Exosomal Biomarkers and Extracellular Vesicles in Diabetic Retinopathy: Emerging Mechanisms, Diagnostic Signatures and Therapeutic Frontiers
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Abstract
Diabetic retinopathy is a progressive complication of diabetes, a form of microvascular and neurodegenerative microvascular and neurodegenerative impairment that progresses to visual impairment and is a leading avoidable etiology of blindness in the world. The recent studies have highlighted the critical role of exosomes and extracellular vesicles in clarifying the pathophysiological mechanisms behind it, equipping the diagnostic modalities, and promoting therapeutic development that is relevant to diabetic retinopathy. Previously, these nanosized vesicles include a heterogeneous collection of molecular constituents, including microRNAs, proteins, lipids and metabolites and are utilized as active mediators of intercellular communication in the diabetic retina. Endothelial dysfunction, loss of the blood retinal barrier, oxidative stress, chronic inflammation, apoptosis of pericytes, and altered angiogenesis have all been implicated in the involvement of extracellular vesicles in the initial neuronal pathology and the subsequent vascular pathology. Observable exosomal signatures quantifiable in the plasma and vitreous fluid have a promising potential of being minimally invasive biomarkers by which early detection, disease progression, and prognostication can be performed. It is worth noting that exosomal miRNAs that mediate angiogenic and inflammatory pathways have a high diagnostic specificity. Exosomes made of mesenchymal stem cells have shown strong anti-inflammatory, anti-oxidative and neuroprotective effects therapeutically, making them a safe, cell-free, regenerative approach with a low immunogenicity. Further innovations in extracellular vesicle isolation methods, full molecular profiling and the nanotechnology-based platforms of delivery are also enhancing their translational capability. Nevertheless, even in the face of ongoing issues of standardization and clinical validation, exosome studies provide new mechanistic understanding and open new opportunities of specific diagnostics and therapeutic methods of diabetic retinopathy.
Keywords: Exosomes, Diabetic Retinopathy, miRNAs, Biomarkers, Angiogenesis, Inflammation.
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