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. 2022 Nov 10;16(11):17802–17846. doi: 10.1021/acsnano.2c08774

Table 1. Roles of Exosomes in Health and Disease.

Exosome role Details and references
cell–cell communication Exosomes can participate in an autocrine, paracrine, or endocrine communication reaching their target cells via the systemic or local circulation. They are important participants in cell communication including cell migration, proliferation, and senescence.66,67
immune response The cells of the immune system are known to release exosomes.29 Exosomes mediate immune modulation, both immunosuppression and immunostimulation.68
signal transduction Exosomes enable intercellular communication between various types of cells, regulating gene expressions and cellular signaling pathways of recipient cells by delivering their components, such as specific lipids, proteins, and RNAs. Certain lipid components including sphingomyelin, cholesterol, and ceramides have been involved in signaling;69,70 phosphatidylinositol-3-phosphate (PI3P) is also known to participate in regulating cell signaling.71 The presence of multiple kinds of signaling molecules—lipids, proteins, and RNAs—results in rapid signal changes in the target cell.
material (cargo) transport Exosomes transport their constituents involving proteins, nucleic acids, lipids, and metabolites between cells, both in the close vicinity of the parent cell and at distant sites in the body carried by biofluids. It has been reported that RNA cargo of exosomes can modify gene expression in recipient cells.72,73
pathogenesis Viruses are known to make use of exosome biogenesis pathways to release a variety of pathogenic factors. Thus, a number of pathogen-derived components have been detected on exosomes after infection. These include, e.g., human immunodeficiency virus, Epstein–Barr virus, cytomegalovirus, hepatitis C virus, and herpes simplex virus.74 Exosomes play multiple roles in the progression of cancer via various communication pathways.75 Exosomes are more often released by tumor cells than by healthy ones and facilitate communication within the tumor microenvironment.76
blood–brain communication Exosomes are able to cross the BBB in both directions—from the brain to the bloodstream and from the blood to the CNS. Moreover, exosomes can interact with the BBB, leading to changes in the barrier’s properties.77
target cell delivery The delivery of cargos such as bioactive RNAs, proteins, metabolites, and/or lipid makes the capture of exosomes by target cells of vital importance in a variety of key biological processes such as angiogenesis,78 bone development,79 and cell migration.80