Year: 2026
Type: review
Abstract: Exosomes are central mediators of intercellular communication in the tumor microenvironment, transferring proteins, lipids, metabolites, and nucleic acids that regulate cancer progression. Recent advances in multi-omics and extracellular vesicle profiling have revealed substantial molecular and functional heterogeneity, extending beyond classical membrane-bound exosomes to nonmembranous extracellular nanoparticles such as exomeres and supermeres. Here, we provide a pan-cancer synthesis of exosome biology, integrating mechanisms of biogenesis, cargo sorting, and secretion with emerging concepts of extracellular nanoparticle diversity. We examine how tumor-derived exosomes remodel local and distant microenvironments by promoting angiogenesis, metabolic reprogramming, immune suppression, premetastatic niche formation, and cancer-associated cachexia. We also discuss the relative contributions of active organotropic targeting and passive spatiotemporal accumulation to metastatic dissemination, together with tissue-specific mechanisms governing endothelial barrier crossing, myeloid-cell reprogramming, and intercellular network integration. Clinically, we evaluate exosome-based liquid biopsy, molecular subtyping, engineered delivery systems, and strategies that inhibit endogenous vesicle production or circulation. Finally, we outline key translational challenges, including single-vesicle heterogeneity, limited intravital tracking, and the absence of standardized cGMP manufacturing and analytical frameworks across diverse tumor types and clinically relevant biological contexts worldwide. This review defines a roadmap for exosome-guided precision oncology.
Source: MedComm
DOI: 10.1002/mco2.71074
Language: English
Subfield: Molecular Biology
Domain: Life Sciences
Open Access status: gold
Estimated APC paid: $3,500
OpenAlex ID: W7223156626