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Preeclampsia Diagnostics and Therapeutics: Advances, Challenges, and Prospects in Nanoscale Exosome-Based Clinical Translation

Year: 2025

Type: article

Abstract: Preeclampsia (PE) is a life-threatening pregnancy disorder and remains a major global cause of maternal and perinatal morbidity and mortality. Despite decades of research, effective early diagnostic tools remain elusive, largely due to the disease’s heterogeneous pathophysiology, unpredictable onset, and lack of reliable biomarkers. In recent years, attention has turned to placental exosomes, which are nanoscale extracellular vesicles (EVs) secreted by trophoblasts, as promising noninvasive indicators of placental function and dysfunction. These vesicles carry a rich cargo of proteins, lipids, and nucleic acids that reflect the dynamic physiological state of the placenta, offering a molecular window into early pathological changes, long before clinical symptoms arise. Here, we critically evaluate the emerging role of placental exosomes in transforming the diagnosis and management of PE. We highlight recent technological advances in exosome isolation, characterization, and detection. These technologies offer notable improvements over traditional diagnostic modalities in terms of sensitivity, specificity, and scalability. Compared with earlier efforts that struggled with low yield and analytical variability, the emerging toolkit of exosome-based diagnostics presents a more robust and targeted approach. However, challenges remain, particularly the biological heterogeneity of exosomes, the lack of assay standardization, and variability in study outcomes, which collectively hinder widespread clinical adoption. Despite these hurdles, integrated strategies, combining placenta-specific capture technologies, lab-on-a-chip platforms, and artificial intelligence (AI)-driven multiomics data interpretation, offer a path toward personalized and predictive prenatal care. The integration of exosome-based diagnostics into routine obstetric practice could shift PE management from late-stage intervention to early risk stratification, improving outcomes for mothers and their babies worldwide.

Source: ACS Nano Medicine

DOI: 10.1021/acsnanomed.5c00056