Bio fluid exosomes: promises, challenges, and future directions in translational medicine

Exosomes, a subset of extracellular vesicles (EVs) secreted by virtually all cell types, have emerged as pivotal nanocarriers of bioactive molecules, including proteins, nucleic acids, and lipids, facilitating intercellular communication and modulating physiological and pathological processes. Initially discovered in reticulocytes, exosomes have since been recognized for their diverse roles in immune regulation, antigen presentation, and disease progression, paving the way for their application in diagnostics, therapeutics, and personalized medicine. This review comprehensively examines biofluid-derived exosomes, focusing on their biogenesis, molecular composition, and innovative isolation techniques from various biological fluids. We highlight their diagnostic potential as non-invasive biomarkers for diseases such as cancer, neurodegenerative disorders, and infectious diseases, as well as their therapeutic applications in drug delivery, regenerative medicine, and immunotherapy. Additionally, we discuss ongoing and completed clinical trials leveraging exosomes for precision medicine, while addressing the technical challenges and limitations in exosome isolation, characterization, and clinical translation. By integrating the latest advancements and future perspectives, this review underscores the transformative potential of biofluid exosomes in revolutionizing modern medicine.