Exosome-Based Theranostic for Gastrointestinal Cancer: Advances in Biomarker Discovery and Therapeutic Engineering

Exosomes have emerged as versatile biomolecules in gastrointestinal (GI) cancer management, leveraging their inherent cargo-carrying capabilities to overcome the limitations of current diagnostic and therapeutic strategies. This review provides a comprehensive exploration of exosome-based technologies, highlighting their dual roles as diagnostic biomarkers and therapeutic vehicles. On the diagnostic front, this review investigates specific exosomal biomarkers-including miRNAs, lncRNAs, circRNAs, and proteins-emphasizing their roles in tumor biology and their clinical utility, such as diagnostic accuracy, early detection potential, and prognostic significance. Therapeutically, this study examines the sources, purification methodologies, and engineering strategies that enhance the therapeutic efficacy of exosomes in modulating immune responses, overcoming drug resistance, and suppressing metastasis. By providing a comprehensive overview of the field, this review serves as a guideline for researchers and clinicians entering this field, offering novel insights into the potential of exosome-based theranostic systems and delineating future directions to overcome existing challenges.