Cited by 297Extracellular vesicles in diseaseNanoparticle-Based Drug DeliveryNanoplatforms for cancer theranostics

The DOI matches its Crossref record; 295 of the 295 references it cites were found in a registry or an index; 37 of the 358 sources its claims cite were checked for support.

Emerging role of exosomes in cancer therapy: progress and challenges

Open access
Li, Jiale, Wang, Jiachong, Chen, Zigui·2025·Molecular Cancer

Abstract

This review highlights recent progress in exosome-based drug delivery for cancer therapy, covering exosome biogenesis, cargo selection mechanisms, and their application across multiple cancer types. As small extracellular vesicles, exosomes exhibit high biocompatibility and low immunogenicity, making them ideal drug delivery vehicles capable of efficiently targeting cancer cells, minimizing off-target damage and side effects. This review aims to explore the potential of exosomes in cancer therapy, with a focus on applications in chemotherapy, gene therapy, and immunomodulation. Additionally, challenges related to exosome production and standardization are analyzed, highlighting the importance of addressing these issues for their clinical application. In conclusion, exosome-based drug delivery systems offer promising potential for future cancer therapies. Further research should aim to enhance production efficiency and facilitate clinical translation, paving the way for innovative cancer treatment strategies.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This review summarizes exosome-based drug delivery for cancer therapy, covering exosome biogenesis, cargo loading, engineering strategies, and applications across multiple cancer types. It concludes that exosomes offer biocompatibility, low immunogenicity, and targeting advantages, but clinical translation is limited by production scalability, standardization, safety, and regulatory challenges.

Key findings

  • Exosomes are 30–150 nm small extracellular vesicles originating from the endosomal pathway; they have high biocompatibility and low immunogenicity, can carry small molecules, nucleic acids, and proteins, and can cross biological barriers including the blood-brain barrier.
  • Across cancer types, the review reports examples such as oral FA-ExoPAC achieving a 55% tumor inhibition rate in animal models, intravenous FA-ExoPAC surpassing Abraxane, and CTX/DOX exosomes extending survival of glioma-bearing rats by 47% compared with DOX monotherapy.
  • For small-molecule drug loading, electroporation shows 0.5–50% efficiency, sonication 8–30%, and incubation 1–67%; ultracentrifugation can yield around 440.22 ± 11.71 µg/mL, while serial extruding synthetic exosomes can yield up to 500-fold higher than natural exosomes.
  • Major barriers include large-scale production, standardization, regulatory uncertainty, limited clinical trials, and safety concerns because tumor-derived exosomes can promote tumor growth, metastasis, angiogenesis, and immune evasion.

Methods

  • Design: narrative review; no primary experiments, systematic search strategy, or inclusion/exclusion criteria are described.
  • Data/sample: synthesizes published literature and selected preclinical/clinical examples across cancer types, including chemotherapy, gene therapy, and immunotherapy applications.
  • Main analysis: thematic synthesis of exosome biogenesis, cargo loading, natural/synthetic/hybrid delivery systems, and cancer-specific applications, with tables comparing isolation methods and delivery platform features.

Limitations

  • Stated in the paper: production and scalability, quality control, regulatory and safety issues, and clinical translation remain unresolved; there is an absence of large-scale randomized controlled trials, and optimal dosage, administration route, predictive biomarkers, and long-term side effects are not fully understood.
  • Stated in the paper: tumor-derived exosomes can carry oncogenic substances and promote tumor progression, metastasis, angiogenesis, and immune evasion, raising safety concerns for therapeutic use.
  • Evident from the text: as a narrative review, it lacks a described systematic search or quantitative synthesis, and many cited applications are preclinical/animal or early-phase, so patient-level efficacy and safety remain uncertain.

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Integrity signals

Registry

Crossref · 10.1186/s12943-024-02215-4

Cites

295 of 295 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Figures

Fig. 1 A representative scheme of exosomal composition. Exosomes encompass cellular lipids, proteins, and nucleic acids, mirroring the state and function of their parent cell. Comprehending their formation is crucial for exploiting EVs in diagnostic and therapeutic applications
Fig. 1 A representative scheme of exosomal composition. Exosomes encompass cellular lipids, proteins, and nucleic acids, mirroring the state and function of their parent cell. Comprehending their formation is crucial for exploiting EVs in diagnostic and therapeutic applicationsCC BY-NC-ND · PubMed Central
Fig. 2 Production of extracellular vesicles. The formation of extracellular vesicles. EVs are membrane-enclosed particles discharged by cells and categorized into exosomes, microvesicles, and apoptotic bodies in accordance with their origin and size. Exosomes are formed within multivesicular bodies and are released when these bodies merge with the plasma membrane. Microvesicles sprout directly from the plasma membrane, while apoptotic bodies arise from cell fragmentation during apoptosis
Fig. 2 Production of extracellular vesicles. The formation of extracellular vesicles. EVs are membrane-enclosed particles discharged by cells and categorized into exosomes, microvesicles, and apoptotic bodies in accordance with their origin and size. Exosomes are formed within multivesicular bodies and are released when these bodies merge with the plasma membrane. Microvesicles sprout directly from the plasma membrane, while apoptotic bodies arise from cell fragmentation during apoptosisCC BY-NC-ND · PubMed Central
Fig. 3 Multiple mechanisms regulate the formation of ILVs. Reproduced from ref. 17 with permission from Springer Nature copyright 2022
Fig. 3 Multiple mechanisms regulate the formation of ILVs. Reproduced from ref. 17 with permission from Springer Nature copyright 2022CC BY-NC-ND · PubMed Central
Fig. 4 Exosome Production and Isolation
Fig. 4 Exosome Production and IsolationCC BY-NC-ND · PubMed Central
Fig. 5 Extracellular vesicle (EV) loading methods for drug delivery: (A) Exogenous Loading Method: EVs are isolated separately, and the biologic drug is produced (steps 1–4). The EVs are then loaded with the drug, which may also be a small synthetic compound. Loading can be passive or active: passive loading involves (I) drug incubation with EVs, while active methods include (II) extrusion, (III) sonication, (IV) electroporation, and (V) freeze–thaw cycles. (B) Endogenous Loading Method: This includes (I) genetic engineering and (II) incubation. Parental cells are engineered via (i) stable transduction or (ii) transient transfection. Genetic engineering removes the need for separate biologic drug production and EV loading, combining these processes for efficiency. Once the cell line is established, EV production, isolation, and drug loading are integrated. Incubation involves producing the drug and adding it to the cell culture, similar to the exogenous approach, requiring separate phases. Reproduced from ref. 41 with permission from Elsevier copyright 2024
Fig. 5 Extracellular vesicle (EV) loading methods for drug delivery: (A) Exogenous Loading Method: EVs are isolated separately, and the biologic drug is produced (steps 1–4). The EVs are then loaded with the drug, which may also be a small synthetic compound. Loading can be passive or active: passive loading involves (I) drug incubation with EVs, while active methods include (II) extrusion, (III) sonication, (IV) electroporation, and (V) freeze–thaw cycles. (B) Endogenous Loading Method: This includes (I) genetic engineering and (II) incubation. Parental cells are engineered via (i) stable transduction or (ii) transient transfection. Genetic engineering removes the need for separate biologic drug production and EV loading, combining these processes for efficiency. Once the cell line is established, EV production, isolation, and drug loading are integrated. Incubation involves producing the drug and adding it to the cell culture, similar to the exogenous approach, requiring separate phases. Reproduced from ref. 41 with permission from Elsevier copyright 2024CC BY-NC-ND · PubMed Central
Fig. 6 sEVs in anti-cancer therapy. Depleting tumor-derived exosomes (TDEs) through methods like inhibiting their production, filtering them from circulation, or blocking their interaction with cells could disrupt neoplastic progression. sEVs also serve as effective drug delivery vectors. With enhanced permeability and retention (EPR) effects, the ability to traverse biological barriers, and reduced immunogenicity, sEVs can efficiently deliver anticancer medications to target cells for both single therapy and combination therapy. Reproduced from ref. 75 with permission from Elsevier copyright 2021
Fig. 6 sEVs in anti-cancer therapy. Depleting tumor-derived exosomes (TDEs) through methods like inhibiting their production, filtering them from circulation, or blocking their interaction with cells could disrupt neoplastic progression. sEVs also serve as effective drug delivery vectors. With enhanced permeability and retention (EPR) effects, the ability to traverse biological barriers, and reduced immunogenicity, sEVs can efficiently deliver anticancer medications to target cells for both single therapy and combination therapy. Reproduced from ref. 75 with permission from Elsevier copyright 2021CC BY-NC-ND · PubMed Central
Fig. 7 Engineered exosomes based nanocarrier for 5-FU and miR-21i simultaneously deliver to HCT-1165FR human colon cancer cells for enhancing chemotherapy efficacy. Reproduced from ref. 148 with permission from Springer Nature copyright 2020
Fig. 7 Engineered exosomes based nanocarrier for 5-FU and miR-21i simultaneously deliver to HCT-1165FR human colon cancer cells for enhancing chemotherapy efficacy. Reproduced from ref. 148 with permission from Springer Nature copyright 2020CC BY-NC-ND · PubMed Central

Verification

Claims the paper makes

204 Not checked yet · 80 No full text of the sources · 27 Own interpretation · 23 No basis given · 20 Supported · 12 Partly supported · 2 Sources not found · 2 Check pending · 1 Supported so far · 1 Couldn’t confirm · accuracy not yet measured

Verify all 225 references — free account

Show all 162 claims

  • It may state two separate claims as one. 184
  • Probably not a substantial claim. 42
  • The quote only partly states this claim. 4
210 of 210
  • The paper relies on this without support.

    Findings from preclinical models of exosome-based drug delivery will translate to clinical cancer therapy.

    “These engineered exosomes have demonstrated strong potential as drug carriers, providing targeted delivery, reduced toxicity, and improved therapeutic effectiveness in preclinical models.”
    “In conclusion, exosome-based drug delivery systems offer promising potential for future cancer therapies.”
  • The paper relies on this without support.

    Exosomes inherently possess cell-specific targeting abilities due to surface proteins such as tetraspanins, integrins, and glycoproteins.

    “Exosomes, with surface proteins such as tetraspanins, integrins, and glycoproteins, inherently possess cell-specific targeting abilities.”
  • The paper relies on this without support.

    In glioblastoma, hybrid exosomes incorporating both magnetic nanoparticles and chemotherapeutic drugs have been used to simultaneously target tumor cells and enhance penetration of drugs into the brain.

    “For instance, in GB, hybrid exosomes incorporating both magnetic nanoparticles and chemotherapeutic drugs have been used to simultaneously target tumor cells and enhance the penetration of drugs into the brain.”
  • The paper relies on this without support.

    Scaling exosome production and improving consistency of cargo loading remain significant challenges.

    “However, scaling exosome production and improving the consistency of cargo loading remain significant challenges.”
  • The paper relies on this without support.

    Paclitaxel’s lack of selectivity harms healthy cells, particularly in the liver and kidneys, causing severe systemic toxicity.

    “However, paclitaxel’s lack of selectivity can also harm healthy cells, particularly in the liver and kidneys. This non-specificity often results in severe systemic toxicity with side effects such as nausea, hair loss, immunosuppression, neurotoxicity, and liver dysfunction, complicating treatment and limiting tolerable dosages.”
  • The paper relies on this without support.

    One of the key mechanisms behind multidrug resistance in tumor cells is their ability to actively expel anticancer drugs from the cells.

    “One of the key mechanisms behind multidrug resistance (MDR) in tumor cells is their ability to actively expel anticancer drugs from the cells.”
  • The paper relies on this without support.

    The liver's immune-tolerant nature poses challenges for HCC immune therapy.

    “The liver’s immune-tolerant nature poses challenges for HCC immune therapy.”
  • The paper relies on this without support.

    5-FU-based chemotherapeutic treatment is a crucial component in treating colorectal cancer.

    “5-FU-based chemotherapeutic treatment is a crucial component in treating CRC.”
  • The paper relies on this without support.

    Exosomes derived from tumor cells can specifically target tumors.

    “Exosomes derived from tumor cells can specifically target tumors, facilitate tissue restoration, and regulate the immune response.”
  • The paper relies on this without support.

    Exosomes derived from tumor cells can facilitate tissue restoration.

    “Exosomes derived from tumor cells can specifically target tumors, facilitate tissue restoration, and regulate the immune response.”
  • The paper relies on this without support.

    Exosomes derived from tumor cells can regulate the immune response.

    “Exosomes derived from tumor cells can specifically target tumors, facilitate tissue restoration, and regulate the immune response.”
  • The paper relies on this without support.

    BC cells exhibit a heightened reliance on fucose, a sugar essential for their proliferation and division, causing greater dependence on it compared to normal cells.

    “BC cells exhibit a heightened reliance on fucose, a sugar essential for their proliferation and division, causing greater dependence on it compared to normal cells.”
  • The paper relies on this without support.

    The volume variability of QDs influences cellular absorption dynamics: larger QDs may struggle to penetrate cells, while smaller QDs are more likely to enter cells but may pose a risk of cellular damage.

    “Furthermore, the volume variability of QDs influences cellular absorption dynamics: larger QDs may struggle to penetrate cells, while smaller QDs are more likely to enter cells but may pose a risk of cellular damage.”
  • The paper relies on this without support.

    Exosomes inherently contain the capability to pass through biological barriers, allowing them to restore internalized medications that are lost in circulation.

    “Additionally, exosomes inherently contain the capability to pass through biological barriers, allowing them to restore internalized medications that are lost in circulation.”
  • The paper relies on this without support.

    Downregulating m6A modulators has demonstrated potential in boosting chemotherapy sensitivity and enhancing tumor inhibition.

    “A potential strategy to address these challenges involves downregulating m6A modulators, which have demonstrated potential in boosting chemotherapy sensitivity and enhancing tumor inhibition.”
  • The paper relies on this without support.

    Exosomes are biocompatible and can evade the immune system due to their natural origin.

    “Due to their natural origin, exosomes are biocompatible and can evade the immune system, allowing for the delivery of a wider range of therapeutics, including small molecules, siRNAs, and CRISPR-Cas9 gene editing tools.”
  • The paper relies on this without support.

    Exosomes have natural targeting capabilities.

    “Exosomes’ unique properties, such as high biocompatibility, ability to deliver a wide range of therapeutic agents, and natural targeting capabilities, make them an ideal tool in the fight against cancer.”
  • The paper relies on this without support.

    Exosomes can modulate the tumor microenvironment.

    “One of the most promising future roles for exosomes in cancer treatment is their ability to modulate the TME.”
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Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

2 of 2

Cited works that were retracted

Works this paper cites that were later retracted, from the retraction notices publishers deposit. Major when the notice came out before this paper was published.

2 of 2

Citations

Cites

2 retracted

Show all 292 references

Research works printed but not linked: 2

  1. Kim MS, Haney MJ, Zhao Y, Mahajan V, Deygen I, Klyachko NL, et al. Development of exosome-encapsulated paclitaxel to overcome MDR in cancer cells. Nanomedicine. 2016;12(3):655–64. · DOI · Paper page
  2. Crivii C-B, Boșca AB, Melincovici CS, Constantin A-M, Mărginean M, Dronca E, et al. Glioblastoma Microenvironment Cell Interact Cancers. 2022;14(4):1092.

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Metadata

Authors
Li, J., Wang, J., & Chen, Z.
Affiliations
Central South University (CN)
Corresponding author
  • Wang, Jiachong
  • Chen, Zigui
Venue
Molecular Cancer
Published
2025-01-13
Volume
24
Issue
1
Pages
13-13
ISSN
1476-4598 (ISSN-L)
OpenAlex
W4406300216
Cited by
297
References
292
Citations by year
2026: 169 · 2025: 128
FWCI
21.88
Type
journal article
Language
en
Open access
Locations
  • Molecular Cancer (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • National Natural Science Foundation of China (82160492, 82460479)
  • Supported by the specific research fund of The Innovation Platform for Academicians of Hainan Province (YSPTZX202033)
  • Hainan Province Clinical Medical Research Center (LCYX202410)
  • Hainan Province Clinical Medical Center (0202068)
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Extracellular vesicles in disease
  • Physical Sciences › Materials Science › Biomaterials › Nanoparticle-Based Drug Delivery
  • Physical Sciences › Engineering › Biomedical Engineering › Nanoplatforms for cancer theranostics
Keywords
exosomes, extracellular vesicles, cancer therapy, exosome-based drug delivery, exosome biogenesis, cargo selection, chemotherapy, gene therapy, immunomodulation, exosome production, standardization, clinical translation
MeSH terms
Animals, Antineoplastic Agents, Humans, Neoplasms, Genetic Therapy, Drug Delivery Systems, Exosomes

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