Exosomes in liquid biopsy and oncology: Nanotechnological interplay and the quest to overcome cancer drug resistance

Abstract

Exosomes, small extracellular vesicles of endocytic origin, have emerged as pivotal mediators in intercellular communication, driving transformative advancements across diverse fields of biology and medicine. This comprehensive review delves into the multifaceted roles of exosomes in health and disease, elucidating their biogenesis, cargo composition, and far-reaching implications. Exosomes, secreted by virtually all cell types, encapsulate a cargo comprising proteins, lipids, and nucleic acids, reflecting their cellular origin. Their molecular cargo modulates cellular processes, facilitating complex signalling cascades and contributing to the pathogenesis of various diseases, including cancer, neurodegenerative disorders, and infectious diseases. In cancer, exosomes serve as messengers of tumorigenesis and metastasis, orchestrating critical events within the tumor microenvironment. Furthermore, exosomes participate in drug resistance mechanisms, presenting significant challenges in cancer therapy. The diagnostic potential of exosomes, particularly in the context of liquid biopsy, is underscored by their presence in various biofluids. This offers non-invasive disease monitoring and biomarker discovery, revolutionizing early detection and monitoring strategies. Additionally, exosomes have gained recognition as therapeutic vehicles, holding promise for targeted drug delivery, immunomodulation, and regenerative medicine. This review comprehensively explores the ever-expanding landscape of exosome biology, emphasizing their roles in health and disease. It underscores the transformative potential of exosomes in liquid biopsy-based diagnostics and therapeutics while acknowledging the complexities and challenges that lie ahead in harnessing their full clinical utility.

Keywords: Cancer drug resistance; Exosomes; Liquid biopsy; Nanotechnology; Precision medicine.

Fig. 1

The role and mechanism of EVs in cancer drug resistance. a) EVs transfer specific cargos that regulate signalling pathways associated with autophagy, metabolism, EMT, and CSCs, thus playing important roles in the development of cancer drug resistance. b) EVs contain drug efflux transporters that directly mediate the active extrusion of drugs, leading to the development of drug resistance. c) EVs transport biological active substances to mediate multiple layers of interactions between cancer cells and TME cells, leading to the acquisition of drug resistance. (Reproduced with permission under Creative Commons CC BY 4.0 license from Ref , Copyright 2022 The Authors).