The regulatory landscape for extracellular vesicle therapies: Australian context and future directions.

Extracellular vesicles (EVs) are emerging as promising tools for regenerative medicine and drug delivery, offering unique therapeutic advantages. However, their clinical translation - in Australia and globally - faces persistent challenges. These are commonly framed as technical issues stemming from inherent EV variability and the absence of standardized potency assays. While no EV-based therapeutic has yet received full market approval from any major regulatory agency, this Perspective argues that the barriers to translation are not solely technical but reflect limitations within current regulatory frameworks. In Australia, the Therapeutic Goods Administration (TGA) requires biological products to be included on the Australian Register of Therapeutic Goods (ARTG) before supply to market. However, several alternative regulatory pathways exist that can facilitate clinical access to "unapproved" products. Through analysis of these pathways, and comparison with international approaches, this Perspective highlights how regulatory inflexibility may be as significant a barrier to translating EV medicines as the technical difficulties themselves. Drawing on insights from governmental inquiries into the approval and subsidization of emerging medicines, the Perspective calls for reform of Australia's regulatory systems - including development of EV-specific guidance and policy that introduces adaptive assessment pathways - to better support the safe and timely integration of novel biotechnologies.