Exosomes in pancreatic islet biology and diabetes: Mechanisms, Biomarkers, and potential therapeutic perspectives

Exosomes, nanosized extracellular vesicles ranging from 30 to 150 nm, have gained increasing attention as mediators of cell-to-cell communication. Within the islet microenvironment, exosomes mediate crosstalk among β-cells, immune cells, and endothelial cells, helping maintain islet integrity, modulate immune responses, and influence the progression of type 1 and type 2 diabetes. Because of their intrinsic role in cellular communication, exosomes are being explored as potential therapeutic tools. Engineered exosomes can be tailored to transport bioactive molecules, including insulin, peptides, or anti-inflammatory agents, directly to pancreatic cells. Such targeted delivery may enhance glycemic control while limiting immune-mediated β-cell destruction. Beyond therapy, exosomes are also being investigated as biomarkers, as their molecular cargo reflects disease-specific alterations, offering opportunities for early diagnosis and timely intervention. This review further examines the scope of exosome-based diagnostics and therapeutics, including advances in exosome engineering and stem cell–derived exosomal applications. Compared with conventional systems, exosomes offer superior targeting, fewer off-target effects, and low immunogenicity due to their natural biocompatibility. These attributes position exosomal therapy as a promising avenue for the development of personalized strategies in diabetes management. In addition, novel findings on exosomal microRNAs, proteins, and lipid components involved in β-cell survival, insulin signaling pathways, and islet inflammation are summarized. Together, these insights highlight the emerging relevance of exosome biology in understanding diabetes pathogenesis and shaping innovative therapeutic approaches.