In regenerative medicine, exosomes facilitate tissue repair and regeneration. In cancer therapy, exosomes can deliver therapeutic agents directly to tumor cells. In gene therapy, exosomes serve as vectors for gene delivery. As diagnostic biomarkers, they are useful for diagnose various diseases.
The main clinical application of exosomes is to use them as biomarkers, cell-free therapeutic agents, carriers for drug delivery, basic analyses of exosome kinetics and vaccines against cancer. In several clinical trials, different exosomes of human or plant origin are used. Most researchers used exosomes from the circulatory system for biomarker experiments. Mesenchymal stem cells (MSCs) and dendritic cells (DCs) are two widely used cell sources in exosomes. MSC-derived exosomes are commonly used for the treatment of inflammation and drug delivery, while DCS exosomes are used to induce an inflammatory response in cancer patients.
However, the clinical application of exosomes poses several questions and challenges. In addition, exosome-based clinical trials need to be translated to conform to specific Good Manufacturing Practices (GMP). In this review, we summarize the exosomes used in clinical trials according to the type of application and the disease. We also address major questions and challenges related to exosome kinetics and clinical applications.
In recent years, immunotherapy has been increasingly used in clinical practice to treat tumors. However, the efficacy of immunotherapy varies depending on the type of tumor and the patient population, and long-term drug resistance usually occurs during treatment. Therefore, it is essential to explore the molecular mechanisms of immunotherapy to improve its efficacy. In this review, we focus on the importance of tumor-derived exosomes in the clinical treatment of tumors and how modifying these exosomes can improve immunological efficacy.
Specifically, we analyze the components of exosomes, such as RNA, lipids and proteins, and the role of membrane molecules on exosome surfaces. In addition, we highlight the importance of exosomes designed for tumor immunotherapy. Our goal is to propose new strategies to improve the efficacy of tumor immunotherapy. Cancer remains a global threat despite powerful anticancer drugs, which are often accompanied by unwanted side effects.
Sophisticated multifunctional approaches are essential to improve patient outcomes. Small extracellular vesicles (EVs), a diverse family of natural cell-derived vesicles, offer advantages over synthetic transporters. Among electric vehicles, exosomes facilitate intercellular communication with minimal toxicity, high biocompatibility and low immunogenicity. Its ability to target specific tissues, mediated by surface molecules, allows the precise transport of biomolecules to cancer cells.
Here, we explore the potential of exosomes as innovative therapeutic agents, including cancer vaccines, and their clinical relevance as biomarkers for clinical diagnosis. We highlight cargo possibilities, including nucleic acids and drugs, which make them a good transport system for selective cancer treatment and as contrast agents for disease monitoring. Other general aspects, sources and methodology associated with therapeutic applications against cancer are also reviewed. In addition, the challenges associated with translating exosome-based therapies into clinical practice are discussed, along with the future prospects of this innovative approach. The clinical trials conducted to date are important to demonstrate the feasibility and short-term safety of autologous exosome administration, but there is no doubt that the safety issues of treatments based on exogenous exosome products will be more severe.
Optimization of size-exclusion chromatography for extracellular vesicle enrichment and proteomic analysis from clinically relevant samples. This review summarized current knowledge about the composition, biogenesis, and implications of exosomes, as well as the methods for their isolation and application. The vast majority of clinical trials focus on cancer (8), followed by CVS (2), diabetes (and neurodegenerative diseases). In short, the transition from preclinical studies to clinical trials of exosome therapy has been rapid.
While there are several treatments that are actively undergoing clinical trials, none of them are close to being curative for Alzheimer's disease. One of the main obstacles preventing exosome-based therapies from entering clinical practice is the poor performance and efficiency of exosomes. Some preclinical studies in mice have shown that milk-derived electric vehicles, which are rich in functional miRNA-148a, show potential anticancer effects in the treatment of colorectal cancer. The clinical applications of exosomes include their use as biomarkers for the prognosis and diagnosis of diseases, as carriers for drug delivery, as cell-free therapy and as a vaccine against cancer.
The acidic microenvironment plays a key role in the progression of human melanoma through a sustained transfer of clinically relevant metastatic molecules, mediated by exosomes. Several in vivo studies and clinical trials have explored the use of exosomes as therapy for atherosclerosis. An exhaustive study of vesicular and non-vesicular miRNAs from a volume of cerebrospinal fluid compatible with clinical practice. Finally, focusing on the therapeutic indications of exosome therapy, future preclinical studies and clinical trials should include more diseases than those analyzed in this review.
These include, but are not limited to, exosome treatment for fracture (333), traumatic spinal cord injury (335), traumatic brain injury (335), acute liver injury (336) and hearing loss (304, 306), which could serve as future guidance for therapy-related clinical trials with exosomes.
