Extracellular vesicles (EVs), including exosomes and microvesicles, together with apoptotic bodies form a diverse group of nanoparticles that play a crucial role in intercellular communication, participate in numerous physiological and pathological processes. In the context of cancer, they can allow the transfer of bioactive molecules and genetic material between cancer cells and the surrounding stromal cells, thus promoting such processes as angiogenesis, metastasis, and immune evasion. In this article, we review recent advances in understanding how EVs, especially exosomes, influence tumor progression and modulation of the microenvironment. The key mechanisms include exosomes inducing the epithelial–mesenchymal transition, polarizing macrophages toward protumoral phenotypes, and suppressing antitumor immunity. The therapeutic potential of engineered exosomes is highlighted, including their loading with drugs, RNA therapeutics, or tumor antigens to alter the tumor microenvironment. Current techniques for their isolation, characterization, and engineering are discussed. Ongoing challenges include improving exosome loading efficiency, optimizing biodistribution, and enhancing selective cell targeting. Overall, exosomes present promising opportunities to understand tumorigenesis and develop more targeted diagnostic and therapeutic strategies by exploiting the natural intercellular communication networks in tumors. In the context of oncology, regulatory therapy provides the possibility of reproducing the original conditions that are unfavorable for the existence of the cancer process and may thus be a feasible alternative to population treatments. We also review current access to the technology enabling regulatory intervention in the cancer process using exosomes.
细胞外囊泡（包括外泌体和微囊泡）与凋亡小体共同构成了一类多样化的纳米颗粒，在细胞间通讯中发挥关键作用，并参与众多生理和病理过程。在癌症背景下，它们能够介导癌细胞与周围基质细胞之间生物活性分子及遗传物质的传递，从而促进血管生成、转移和免疫逃逸等过程。本文综述了关于细胞外囊泡（特别是外泌体）如何影响肿瘤进展及微环境调控的最新研究进展。关键机制包括外泌体诱导上皮-间质转化、促使巨噬细胞向促肿瘤表型极化以及抑制抗肿瘤免疫。文章重点探讨了工程化外泌体的治疗潜力，包括通过装载药物、RNA疗法或肿瘤抗原来改变肿瘤微环境。同时讨论了当前外泌体的分离、表征和工程技术，现存挑战包括提高外泌体装载效率、优化生物分布及增强细胞靶向选择性。总体而言，通过利用肿瘤中天然的细胞间通讯网络，外泌体为理解肿瘤发生机制及开发更具靶向性的诊断治疗策略提供了广阔前景。在肿瘤学领域，调控疗法为重建不利于癌症进程存在的原始条件提供了可能，或可成为群体性治疗的可行替代方案。本文亦综述了当前利用外泌体对癌症进程进行调控干预的技术路径。
Exosomes—Promising Carriers for Regulatory Therapy in Oncology
肿瘤(癌症)患者之家