巨噬细胞是高度异质且可塑的免疫细胞，在抗击致病微生物和肿瘤细胞中发挥着重要作用。在不同的刺激下，巨噬细胞可以极化为M1表型，表现出促炎症的效应以及M2表型，表现出抗炎症的效应。巨噬细胞的极化平衡与疾病进展密切相关，通过靶向巨噬细胞极化来重新编程巨噬细胞的治疗方法是可行的。组织细胞中存在大量的外泌体，它们可以在细胞之间传递信息。特别是外泌体中的微小RNA（miRNA），可以调节巨噬细胞的极化，进而影响多种疾病的进展。同时，外泌体也是有效的“药物”载体，为外泌体的临床应用奠定了基础。本综述介绍了M1/M2巨噬细胞极化中涉及的一些途径，以及来自不同来源的携带miRNA的外泌体对巨噬细胞极化的影响。最后，还讨论了外泌体/外泌体miRNA在临床治疗中的应用前景和挑战。版权所有©2023 Elsevier B.V.。

Macrophages are highly heterogeneous and plastic immune cells that play an important role in the fight against pathogenic microorganisms and tumor cells. After different stimuli, macrophages can polarize to the M1 phenotype to show a pro-inflammatory effect and the M2 phenotype to show an anti-inflammatory effect. The balance of macrophage polarization is highly correlated with disease progression, and therapeutic approaches to reprogram macrophages by targeting macrophage polarization are feasible. There are a large number of exosomes in tissue cells, which can transmit information between cells. In particular, microRNAs (miRNAs) in the exosomes can regulate the polarization of macrophages and further affect the progression of various diseases. At the same time, exosomes are also effective "drug" carriers, laying the foundation for the clinical application of exosomes. This review describes some pathways involved in M1/M2 macrophage polarization and the effects of miRNA carried by exosomes from different sources on the polarization of macrophages. Finally, the application prospects and challenges of exosomes/exosomal miRNAs in clinical treatment are also discussed.Copyright © 2023 Elsevier B.V. All rights reserved.