Our results suggested that these exosomal biomarkers had excellent diagnostic capacity in several types of cancer, with good sensitivity and specificity. For the evaluation of prognostic markers, 50 biomarkers and 4797 patients from 42 studies were included.
Exosomes
belong to a subpopulation of extracellular vesicles secreted by the dynamic process of multi-step endocytosis and carry diverse functional molecular loads, such as proteins, lipids, nucleic acids (DNA, messenger and non-coding RNA) and metabolites, to promote intercellular communication. Proteins and non-coding RNA are among the most abundant contents of exosomes; they have biological functions and are selectively packaged in exosomes. Exosomes derived from tumor, stromal, and immune cells contribute to multiple stages of cancer progression, as well as resistance to therapy.In this review, we will analyze the biogenesis of exosomes and their role in cancer development. Since the specific contents of exosomes originate in their cells of origin, this property allows exosomes to function as valuable biomarkers. We will also analyze the potential use of exosomes as biomarkers or predictors of diagnosis and prognosis. for different therapeutic strategies for various types of cancer.
In addition, the applications of exosomes as direct therapeutic targets or vehicles designed for drugs are an important field of studying exosomes. A better understanding of exosome biology can lay the groundwork for promising clinical applications based on exosomes. In summary, exosomes derived from tumor, stromal, and immune cells contribute to multiple stages of cancer progression, as well as resistance to treatment. Since the specific contents of exosomes come from their cells of origin, this property allows exosomes to function as valuable diagnostic and prognostic biomarkers. In addition, applications of exosomes as direct therapeutic targets or vehicles designed for drugs may open up new avenues for therapy.
A better understanding of exosome biology will undoubtedly help pave the way for exosome-based clinical applications. The lipid molecules of exosomes are primarily used to maintain their external morphology. It has been reported that lipid molecules in electric vehicles can not only protect nucleic acids and protein content from harmful stimuli from the extracellular environment, but they also exert bioactive functions to participate in tumor biological processes as signaling molecules (217, 21). It has been demonstrated that lipid molecules from exosomes can also be used as potential biomarkers in cancer patients (136, 219-22), including the expression levels of phosphatidylcholine (PC), hatidylethanolamine (PE), phosphatidylinositol (PI), sphingomyelin (SM), ceramide (Cer) and cholesterol are several different diseases (150, 223-22).
It is important to highlight that amiloride inhibits the formation of ceramides by indirectly inhibiting sphingomide acid myelinase (ASMase), which in turn inhibits the release of exosomes (170) .Together, these findings show that the exosome load in liquid, serum, or plasma biopsies from British Columbia is effectively used as biomarkers for cancer detection, staging, and prognosis. The exosomal lncRNA RP5-977B1 is a new, minimally invasive biomarker for the diagnosis and prognosis of non-small cell lung cancer. There are also other challenges, such as difficulties in developing exosomes from patients, the heterogeneity of malignancies, the complexity of EMT, and the contradictory effects of exosomes. All of these techniques would promote the development and reproducibility of cancer diagnoses and treatments related to exosomes.
Clinical trials on exosome-based biomarkers aim to evaluate their efficacy in the early detection of cancer, monitor disease progression, predict treatment response and prognosis, and identify therapeutic objectives. Long exosomal non-coding RNA (HOTTIP) is a possible new test for diagnostic and prognostic biomarkers for gastric cancer. When analyzing exosomal miRNA 21, the AUC was 0.927, but the study did not eliminate microvesicles from the samples. In addition, the regulation of exosome biogenesis processes involves the coordination of many different signaling mechanisms and molecular loads, mainly dominated by mechanisms dependent on ESCRT, lipid raft and tetraspanine proteins, and Rab proteins further aid in cargo classification and to the release of exosomes.
Improved detection of the EGFR mutation by combining exosomal RNA and circulating tumor DNA in the plasma of patients with NSCLC. Exosomes can cross the blood-brain barrier (BBB) under specific conditions, opening up the possibility of therapies that include small molecules, RNA therapy, proteins and gene editing using CRISPR. Recent research has demonstrated that exosome-based diagnostics can be successfully developed using fast, high-performance technology without the need to purify exosomes. In addition to PPIs, extracorporeal hemofiltration could also be used to remove circulating exosomes derived from tumors.
While they face challenges similar to those of natural exosomes, the development of artificial exosomes will have commercial advantages, such as higher performance, easier quality control, greater reproducibility, and productivity on a larger scale. New biomarkers are needed to prevent unnecessary invasive procedures, such as prostate biopsies, and to support an optimized and accurate treatment plan.
