Innovative applications of exosomes in precision medicine: From diagnostic biomarkers to engineered therapeutics

Exosomes, as cell-derived nanoscale vesicles, are characterized by their ability to selectively encapsulate and transfer biomolecules—including proteins, nucleic acids, and lipids—from their parental cells, thereby playing a pivotal role in intercellular communication and regulating various physiological and pathological processes. These vesicles exhibit distinct biological properties, such as excellent biocompatibility, multifaceted heterogeneity, and effective targeting. With the in-depth study of the biological properties of exosomes and their functions, strategies for their application in disease diagnosis and therapy have been expanding. This review offers a detailed overview of exosome biogenesis, isolation, and identification, elucidates the properties of exosomes and their impact on biological responses, and evaluates the current state of research on exosomes in disease diagnosis and treatment through clinical trials and published literature. We particularly highlight the application of exosomes as biomarkers for early screening and monitoring of refractory diseases, such as cancer and neurodegenerative disorders. Furthermore, we summarize the innovative applications of exosomes that are currently at the forefront of drug delivery, gene therapy, and regenerative medicine. The study also deeply analyzes the technical bottlenecks facing the clinical application of exosomes and proposes directions for future research. In conclusion, exosomes, as emerging molecules for disease diagnosis and treatment, hold significant clinical application prospects through multidisciplinary collaborative innovation.