Search Results (1,067)

Diabetic kidney disease (DKD) remains one of the most severe microvascular complications of type 2 diabetes mellitus (T2DM) and a leading cause of chronic kidney disease (CKD) worldwide. Nevertheless, despite considerable progress in elucidating its molecular background, early diagnosis and accurate stratification of disease progression remain challenging when relying on conventional clinical biomarkers such as albuminuria and estimated glomerular filtration rate (eGFR). Growing evidence indicates that DKD is driven by interconnected pathogenic mechanisms, including chronic hyperglycemia, activation of the protein kinase C (PKC) signaling pathway, renin–angiotensin–aldosterone system (RAAS) dysregulation, oxidative stress, inflammatory cascades, and immune system activation involving Toll-like receptors (TLR) and the NLRP3 inflammasome. These processes collectively contribute to endothelial dysfunction, podocyte injury, extracellular matrix accumulation, and progressive renal fibrosis. Exosomes and their molecular cargo, particularly miRNAs, have emerged as promising regulators and non-invasive biomarkers reflecting ongoing renal injury. Urinary exosomal microRNAs (uEV-miRNAs) are of interest due to their stability in biological fluids and their direct origin from nephron segments, enabling real-time reflection of renal pathophysiology. Accumulating studies suggest that differentially expressed microRNAs (miRNAs), including miR-21-5p, miR-30a-5p, miR-192-5p, and miR-142-3p, are closely associated with key pathways in DN. However, their clinical translation remains limited by methodological heterogeneity, the lack of standardized isolation protocols, and insufficient validation in large longitudinal cohorts. This review navigates the current landscape of knowledge on the molecular mechanisms underlying DKD and examines the emerging role of uEV-miRNAs as diagnostic biomarkers. Altogether, uEV-miRNAs offer a promising avenue for improving early detection, risk stratification, and disease monitoring in DKD. Full article

Human papillomavirus (HPV)-associated cervical lesions remain a significant disease burden and minimally invasive blood-based biomarkers could complement cytology and HPV testing. This study aimed to characterize the proteomic composition of plasma-derived CD9⁺ small extracellular vesicles (sEVs) across the morphological spectrum of HPV-associated cervical disease, from histologically normal (NILM) through low-grade (LSIL) and high-grade (HSIL) lesions to invasive squamous cell carcinoma (SCC). Plasma samples from 34 women (NILM, LSIL, HSIL, SCC) were pooled per group, and CD9⁺ sEVs were isolated using an electrochemically controlled immunoaffinity capture method, followed by nanoparticle tracking analysis, transmission electron microscopy, Western blotting, and label-free LC–MS/MS proteomic profiling. The core sEV proteome comprised 258 shared proteins. LSIL showed the most pronounced changes with broad enrichment of complement and coagulation components and acute-phase reactants alongside depletion of immunoglobulin chains and complement C1r-like protein (C1RL). HSIL exhibited few differential proteins, dominated by neutrophil degranulation and retinoid metabolism pathways. SCC demonstrated extensive cargo depletion (22 downregulated proteins) and a nearly sevenfold upregulation of C1RL. Five proteins (including immunoglobulin chains and GPLD1) correlated positively with lesion severity. Pathway analysis consistently implicated platelet activation, lipoprotein remodeling, and insulin-like growth factor signaling. We conclude that plasma CD9⁺ sEVs carry stage-specific proteomic signatures distinguishing HPV-associated cervical lesions, with C1RL emerging as a candidate biphasic marker warranting further validation. Full article

Background/Objectives: Type 2 diabetes is increasingly recognized as a systemic disorder driven not only by chronic hyperglycemia and insulin resistance, but also by dysregulated interorgan communication. Extracellular vesicles (EVs), including exosomes and microvesicles, have emerged as biologically active carriers of proteins, lipids, and microRNAs capable of modulating gene expression in recipient cells. This narrative review integrates clinical, experimental, and translational evidence on EV-associated microRNAs as candidate biomarkers and potential mediators of diabetic complications, with emphasis on diabetic neuropathy, diabetic kidney disease, diabetic retinopathy, and metabolic dysfunction-associated steatotic liver disease (MASLD). Methods: This review was aligned with the SANRA framework and focused on biological plausibility, evidence from tissue and biofluids, biomarker potential, therapeutic implications, and barriers to clinical translation. Studies were additionally interpreted according to biological matrix, EV-carrier specificity, analytical platform, study design, and level of functional validation. Results: Across complications, EV-associated microRNAs appear to participate in shared pathogenic processes, including oxidative stress, inflammation, endothelial dysfunction, fibrosis, angiogenesis, neurodegeneration, and metabolic memory. In diabetic neuropathy, microRNAs such as miR-146a, miR-155, miR-21-5p, and miR-148a-3p have been linked to neuroinflammation, Schwann-cell dysfunction, axonal injury, and neuropathic pain. In diabetic kidney disease, miR-21, miR-29, miR-30, and miR-126 are implicated in podocyte injury, tubulointerstitial fibrosis, albuminuria, and microvascular dysfunction. In diabetic retinopathy, microRNAs including miR-146a, miR-155, miR-21, miR-126, and miR-200b contribute to neurovascular injury, inflammation, barrier disruption, and angiogenesis. In MASLD associated with diabetes, hepatocyte-derived EVs carrying microRNAs such as miR-1 and miR-126a-3p may link hepatic lipotoxicity to endothelial inflammatory and β-cell dysfunction. Conclusions: Although EV-associated microRNAs offer promising opportunities for biomarker discovery, risk stratification, and targeted therapies, clinical translation remains limited by heterogeneity in EV isolation, microRNA quantification, biological matrices, and outcome definitions. Distinguishing EV-associated miRNAs from total circulating extracellular miRNAs remains essential for biological interpretation. Standardized, longitudinal, and externally validated studies are required before these signals can be implemented as actionable tools in precision diabetes care. Full article

Multiple myeloma (MM) is a genetically and clinically heterogeneous plasma cell malignancy characterised by clonal expansion of differentiated B cells within the bone marrow (BM). Patients start with monoclonal gammopathy of undetermined significance (MGUS) and progress to an intermediate stage called smouldering multiple myeloma (SMM), characterised by several genetic alterations that represent the genomic backbone of the malignant clone. Immune checkpoint pathways play a central role in shaping an immunosuppressive BM niche, contributing to T-cell dysfunction, immune evasion, and therapeutic resistance. Key inhibitory receptors such as PD-1, CTLA-4, TIM-3, LAG-3, and CD47 are frequently dysregulated, promoting T-cell exhaustion, anergy, and senescence. Emerging evidence highlights extracellular vesicles (EVs) as critical mediators of intercellular communication in MM. MM-derived EVs carry bioactive cargo, including proteins and miRNAs, that reprogram immune and stromal cells, enhancing tumour progression and immune escape. Notably, EV-associated immune checkpoint molecules contribute to the establishment of a permissive microenvironment. This review provides an integrated overview of immune checkpoint dysregulation and EV-mediated immunomodulation in MM, emphasising their role in disease pathogenesis and progression. Furthermore, we discuss the therapeutic potential of targeting immune checkpoints and exploiting EVs as novel biomarkers and drug delivery systems, highlighting their promise for improving precision medicine approaches in MM. Full article

The intricate intercellular communication within the tumor microenvironment (TME) critically drives cancer progression and therapeutic resistance. Natural killer (NK) cells are potent sentinels of the innate immune system, but their antitumor functions are often severely compromised by the TME’s immunosuppressive networks. Moving beyond protein-coding genes, non-coding RNAs (ncRNAs)—with microRNAs (miRNAs) playing a foundational role alongside long non-coding RNAs (lncRNAs) and circular RNAs (circRNAs)—have emerged as vital components of the regulatory networks influencing immune responses. Rather than dictating immune cell fate, these diverse transcriptomic classes form complex networks that modulate NK cell functional states and TME immunosuppression. This review systematically elucidates the molecular mechanisms by which these ncRNA networks influence NK cell biology in the TME. We dissect three core regulatory axes driven by extracellular vesicle (EV)-mediated communication, competitive endogenous RNA crosstalk, and epigenetic remodeling: the extrinsic suppression of NK cells by EV-derived and secreted ncRNAs from TME-resident cells, the reciprocal modulation of TME components by NK cell-derived ncRNAs, and the intrinsic regulation of NK cell functions by endogenous ncRNAs. Furthermore, we critically assess the clinical translational potential of targeting these networks. We highlight specific ncRNAs as non-invasive prognostic biomarkers and summarize targeted therapeutic interventions using antisense oligonucleotides, small interfering RNAs, and nano-delivery systems. Modulating these core ncRNA nodes to mitigate TME immunosuppression offers a novel paradigm for precision oncology, holding substantial promise for enhancing immune checkpoint blockade and NK cell-directed immunotherapies. Full article

Globally, chronic kidney disease (CKD) is an increasingly prevalent public health challenge. The current kidney function tests, which include serum creatinine, estimated glomerular filtration rate (eGFR), and proteinuria, are highly useful in clinical practice. Nevertheless, they are characterized by substantial limitations that prevent the early detection of CKD. In contrast, urinary extracellular vesicles (uEVs) may offer an effective alternative for the diagnosis and monitoring of chronic kidney disease if successfully translated. Urinary extracellular vesicles are a wide range of nanosized membrane vesicles that are excreted by cells that line the nephron and urinary tract. These uEVs contain proteins, lipids, and nucleic acids that reflect the pathophysiological state of their cells of origin. This review summarizes the biological evidence for uEV biomarkers in major CKD entities, including diabetic kidney disease, FSGS, IgA nephropathy, ADPKD, and lupus nephritis. From a clinical laboratory perspective, we critically examine pre-analytical variables, analytical factors and validation requirements aligned with ISO 15189 accreditation. We discuss regulatory pathways and the balance between laboratory-developed tests and commercial IVD platforms. Moreover, we conclude that there is an essential need for reference materials, internal quality control, and external quality assessment. Finally, we outline a practical implementation pathway for transitioning uEV assays from research use to routine diagnostics. If successfully translated, uEV-based assays could facilitate earlier detection of CKD, more precise phenotyping, and personalized therapeutic monitoring. Full article

PSA testing plays an important role in the diagnostic workup of prostate cancer; despite this, its cancer specificity is a well-recognised limitation. Consequently, more reliable, non-invasive diagnostic tools that are capable of improving specificity while maintaining sensitivity are needed, thereby enabling better risk stratification, personalised patient management, and reduction in unnecessary invasive procedures. In this study, we characterised the small RNA profile—including miRNAs and tsRNAs—in seminal small extracellular vesicles (sEVs) using high-throughput sequencing to expand biomarker discovery for distinguishing benign from malignant prostate conditions in patients with moderately elevated PSA levels, a setting where non-invasive biomarkers are critically needed. Our analysis confirms a small number of differentially represented sncRNA transcripts contained in seminal sEVs between benign and malignant prostate disease, most of which are of low abundance. This result suggests that shared underlying molecular mechanisms are likely to occur between both prostate disease conditions, especially in patients with moderate PSA levels. Subsequent RT-qPCR analysis revealed differences in expression in PCa compared with healthy controls but not when compared with benign prostatic disease. Given the complexity of the underlying pathophysiological process and the heterogeneity in clinical phenotypes, this limitation was addressed through the application of multivariate approaches (including isomiRs or tRFs), which are proposed as fluid-based biomarkers for prostate cancer, collectively offering improved accuracy and enhancing the negative predictive value of PSA used in clinical settings. Full article

Oral squamous cell carcinoma (OSCC) remains a major global health burden with limited improvement in survival rates. While traditional risk factors such as tobacco and alcohol are well established, increasing evidence highlights the role of the oral microbiome in carcinogenesis. Among microbial species, Candida albicans (C. albicans) has emerged as a potential contributor to tumor-promoting processes. Clinical studies consistently report increased fungal colonization in oral potentially malignant disorders and OSCC, with associations to disease severity and recurrence. Mechanistically, C. albicans contributes to carcinogenesis through acetaldehyde production, chronic inflammation, oxidative stress, epithelial signaling modulation, and extracellular vesicle (EV)-mediated communication. These pathways promote tumor microenvironment remodeling and epithelial transformation. However, conflicting evidence exists regarding causality, suggesting that fungal colonization may also result from tumor-associated ecological changes. From a translational perspective, C. albicans and EV-associated signatures may represent promising biomarkers and therapeutic targets, although further validation is required. This review highlights the emerging role of fungal–host interactions in OSCC and underscores their potential in microbiome-informed precision oncology. Full article

Alzheimer’s disease (AD) is a progressive neurodegenerative disorder characterized by cognitive decline and significant neuropathological changes. Early and accurate diagnosis remains a major challenge, highlighting the need for reliable, minimally invasive biomarkers. MicroRNAs (miRNAs), small non-coding RNAs that regulate gene expression, have emerged as promising candidates. Their expression is altered in the brains of AD patients, reflecting disease-specific pathological processes, and they are detectable in peripheral biofluids. However, discrepancies in miRNA profiles between the brain and the circulation, and between patient populations remain a significant limitation, raising questions about their origin, transport across the blood–brain barrier, and their reliability in reflecting central nervous system pathology. This review provides a comprehensive overview of current research comparing miRNA expression profiles in brain tissue and blood in AD, with a focus on their biological relevance, mechanisms of release and transport, and diagnostic potential. We also discuss the challenges associated with cross-tissue variability, methodological inconsistencies, and the need for standardized approaches. Finally, we highlight future directions, including multi-tissue analyses and integration with other noninvasive modalities, to improve the clinical utility of miRNA-based biomarkers in AD. Full article

Triple negative breast cancer (TNBC) is an aggressive and heterogeneous subtype of breast cancer characterized by the absence of the estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2), resulting in limited options for targeted therapy and high rates of metastasis, recurrence and death. Extracellular vesicles (EVs) have emerged as central mediators of TNBC pathophysiology, functioning as key intercellular communication vehicles transporting oncogenic proteins, nucleic acids, lipids, and metabolites. These EV-mediated interactions promote tumor microenvironment (TME) remodeling, immune evasion, metastatic niche formation, and therapeutic resistance. Given their stability, accessibility, and molecular complexity, EVs also represent promising diagnostic and prognostic biomarkers for TNBC. Advances in isolation and molecular profiling technologies have enabled the identification of EV-associated signatures that predict therapeutic response and stratify patient risk. Beyond their utility as biomarkers, EVs are rapidly emerging as therapeutic targets and delivery platforms, demonstrating efficacy in transporting chemotherapeutics, RNA-based therapeutics, immune modulators, and photosensitizers with enhanced targeting specificity and therapeutic efficiency. Collectively, EVs play a multifaceted role in TNBC biology, serving simultaneously as drivers of disease progression, minimally invasive biomarkers, and versatile therapeutic vehicles. The integration of EV-centered diagnostics, multi-omic profiling, and engineered therapeutics holds significant potential to transform TNBC management and advance precision oncology for this challenging breast cancer subtype. Full article

Introduction: Cutaneous T cell lymphoma (CTCL), most commonly known as mycosis fungoides (MF), is characterized by an increasingly immunosuppressive tumor microenvironment (TME) as the disease progresses. Cancer-associated fibroblasts (CAFs) are key stromal components that support a permissive niche, in part through the secretion of small extracellular vesicles (sEVs), predominantly exosomes, that mediate intercellular communication. We investigated the immunomodulatory role of exosome-enriched sEVs derived from MF fibroblasts (MF-Fs) compared to normal fibroblasts (N-Fs). Materials and Methods: Primary MF-Fs from early-stage MF biopsies and N-Fs from healthy skin were cultured in vitro. sEVs enriched with exosomes were isolated by ultracentrifugation and characterized by flow cytometry (CD81), electron microscopy, Nanosight analysis, and protein quantification, and their uptake by normal peripheral blood mononuclear cells (nPBMCs) was confirmed using PKH26-labeled sEVs. nPBMCs, monocytes, CD4⁺ and CD8⁺ T cells from healthy donors were exposed to MF-F or N-F sEVs. Cell viability was assessed using MTT and trypan blue exclusion assays. Mass cytometry (CyTOF) profiled immune subsets and regulatory proteins for preliminary observation. Monocyte polarization was evaluated by flow cytometry for M1 (CD80, CD86) and M2 (CD163, CD206) markers and PD-L1 expression; M1/M2-associated cytokines and sEV-microRNAs were quantified by qRT-PCR. Results: Both MF-F and N-F sEVs were internalized by nPBMCs and reduced their viability, with a more pronounced effect observed for MF-F sEVs. In nPBMCs, MF-F sEVs also increased the frequency of M2-like macrophages, decreased M1 polarization, and enhanced PD-L1 expression. In primary monocytes, MF-F- compared with N-F-derived sEVs upregulated M2-associated cytokines (IL-10, TGF-β), increased PD-L1 expression, and generated M2-like cells that suppressed CD4⁺ and CD8⁺ T cell viability. Conclusions: MF-F sEVs promote an immunosuppressive TME and represent potential therapeutic or biomarker targets in MF. Full article

Xerostomia is a common and debilitating condition caused by salivary gland dysfunction, frequently associated with primary Sjögren’s syndrome and head and neck radiotherapy. Current management is largely symptomatic and does not address underlying glandular injury. Extracellular vesicles (EVs), including exosomes, have emerged as candidate mediators of intercellular communication that have been proposed for diagnostic and therapeutic applications; however, their translational relevance to xerostomia remains uncertain and is currently supported only by exploratory evidence. This scoping review aimed to map and interpret current evidence on EV-based approaches in xerostomia and salivary gland dysfunction. A scoping review was conducted in accordance with “Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR)” checklist. Twenty-five articles were included, comprising 14 primary studies and 11 review articles. Studies were analysed based on application focus, methodological characteristics, reported outcomes, and translational readiness. Most primary studies focused on EVs as diagnostic biomarkers or their roles in immune–epithelial signalling. Therapeutic research was limited and largely confined to human-relevant translational models, namely human peripheral blood mononuclear cell (PBMC) assays and freshly resected human salivary gland tissue-maintained ex vivo. Outcomes were predominantly molecular and cellular, with minimal assessment of salivary flow or patient-reported symptoms. The current evidence base, although biologically plausible, remains exploratory: most included studies are mechanistic, and no clinical efficacy studies in xerostomia were identified. A substantial gap therefore persists between molecular findings and clinically meaningful outcomes, and further translational research is required before any conclusions can be drawn regarding the clinical utility of EV-based approaches. Full article

Introduction: Cervical cancer ranks among the leading cancers in women worldwide, with mortality disproportionately affecting low- and middle-income countries. Traditional diagnostic and prognostic tools have limited sensitivity and specificity, and accessibility challenges, underscoring the need for innovative biomarkers. Recent findings suggest that extracellular vesicles (EVs), released by both tumor and immune cells, may reflect the disease state and serve as minimally invasive biomarkers. This study investigates circulating EVs and their potential role as biomarkers in cervical cancer. Objective: To evaluate the levels and cellular origins of circulating EVs in cervical cancer patients across different clinical stages and outcomes, assessing their potential as diagnostic and prognostic biomarkers. Methods: In this study, we analyzed 96 cervical cancer patients and 31 healthy controls. Peripheral blood samples were processed to isolate and quantify EVs, followed by immunophenotyping using flow cytometry. Specific markers identified EVs originating from neutrophils, lymphocytes, platelets, and endothelial cells. Comparative analyses were conducted to assess EV profiles in relation to clinical stages and patient outcomes. Statistical significance was set at p < 0.05. Machine learning approaches were employed to assess EV performance. Results: Circulating EV levels were significantly elevated in cervical cancer patients compared to healthy controls (p < 0.01). Immunophenotyping revealed marked increases in EVs derived from neutrophils (CD66⁺, CD16⁺), T lymphocytes (CD3⁺), leukocytes (CD45⁺), platelets (CD41a⁺), and endothelial cells (CD51/CD61⁺), all of which were highly significant (p < 0.0001). Monocyte-derived EVs (CD14⁺) and erythrocyte-derived EVs (CD235a⁺) were also significantly elevated (p < 0.01 and p < 0.001, respectively). When stratified by survival outcomes at 8 months post-treatment, responders exhibited a more pronounced elevation in erythrocyte-derived EVs compared to non-responders and deceased patients (p = 0.0002), suggesting a potential association with improved outcomes. Total EV levels were significantly higher in advanced-stage patients (Stages III and IV) than in controls (p < 0.05), but not in early-stage patients (Stages I and II). However, EVs derived from specific cell types were significantly increased in both early and advanced stages (all p < 0.05), with no significant differences between the stages, indicating a consistent elevation regardless of disease progression. Regarding histopathological grades, total EV levels were significantly elevated in patients with Grade I and Grade III tumors (both p < 0.05) but not in those with Grade II tumors. Cell-specific EV elevations were observed across all grades, though with some variations; for instance, monocyte-derived EVs were significantly elevated in Grades I and III (both p < 0.05) but not in Grade II. These findings highlight that while elevated EV levels are a hallmark of cervical cancer, specific EV subtypes may have distinct associations with clinical stages, histopathological grades, and patient outcomes. This underscores their potential utility as diagnostic and prognostic biomarkers. Conclusions: This study highlights the potential of circulating EVs as non-invasive biomarkers for cervical cancer, with distinct EV profiles associated with disease severity and prognosis. These findings suggest that EV analysis could aid in stratifying patients by risk, enhancing personalized treatment strategies. Future research should explore the molecular cargo within EVs to further elucidate their role in tumor biology and as therapeutic targets. Full article

Background: Designing studies to increase knowledge of the beneficial effects of volatile halogenated anaesthetics(VHAs) is critical to understand the mechanisms activated by myocardial conditioning during ischaemia-reperfusion(I/R) injury. Our research group has identified specific enzymes associated with the SAFE/RISK signalling pathways involved in halogen-induced cardioprotection and has observed a direct correlation between the expression of specific microRNA(miRNAs) and the cardioprotective effect conferred by VHA. Objective: This protocol study has been designed to increase knowledge regarding the cardioprotective effects generated by induced cardioprotective miRNAs after exposure to halogenated drugs without subjecting the patient to additional surgical procedures. Methods: The experimental design that is proposed will be performed with isogenic Wistar rats, all subjected to an I/R procedure. The animals will be randomly divided into two groups: the Donor group and the Recipient group. Half of the rats included in both groups will be exposed to sevoflurane (S), a hypnotic drug, during the I/R procedure, and the other half will be injected with propofol (P), a hypnotic. EVs will be isolated from plasma samples extracted from rats in the Donor group 24 h after the I/R procedure. In vitro EV characterisation will be performed by conducting an ultramorphological analysis, identifying the EV immunophenotype, and quantifying miRNAs. Cardiac function will be assessed by transthoracic echocardiography, histological, and immunohistochemical analyses. Results: The results derived from studies conducted according to this experimental design will support its validation as a preclinical study by regulatory authorities for approval and will serve to design a Phase I clinical trial. Conclusions: The proposed scientific rationale of applying this proposed experimental design will enable the generation of knowledge ‘from the bench to the bedside’ regarding miRNAs with cardioprotective properties induced by exposure to halogenated agents, which could be considered as biomarkers of cardioprotection. Furthermore, biomarker administration could reduce cardiac damage in patients undergoing additional cardiac surgery. Full article

Pancreatic ductal adenocarcinoma (PDAC) is increasingly recognized as a systemic malignancy, characterized by profound alterations in tumor–host interactions. Small extracellular vesicles (sEVs) in peripheral blood may reflect these alterations and represent a promising minimally invasive source of biomarker information. In this proof-of-principle study, plasma-derived sEVs from patients with PDAC, healthy controls, and a comparative cohort with neuroendocrine lung cancer (NLC) were isolated by differential ultracentrifugation and characterized by western blotting and nanoparticle tracking analysis. Surface marker profiling was performed using the MACSPlex EV Kit IO, followed by univariate, multivariate, and machine-learning-based analyses. PDAC samples exhibited a distinct sEV immunophenotype with coordinated enrichment of angiogenesis-related markers (including CD105 and CD146), immune-regulatory markers (including CD25 and CD40), the coagulation-related marker CD142 and the invasion-associated marker MCSP. Principal component analysis, hierarchical clustering, and Random Forest classification showed exploratory separation of PDAC patients from healthy controls and NLC, supporting the presence of disease-specific vesicle surface marker patterns. In a very small subset of paired samples, descriptive longitudinal analyses illustrated measurable intra-individual changes during chemotherapy. Plasma sEV immunophenotyping is a technically feasible approach for capturing systemic disease-associated alterations in PDAC and provides a foundation for future biomarker-oriented validation studies. Full article