Review
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Apr 15, 2025; 17(4): 103591
Published online Apr 15, 2025. doi: 10.4251/wjgo.v17.i4.103591
Exosomal biomarkers: A novel frontier in the diagnosis of gastrointestinal cancers
Yuan Zhang, Ning-Ning Yue, Li-Yu Chen, Cheng-Mei Tian, Jun Yao, Li-Sheng Wang, Yu-Jie Liang, Dao-Ru Wei, Hua-Lin Ma, De-Feng Li
Yuan Zhang, Li-Yu Chen, Li-Sheng Wang, De-Feng Li, Department of Gastroenterology, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen 518000, Guangdong Province, China
Yuan Zhang, Department of Medical Administration, Huizhou Institute for Occupational Health, Huizhou 516000, Guangdong Province, China
Ning-Ning Yue, Department of Gastroenterology, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University), Shenzhen 518000, Guangdong Province, China
Cheng-Mei Tian, Department of Emergency, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen 518000, Guangdong Province, China
Jun Yao, Department of Gastroenterology, Shenzhen People’s Hospital (Jinan University of Second Clinical Medical Sciences), Shenzhen 518000, Guangdong Province, China
Yu-Jie Liang, Department of Child and Adolescent Psychiatry, Shenzhen Kangning Hospital, Shenzhen 518000, Guangdong Province, China
Dao-Ru Wei, Department of Rehabilitation, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen 518000, Guangdong Province, China
Hua-Lin Ma, Department of Nephrology, The Second Clinical Medical College, Jinan University, Shenzhen 518020, Guangdong Province, China
Co-first authors: Yuan Zhang and Ning-Ning Yue.
Co-corresponding authors: Hua-Lin Ma and De-Feng Li.
Author contributions: Liang YJ contributed towards the conceiving and illustration of this manuscript; Zhang Y, Yue NN, and Li DF were responsible for writing of this review; Chen LY and Tian CM were responsible for assisting in collecting the literature and revising this review; Wei DR and Ma HL provided some suggestions; Yao J and Wang LS contributed to discussion; Zhang Y and Yue NN have made equal contributions to the drafting of the manuscript and the organization of the literature as co-first authors of this manuscript. Ma HL and Li DF have made equal contributions to the conception and revision of the manuscript and as co-corresponding authors. All authors read and approved the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: De-Feng Li, MD, PhD, Associate Chief Physician, Department of Gastroenterology, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), No. 1017 Dongmen North Road, Luohu District, Shenzhen 518000, Guangdong Province, China. li.defeng@szhospital.com
Received: November 28, 2024
Revised: January 24, 2025
Accepted: February 25, 2025
Published online: April 15, 2025
Processing time: 121 Days and 14.7 Hours
Abstract

Gastrointestinal (GI) cancers, which predominantly manifest in the stomach, colorectum, liver, esophagus, and pancreas, accounting for approximately 35% of global cancer-related mortality. The advent of liquid biopsy has introduced a pivotal diagnostic modality for the early identification of premalignant GI lesions and incipient cancers. This non-invasive technique not only facilitates prompt therapeutic intervention, but also serves as a critical adjunct in prognosticating the likelihood of tumor recurrence. The wealth of circulating exosomes present in body fluids is often enriched with proteins, lipids, microRNAs, and other RNAs derived from tumor cells. These specific cargo components are reflective of processes involved in GI tumorigenesis, tumor progression, and response to treatment. As such, they represent a group of promising biomarkers for aiding in the diagnosis of GI cancer. In this review, we delivered an exhaustive overview of the composition of exosomes and the pathways for cargo sorting within these vesicles. We laid out some of the clinical evidence that supported the utilization of exosomes as diagnostic biomarkers for GI cancers and discussed their potential for clinical application. Furthermore, we addressed the challenges encountered when harnessing exosomes as diagnostic and predictive instruments in the realm of GI cancers.

Keywords: Exosomes; Exosomal cargo; Liquid biopsy; Biomarkers; Gastrointestinal malignancies; Gastrointestinal tumor diagnosis

Core Tip: In this comprehensive review, we explore the innovative potential of exosomal biomarkers in the diagnosis of gastrointestinal (GI) cancers. Liquid biopsy, a non-invasive diagnostic approach, has revolutionized early detection of GI cancers by leveraging the presence of exosomes in body fluids. These exosomes, rich in tumor-derived proteins, lipids, microRNAs, and RNAs, serve as reflective indicators of tumorigenesis and progression. Our analysis underscores the diagnostic, prognostic, and predictive value of exosomes, while also highlighting the clinical evidence supporting their application. We critically discuss the challenges in utilizing exosomes as biomarkers and their implications for early diagnosis, molecular analysis in GI cancers.