Terrasini Nora, Lionetti Vincenzo
1Laboratory of Translational Critical Care Medicine (TRANCRILAB), Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy. 2U.O.S Anesthesiology and Intensive Care Medicine, Fondazione Toscana "G. Monasterio," Pisa, Italy.
Crit Care Med. 2017 Jun;45(6):1054-1060. doi: 10.1097/CCM.0000000000002328.
Exosomes are small, cell-released vesicles (40-100 nm in size) with the potential to transfer proteins, lipids, small RNAs, messenger RNAs, or DNA between cells via interstitial fluids. Due to their role in tissue homeostasis, exosomes have emerged as a new type of therapeutic and diagnostic (theranostic) tool in the noninvasive assessment of organ response to injury or treatment and in the development of reliable organ-protective intensive therapy. Our review provides current insights into the role of exosomes in the personalized management of injury and repair responses in critical illness.
Data were obtained from a PubMed search of the most recent medical literature, including the PubMed "related articles" search methodology.
Articles considered include original articles, review articles and conference proceedings.
A detailed review of scientific, peer-reviewed data was performed. Relevant pre-clinical and clinical studies were included and summarized.
Current scientific evidence is focused on the following: 1) Frontiers in the management of critical illness; 2) Biogenesis, characterization, and function of circulating exosomes; 3) The role of exosomes in acute lung injury; 4) The role of exosomes in acute cardiac injury; 5) The role of exosomes in acute kidney injury; 6) The role of exosomes in sepsis; 7) Limitations of exosome isolation protocols; and 8) Perspectives in the theranostic use of exosomes.
Circulating levels of exosomes are associated with the onset and clinical course of critical illness. Exosomes released from cells with different phenotypes exert different functions in order to protect tissue and preserve organ function. Therefore, multifunctional exosomes with combined diagnostic and therapeutic functions show great promise in terms of personalized nanomedicine for patient-specific diagnosis and treatment of critical illness.
外泌体是细胞释放的小囊泡（大小为40 - 100纳米），具有通过组织液在细胞间传递蛋白质、脂质、小RNA、信使RNA或DNA的潜力。由于其在组织稳态中的作用，外泌体已成为一种新型的治疗和诊断（治疗诊断）工具，可用于器官对损伤或治疗反应的无创评估以及可靠的器官保护强化治疗的开发。我们的综述提供了关于外泌体在危重病损伤和修复反应的个性化管理中作用的当前见解。
数据来自对最新医学文献的PubMed搜索，包括PubMed“相关文章”搜索方法。
考虑的文章包括原创文章、综述文章和会议论文集。
对经过科学同行评审的数据进行了详细综述。纳入并总结了相关的临床前和临床研究。
当前的科学证据集中在以下方面：1）危重病管理的前沿；2）循环外泌体的生物发生、特征和功能；3）外泌体在急性肺损伤中的作用；4）外泌体在急性心脏损伤中的作用；5）外泌体在急性肾损伤中的作用；6）外泌体在脓毒症中的作用；7）外泌体分离方案的局限性；8）外泌体治疗诊断应用的前景。
外泌体的循环水平与危重病的发生和临床过程相关。不同表型细胞释放的外泌体发挥不同功能以保护组织和维持器官功能。因此，具有联合诊断和治疗功能的多功能外泌体在针对危重病患者特异性诊断和治疗的个性化纳米医学方面显示出巨大潜力。
