Exosomes and pancreatic diseases: mechanisms, applications, and challenges

Exosomes, nanoscale extracellular vesicles secreted by various cell types, have emerged as pivotal mediators of intercellular communication in pancreatic diseases. They carry proteins, lipids, and nucleic acids that mirror the molecular state of their parent cells, thereby influencing inflammation, fibrosis, and tumorigenesis. This review summarizes current evidence on the roles of exosomes in acute and chronic pancreatitis as well as pancreatic cancer. In acute pancreatitis, exosomes regulate inflammatory cascades and contribute to remote organ injury, while mesenchymal stem cell-derived exosomes exhibit protective effects, highlighting their therapeutic potential. In chronic pancreatitis, exosomes mediate acinar-stellate cell interactions and fibrosis progression, with exosomal miRNAs and proteins showing promise for differential diagnosis and targeted interventions. In pancreatic cancer, tumor-derived exosomes foster immune evasion, chemoresistance, and metastasis but also serve as valuable candidates for liquid biopsy and as innovative drug delivery vehicles. Despite these advances, challenges remain, including standardization of exosome isolation and characterization methods, optimization of targeting strategies, and verification of clinical safety and efficacy. Collectively, exosomes represent a promising frontier for improving diagnosis, prognosis, and treatment of pancreatic diseases, though further translational research is needed to fully realize their clinical applications.