Abstract
<jats:p>This literature review systematically synthesizes current data on the regulatory role of non-coding RNAs (ncRNAs) and exosomes in the pathogenesis of inflammatory bowel disease (IBD). The review was prepared by searching PubMed, OVID MEDLINE, Google Scholar, and ScienceDirect databases for the period 2018–2025 using relevant keywords. Inclusion criteria were original studies investigating the molecular mechanisms of IBD, focusing on the role of ncRNAs and exosomes in IBD diagnosis and therapy. Various classes of ncRNAs were found to be key regulators of immune response, inflammation, and intestinal barrier integrity. Pro-inflammatory miRNAs (e.g., miR-21, miR-155) promote chronic inflammation by activating the NF-κB pathway, while reduced anti-inflammatory mirnas (e.g., miR-146a) can lead to immune system component dysfunction. Exosomes, in turn, mediate intercellular communication with ambivalent effects: they can exacerbate inflammation by transferring pro-inflammatory factors or exert significant therapeutic effects by delivering anti-inflammatory agents. Exosomes from mesenchymal stem cells showed the highest efficacy due to their ability to polarize macrophages towards an anti-inflammatory M2 phenotype, restore barrier function, and modulate cytokines. The findings open new perspectives for developing non-invasive diagnostic biomarkers based on ncRNAs and innovative therapeutic strategies, such as inhibiting pathogenic ncRNAs with antisense oligonucleotides and using anti-inflammatory exosomes for targeted therapy. However, standardization of isolation methods, biomarker validation, and addressing safety concerns for their application and production are necessary for clinical implementation.</jats:p>