Diabetes mellitus (DM) is one of the most common chronic diseases affecting millions of people worldwide. Despite advances in the development of insulin and other drugs, disease control and the prevention of complications remain challenging tasks. One of the promising directions in modern medicine is the use of exosomes — extracellular vesicles that play an important role in intercellular communication. Let's consider how exosomes can change the approach to diabetes treatment, with an emphasis on type 1 diabetes.
What are exosomes and why are they important?
Exosomes are microscopic vesicles with a diameter of 30-150 nm, which are secreted by the cells of the body. They contain biologically active molecules such as microRNAs, proteins, lipids, and other compounds. Exosomes ensure the transfer of information between cells, influencing their functions.
In the context of diabetes, exosomes are interesting because:
They are involved in the regulation of inflammation, insulin resistance, and regeneration processes.
They can be biomarkers for the diagnosis and monitoring of disease progression.
Their content can be modified for the delivery of therapeutic molecules.
Improving pancreatic regeneration
Exosomes derived from stem cells contain growth factors and microRNAs that can stimulate the restoration of pancreatic β-cells. This is especially important in type 1 diabetes, where autoimmune destruction of β-cells leads to decreased insulin production.
Reducing insulin resistance
In type 2 diabetes, insulin resistance plays a key role. Exosomes can:
Transfer microRNAs that regulate the expression of genes associated with glucose metabolism.
Reduce inflammation that exacerbates insulin resistance.
For example, exosomes from mesenchymal stem cells (MSCs) have shown the ability to reduce the levels of pro-inflammatory cytokines such as TNF-α and IL-6, which helps improve tissue sensitivity to insulin.
Preventing complications
Diabetes is often accompanied by complications such as diabetic nephropathy, retinopathy, and neuropathy. Exosomes can be used to:
Protect kidney cells from damage through antioxidant and anti-inflammatory effects.
Improve nerve fiber regeneration in diabetic neuropathy.
Reduce vascular damage in the retina in retinopathy.
Targeted drug delivery
Exosomes can be modified to deliver therapeutic molecules — for example, insulin, antioxidants, or anti-inflammatory drugs — directly to target cells. This reduces side effects and increases the effectiveness of treatment.
Diagnosis and monitoring
The composition of exosomes in the blood of patients with diabetes differs from that of healthy individuals. Analyzing exosomes can help:
Early detection of diabetes development.
Monitoring the effectiveness of therapy.
Assessing the risk of complications.
Autologous and donor protocols: Features and advantages
In exosome therapy, two main approaches are used: autologous and donor protocols. Both have their advantages depending on the clinical situation and treatment goals.
Autologous protocol
This method involves using exosomes derived from the patient's own cells.
Advantages:
Minimal risk of immune reactions or rejection.
High compatibility with the patient's body.
Possibility of a personalized approach.
Donor protocol
This approach uses exosomes obtained from donors, most often from stem cells or other sources.
Advantages:
Mass production and standardization.
Speed of obtaining ready therapeutic material.
Possibility of use when there are not enough healthy cells in the patient.
Research and clinical prospects
Scientific research confirms the effectiveness of exosomes in diabetes treatment. For example:
Exosomes from stem cells have shown the ability to protect and restore pancreatic β-cells.
In experimental conditions, exosomes reduced blood glucose levels and improved metabolism.
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