Bidirectional Regulatory Roles in the Immune Modulation, Organ Dysfunction, and Therapy of Sepsis

Exosomes have emerged as central mediators in sepsis pathogenesis and therapy. Exosomes play an important role in cell communication by transferring functional proteins, metabolites, and nucleic acids to recipient cells. Recently, Low-immunogenic exosomes serve as novel biomarkers in sepsis, and they confer a 46% enhancement in survival benefit in animal models. However, exosomes drive the early inflammatory storm and late immune paralysis in sepsis. There are also limitations related to heterogeneity and translational barriers. Therefore, this review discusses the basic signaling pathways underlying the bidirectional effects of exosomes in the pathogenesis and treatment of sepsis, the interaction between organ dysfunction and exosomes in sepsis, the current progress in exosome therapy for sepsis, as well as the challenges and limitations faced in this field. In summary, exosomes have bright prospects in diagnosis and clinical translation, as well as the potential for standardized production.