Exosomes: A potential biomarker and therapeutic target in diabetic cardiomyopathy

Researchers from Nanjing University and the Army Engineering University of PLA have published a review in ExRNA, shedding light on the critical role of exosomes in diabetic cardiomyopathy (DCM). Exosomes are nanoscale vesicles involved in cell-to-cell communication and carry bioactive molecules, such as proteins, lipids, and microRNAs (miRNAs), which are essential in DCM progression. This paper summarizes the underlying mechanisms of DCM and discusses exosomes as potential diagnostic tools and therapeutic targets.

Diabetic cardiomyopathy is a complication of diabetes characterized by cardiac dysfunctions such as left ventricular hypertrophy, myocardial fibrosis, and impaired systolic and diastolic function. "DCM is often underrecognized yet poses significant risks to diabetic patients," explains Dr. Xin Yin, co-author from Nanjing University. Key factors contributing to DCM include metabolic abnormalities, oxidative stress, inflammation, and disrupted calcium handling, driven by hyperglycemia and insulin resistance. These processes collectively damage cardiac tissue, leading to progressive heart failure.

Exosomes have emerged as critical players in DCM by transporting detrimental or protective molecules, including miRNAs, between cells. "Exosomes from diabetic cardiomyocytes often carry pro-inflammatory factors and miRNAs like miR-21 that can exacerbate cardiac damage, while others such as miR-133a show cardioprotective effects," notes co-author Dr. Jizheng Ma. These findings highlight exosomes as both contributors to disease pathology and potential therapeutic targets.

Exosome-based therapies for DCM are promising due to their natural ability to deliver therapeutic molecules. "By engineering exosomes to carry therapeutic miRNAs, it’s possible to target damaged cardiac tissues directly, potentially reversing pathological remodeling and improving heart function," says Azhar Anwar, lead author. Beyond diagnostics, exosomes also serve as potential drug delivery vehicles, leveraging their biocompatibility and low immunogenicity for targeted therapy in DCM.

Despite significant advancements, Dr. Yin emphasizes the need for standardized methods in exosome isolation and characterization to enhance consistency and clinical translation. Future research will focus on understanding exosome biogenesis and cargo sorting mechanisms to optimize therapeutic efficacy. Integrating multi-omics approaches will also enable a comprehensive analysis of exosome functionality, helping to uncover new biomarkers and therapeutic targets in DCM.

This review provides insights into the potential of exosomes as diagnostic and therapeutic agents in diabetic cardiomyopathy. "Our findings suggest that exosomes could pave the way for innovative, personalized treatment strategies for DCM, ultimately improving patient outcomes," concludes Dr. Yin.

Azhar Anwar, Jizheng Ma, Xin Yin. Exosomes: a potential biomarker and therapeutic target in diabetic cardiomyopathy. ExRNA 2024(3):0015, https://doi.org/10.55092/exrna20240015.