Abstract
The importance of molecular re-characterization of metastatic disease with the purpose of monitoring tumor evolution has been acknowledged in numerous clinical guidelines for the management of advanced malignancies. In this context, an attractive alternative to overcome the limitations of repeated tissue sampling is represented by the analysis of peripheral blood samples as a ‘liquid biopsy’. In recent years, liquid biopsies have been studied for the early diagnosis of cancer, the monitoring of tumor burden, tumor heterogeneity and the emergence of molecular resistance, along with the detection of minimal residual disease. Interestingly, liquid biopsy consents the analysis of circulating tumor cells, circulating tumor DNA and extracellular vesicles (EVs). In particular, EVs play a crucial role in cell communication, carrying transmembrane and nonmembrane proteins, as well as metabolites, lipids and nucleic acids. Of all EVs, exosomes mirror the biological fingerprints of the parental cells from which they originate, and therefore, are considered one of the most promising predictors of early cancer diagnosis and treatment response. The present review discusses current knowledge on the possible applications of exosomes in breast cancer (BC) diagnosis, with a focus on patients at higher risk.
Highlights
Liquid Biopsy and Extracellular VesiclesCancer is a dynamic and heterogeneous entity following the principles of clonal evolution
Wang and colleagues [51] recently showed that the level of exosomal tetraspanin CD82 was significantly higher in the serum of BC patients compared to healthy controls, while the expression of CD82 significantly increased with malignant breast cancer progression
Moon and colleagues [54,55] found that both plasma levels of developmental endothelial locus-1 protein (Del-1) and fibronectin expressed by circulating exosomes were significantly higher in patients with BC than in controls
Summary
Cancer is a dynamic and heterogeneous entity following the principles of clonal evolution. Liquid biopsy mainly targets materials pulling away from tumor edges and swept away by the bloodstream, including circulating tumor cells, circulating tumor DNA and extracellular vesicles (EVs) [11]. It is well-known that nucleic acids are present in biological fluids in healthy subjects in stable low concentrations and are immunologically inactive; they change dramatically in cancer and autoimmune disorders [12]. Bilayer-enclosed by the presence of transmembrane tetraspanin protein and a content of RNA, DNA, miRNA as well as proteins
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