Abstract
Liquid biopsy, characterized by minimally invasive detection through biofluids such as blood, saliva, and urine, has emerged as a revolutionary strategy for cancer diagnosis and prognosis prediction. Exosomes are a subset of extracellular vesicles (EVs) that shuttle molecular cargoes from donor cells to recipient cells and play a crucial role in mediating intercellular communication. Increasing studies suggest that exosomes have a great promise to serve as novel biomarkers in liquid biopsy, since large quantities of exosomes are enriched in body fluids and are involved in numerous physiological and pathological processes. However, the further clinical application of exosomes has been greatly restrained by the lack of high-quality separation and component analysis methods. This review aims to provide a comprehensive overview on the conventional and novel technologies for exosome isolation, characterization and content detection. Additionally, the roles of exosomes serving as potential biomarkers in liquid biopsy for the diagnosis, treatment monitoring, and prognosis prediction of cancer are summarized. Finally, the prospects and challenges of applying exosome-based liquid biopsy to precision medicine are evaluated.
Highlights
Cancer is a leading cause of death around the world [1]
At present, the limitation of tissue biopsy has been gradually recognized in the field of precision medicine
Exosomes have been confirmed to stably circulate in body fluids and contain diverse information that reflects the status of tumor progression [28, 33]
Summary
Cancer is a leading cause of death around the world [1]. Mounting evidence suggests that the development of cancer is a dynamic process and diverse components are involved, including tumor cells, stromal cells, and immune cells. The extracted small tissues fail to represent tumor heterogeneity or monitor dynamic tumor progression, and the potential of metastasis may be increased by this invasive method, leading to poor survival and prognosis [3]. Yu et al Molecular Cancer (2022) 21:56 biopsy (Fig. 1), highlighting the potential of exosomes as biomarkers for cancer diagnosis, progression monitoring, and prognosis prediction. Circulating tumor cells (CTCs), circulating tumor DNA (ctDNA) and exosomes have become the three main branches of liquid biopsy [15, 16]. Exosome is more representative than ctDNA, which limitedly reflects the information of apoptotic or dead tumor cells [11, 14]. One of the big challenges for the application of exosomes in liquid biopsy is isolation with high efficiency and purity, which arises from their nanoscale size and intrinsic heterogeneity [18–20]. Notable progress has been made, the limited sensitivity and specificity, low purity and throughput remain significant challenges for academic research and practical use [27]
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