Abstract

INVESTIGATION ON THE ROLE OF EXOSOMES IN CELL COMMUNICATION AND THEIR POTENTIAL THERAPEUTIC STRATEGIES IN DIABETES

Surabhi S. M., Pinki Verma*

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Abstract

Background: Exosomes, nanosized extracellular vesicles (30– 150 nm), are critical mediators of intercellular communication, transferring bioactive cargo (proteins, lipids, RNA) to modulate cellular functions. In diabetes mellitus (DM), a metabolic disorder affecting over 500 million globally, exosomes exhibit dual roles: they contribute to disease pathogenesis by exacerbating β-cell dysfunction, insulin resistance, and vascular complications, while offering therapeutic promise as drug delivery vehicles or regenerative tools. Despite advancements in diabetes management, current therapies often fail to address underlying molecular mechanisms or prevent complications, underscoring the need for innovative strategies. Exosomes inherent biocompatibility, low immunogenicity, and capacity to cross biological barriers position them as transformative candidates for precision diagnostics and therapeutics in DM. Main Text Exosomes play a dual role in diabetes, serving as both mediators of disease progression and vehicles for innovative therapies. In T2DM, adipose and liver-derived exosomes transfer insulinresistance- inducing miRNAs (miR-34a, miR-155) and pro-inflammatory cytokines, disrupting metabolic homeostasis. For T1DM, β-cell exosomes deliver autoantigens that trigger autoimmune destruction, while immune cell exosomes propagate inflammation through miR-21 and other mediators. These vesicles also drive diabetic complications by shuttling pathogenic cargo - fibrotic factors in nephropathy, angiogenic miRNAs in retinopathy, and neurotoxic proteins in neuropathy. Therapeutically, engineered exosomes show remarkable promise. MSC-derived exosomes promote β-cell regeneration, while CRISPR-edited exosomes enable precise drug/gene delivery. Advances in nanotechnology allow tissue-specific targeting, and AI helps optimize exosome design. However, challenges like production scalability, cargo consistency, and long-term safety must be addressed before clinical translation. Future research should focus on standardizing isolation methods, improving targeting efficiency, and developing personalized approaches through multi-omics profiling. With their ability to modify disease processes rather than just manage symptoms, exosome-based therapies represent a paradigm shift in diabetes treatment. Realizing their full potential will require overcoming technical hurdles through interdisciplinary collaboration, paving the way for transformative therapies that restore metabolic health. Conclusion: Exosomes represent a paradigm shift in diabetes management, both as biomarkers of early disease and as versatile therapeutic platforms. Future innovation lies in overcoming biological and technical barriers through interdisciplinary collaboration. By harnessing exosome biology, next-generation therapies could reverse insulin resistance, regenerate β-cells, and prevent complications, transforming diabetes care from symptomatic treatment to disease modification.

Keywords: Extracellular vesicles, Exosome biogenesis, Intercellular communication, β-cell dysfunction, MicroRNAs (miRNAs), Long non-coding RNAs.