Abstract
Exosomes are extracellular vesicles, enriched in biomolecular cargo consisting of nucleic acids, proteins, and lipids, which take part in intercellular communication and play a crucial role in both physiologic functions and oncogenesis. Bladder cancer is the most common urinary malignancy and its incidence is steadily rising in developed countries. Despite the high five-year survival in patients diagnosed at early disease stage, survival substantially drops in patients with muscle-invasive or metastatic disease. Therefore, early detection of primary disease as well as recurrence is of paramount importance. The role that exosomal biomarkers could play in bladder cancer patient diagnosis and surveillance, as well as their potential therapeutic applications, has not been extensively studied in this malignancy. In the present review, we summarize all relevant data obtained so far from cell lines, animal models, and patient biofluids and tissues. Current literature suggests that urine is a rich source of extracellular vesicle-derived biomarkers, compared with blood and bladder tissue samples, with potential applications in bladder cancer management. Further studies improving sample collection procedures and optimizing purification and analytical methods should augment bladder cancer diagnostic, prognostic, and therapeutic input of extracellular vesicles biomarkers in the future.
Highlights
Bladder Cancer (BC) is the ninth most common malignancy worldwide and the most common genitourinary malignancy in both men and women, with incidence being over four times higher in men
extracellular vesicles (EVs) derived biomarkers have attracted the interest of the scientific community as a potential candidate for primary disease diagnosis as well as early detection of recurrence, a prevalent phenomenon among BC patients
Existing literature suggests that EVs biomarkers display a higher sensitivity in detecting BC compared to the conventional screening methods, namely, cytology and urine occult blood test, but are not sensitive enough to eliminate the need for cystoscopy with tissue sampling, which remains the cornerstone of BC diagnosis
Summary
Bladder Cancer (BC) is the ninth most common malignancy worldwide and the most common genitourinary malignancy in both men and women, with incidence being over four times higher in men. The abovementioned shortcomings of the current diagnostic modalities underscore the importance of extensive research in order to identify additional sensitive and specific biomarkers, that could be of great value in the early detection of BC as well as in surveillance of patients already diagnosed with the disease The latter is of paramount importance as BC is associated with high recurrence rates and an estimated 10% of patients with Ta and T1 disease eventually progress to muscle invasive disease, while the risk has been reported to be almost five times higher for patient with in situ carcinoma [12]. We aim to present the current knowledge base on the potential applications of EVs biomarkers in clinical diagnostics and surveillance of patients with BC, as well as their prospective therapeutic implementations
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