Bioengineered extracellular vesicles: future of precision medicine for sepsis

Abstract

Sepsis is a syndromic response to infection and is frequently a final common pathway to death from many infectious diseases worldwide. The complexity and high heterogeneity of sepsis hinder the possibility to treat all patients with the same protocol, requiring personalized management. The versatility of extracellular vesicles (EVs) and their contribution to sepsis progression bring along promises for one-to-one tailoring sepsis treatment and diagnosis. In this article, we critically review the endogenous role of EVs in sepsis progression and how current advancements have improved EVs-based therapies toward their translational future clinical application, with innovative strategies to enhance EVs effect. More complex approaches, including hybrid and fully synthetic nanocarriers that mimic EVs, are also discussed. Several pre-clinical and clinical studies are examined through the review to offer a general outlook of the current and future perspectives of EV-based sepsis diagnosis and treatment.

Insight into the Functional Dynamics and Challenges of Exosomes in Pharmaceutical Innovation and Precision Medicine

“…Recent advancements in liquid biopsy technologies have further streamlined the profiling of tumoral databases, encompassing methylation patterns and DNA/chromatin modifications [ 223 ]. Exosomes are integral to liquid biopsies, serving as carriers of biomarkers reflective of cellular conditions and being present across all body fluids [ 224 ]. The principal objective of precision medicine is the targeted treatment, or “ablation,” of pathological states with minimal collateral damage to healthy tissues, contingent upon the availability of comprehensive, personalized data sets [ 225 ].…”

“…Through interdisciplinary strategies, it is possible to load exosomes with specific cargoes, including DNA, RNA, oligonucleotides, proteins, and pharmaceuticals, drawing from extensive databases to maximize therapeutic efficacy. These modularized exosomes can be engineered with customizable surface molecules, enhancing their targeting capabilities, and minimizing damage to healthy tissues [ 224 ]. However, a significant challenge in the development of exosome-based personalized and precision medicine is the inherent heterogeneity of exosomes [ 8 , 229 ].…”