Exosome-loaded nanoradiosensitizers in radiotherapy for preventing post-irradiation tumor recurrence: Mechanisms, preclinical evidence, and translational challenges
Open accessAbstract
Radiotherapy remains a cornerstone in cancer treatment, yet its therapeutic efficacy is often limited by radioresistance, tumor heterogeneity, and recurrence post-irradiation. Nanotechnology has emerged as a promising avenue to enhance radiosensitization, improve tumor selectivity, and reduce off-target toxicity. Among these, exosome-loaded nanoradiosensitizers represent an innovative strategy, leveraging the natural biocompatibility, tumor-homing ability, and immunomodulatory properties of exosomes to deliver radiosensitizing agents with precision. This review examines the design principles, fabrication strategies, and functional mechanisms of exosome-based nanoradiosensitizers, highlighting how they enhance DNA damage, modulate the tumor microenvironment, and overcome intrinsic and acquired radioresistance. We discuss the molecular mechanisms underlying radiosensitization, including reactive oxygen species (ROS) amplification, cell-cycle modulation, hypoxia alleviation, and immune system engagement. Furthermore, we explore in vitro and in vivo preclinical evidence demonstrating the efficacy of these systems in reducing tumor recurrence post-irradiation. Challenges such as scalable exosome production, cargo loading efficiency, targeted delivery, and regulatory considerations are critically evaluated. Finally, the review outlines translational perspectives, potential combinatorial therapies, and key considerations for clinical trial design. By integrating insights from nanomedicine, radiobiology, and exosome biology, this review aims to provide a comprehensive framework for the development of next-generation exosome-based nanoradiosensitizers, ultimately enhancing radiotherapy outcomes and minimizing tumor relapse in resistant cancers.
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Exosome-based and exosome-mimicking systems have attracted increasing interest because of intrinsic biocompatibility, tumor-homing potential, and ability to facilitate intracellular transport of functional cargo.
“In particular, exosome-based and exosome-mimicking systems have attracted increasing interest because of their intrinsic biocompatibility, tumor-homing potential, and ability to facilitate intracellular transport of functional cargo [106,107,108].”
From Nanoparticle-Mediated Radiosensitization in Breast Cancer: A Systematic Review of Preclinical Evidence and Translational Challenges (2026) · cites this paper as [108]
The Introduction and ‘Exosome biology and therapeutic potential’ sections describe exosomes as biocompatible delivery vehicles with tumor-homing potential and effective cellular uptake of cargo. The Introduction distinguishes exosome-mimetic vesicles from the exosomes on which the review focuses; the cited passages do not establish that mimetic systems share all these properties. Page numbers are unavailable in our copy. (LLM, conf=0.85)
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Research works printed but not linked: 3
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Cited by
Sorted by citations
Lunca, S., Morarasu, S., & Dimofte, G. M. (2026) · International Journal of Molecular Sciences · doi:10.3390/ijms27146522 · Cited by 2 · see citing works
“In particular, exosome-based and exosome-mimicking systems have attracted increasing interest because of their intrinsic biocompatibility, tumor-homing potential, and ability to facilitate intracellular transport of functional cargo [106–108].”
Engineered exosomes for CRISPR/Cas delivery to overcome oncogene-driven drug resistance
Uti, D. E. (2026) · Experimental Cell Research · doi:10.1016/j.yexcr.2026.115159
Self-citationExosomes: The Elixir or the Trojan Horse
Khosravipour, A., Mansoori, M., Aboutalebi, H., Hashemi, F., & Vafaei, S. (2026) · Biomedicine & Pharmacotherapy · doi:10.1016/j.biopha.2026.119957
- Authors
- Uti, D. E., Egbung, J. E., Anthony, B. O., Omari, O. R., Omang, W. A., Aggad, W. S., Almohaimeed, H. M., Bainsal, N., Shukla, S. K., Ealla, K. K. R., & Alum, E. U.
- Affiliations
- Kampala International University (UG)
- University of Calabar (NG)
- University of Jeddah (SA)
- Princess Nourah bint Abdulrahman University (SA)
- Chandigarh University (IN)
- Sharda University (IN)
- Malla Reddy Vishwavidyapeeth (IN)
- Corresponding author
- Uti, Daniel Ejim
- ORCID
- Venue
- Discover Nano
- Published
- 2026-05-27
- Volume
- 21
- Issue
- 1
- ISSN
- 2731-9229 (ISSN-L)
- PMC
- PMC13216446
- OpenAlex
- W7162496944
- Cited by
- 3
- References
- 175
- Citations by year
- 2026: 3
- FWCI
- 3.86
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Discover Nano (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Princess Nourah Bint Abdulrahman University (PNURSP2026R213)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Radiation Therapy and Dosimetry
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Extracellular vesicles in disease
- Physical Sciences › Engineering › Biomedical Engineering › Nanoplatforms for cancer theranostics
- Keywords
- radiosensitization, radioresistance (biology), tumor recurrence, exosomes, nanomedicine, reactive oxygen species, tumor hypoxia, tumor microenvironment, cell cycle modulation, targeted delivery, exosome production, radiotherapy
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