liver failure (ACLF), where they have been shown to alleviate CD8+ T cell exhaustion via the TGF-beta/Smad pathway. Compared to whole-cell therapies like CAR-NK, NKEVs offer potential advantages in terms of stability, lower immunogenicity, and reduced risk of cytokine release syndrome.
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