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Smart Drug Delivery Systems – Futuristic Window in Cancer Therapy
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Chapter 5
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Exosome-Based Smart Drug
Delivery for Cancer Treatment
ShabnamMalik, MohammedSikander, SheemaKhan,
D
anielZubieta, Murali M.Yallapu and Subhash C.Chauhan
Abstract
Advances in nanoscale materials have become indispensable for targeted drug
delivery, early detection, and personalized approaches for cancer treatment. Among
various nanoscale materials investigated, exosomes hold significant promise in drug
delivery. Exosomes are nanoscale vesicles that are usually 30–150nm in size and produced by cells for intercellular communication. Due to their unique composition and
inherent tumor-targeting capacity, these particles are well suited for tumor-specific
delivery systems. This chapter discusses exosome isolation, therapeutic loading
methods, key roles of exosomes in the tumor microenvironment, current applications
of exosomes in drug delivery, and possible clinical implications.
Keywords: exosome, tumor microenvironment, drug delivery, miRNAs, lncRNAs
. Introduction
Over the last few decades, there has been a significant increase in the development
of innovative therapeutic drug delivery approaches. Although numerous approaches
have been identified, exosome-based drug delivery has drawn significant attention.
They are generally 30-150nm-sized, membrane-bound nanovesicles with a variety of
biologically active compounds [1, 2]. Intraluminal vesicles are generated by endocytosing various transmembrane proteins into the cell’s endosomes, which are then
sorted and turned into intraluminal vesicles. These vesicles are discharged when an
endosome merges with the cell membrane, delivering their contents into the extracellular space [3]. Tetraspanins (specifically CD9, CD63, and CD81) are among the most
commonly found proteins on the surface of exosomes and are often used as markers
specific to exosomes. It has been demonstrated that these proteins interact with other
proteins, including integrins and major histocompatibility complexes [4].
Exosomes generally function as carriers for genetic and proteomic information,
playing a crucial role in cellular communication [3, 5]. Exosomes have been associated
with cellular communication in the tumor microenvironment. As a result, they are
currently being studied as potential targets for therapy and as vehicles for delivering
treatments [4, 6]. Targeted delivery of therapeutic drugs to cancer cells minimizes
cytotoxic effects on healthy cells. Because of their unique composition and ability to

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receive various therapeutic substances, it is possible that exosomes can be used as a
more precise targeting system for delivering drugs to tumors.
. An overview of methods and strategies for exosome isolation
Ultracentrifugation is a widely used method for the isolation and purification
of exosomes, small extracellular vesicles secreted by cells. This is currently the
“gold standard” for isolating exosomes via a variety of centrifugation methods. The
technique involves the use of high-speed centrifugation to separate exosomes from
other cellular debris and contaminants based on their size and density. Though it is
a standard approach for isolating exosomes, it results in a significant sample loss.
The vesicles may be damaged by repeated centrifugation, and there is a chance that a
highly immunogenic protein aggregate may also co-sediment [7–9]. Repeated ultracentrifugation operations resulted in decreased particle yields and a reduced total
exosome recovery rate [9]. Ultracentrifugation combined with additional isolation
techniques can result in a greater yield of exosomes. Payload concentration determination refers to the process of quantifying the concentration or amount of a target
molecule or particle present in the sample after ultracentrifugation. Once the sample
has been centrifuged and the pellet containing the payload has formed, it is necessary to determine the concentration of the payload accurately [10]. There are several
methods to determine the payload concentration after ultracentrifugation. One
common approach is to resuspend the pellet in a known volume of buffer solution and
measure the optical density (OD) or absorbance at a specific wavelength using a spectrophotometer. By correlating the absorbance measurement with a standard curve
generated from known concentrations of the payload, researchers can determine the
concentration of the target molecule or particle in the sample. Another method is
to measure the mass of the pellet after ultracentrifugation using a sensitive balance.
By weighing the pellet and accounting for the resuspension volume, researchers can
calculate the concentration of the payload in the sample. In addition to these methods,
various analytical techniques such as immunoassays, PCR, or gel electrophoresis can
be employed to determine the concentration or purity of specific components within
the payload.
Ultrafiltration uses filters or membranes with defined pore sizes to selectively
retain particles below a certain size, typically in the range of 10–100 nanometers. The
exosomes, being smaller than the retention size, can pass through the membrane,
while larger contaminants are retained. This technique allows for efficient separation
and concentration of exosomes. Compared to ultracentrifugation, this method is
expected to yield more exosomes, but it also has some potential drawbacks [9, 11].
To assess the concentration of payload during this process, the isolated exosomes are
typically analyzed using various techniques, such as Western blotting, nanoparticle
tracking analysis, or mass spectrometry. These methods allow researchers to assess
the presence and abundance of specific cargo molecules within the exosomes, providing insights into their payload concentration [12].
Exosomes or proteins contained in exosomes could adhere to the membrane,
which would hinder their retrieval for subsequent analysis [13]. Immunoaffinity
capture methods rely on the specific binding between exosomal surface markers and
antibodies, allowing for the selective capture of exosomes from a complex biological
sample. The sample is typically pre-cleared to remove larger particles and debris,
either through centrifugation or by using low-speed filtration. This step helps to

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eliminate background noise and increase the efficiency of immunoaffinity capture.
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Next, specific antibodies targeting exosomal surface markers are immobilized on a
solid support, such as magnetic beads or a microplate. Antibodies against common
exosome markers like CD9, CD63, CD81, or tissue-specific markers can be used.
These antibodies have a high affinity for their respective target, allowing for efficient
capture of exosomes. After capturing, the exosomes can be eluted from the solid
support, usually with a solution that disrupts the antigen-antibody interaction.
The eluted exosomes can then be collected, further purified if needed, and used for
downstream applications such as characterization, analysis, or therapeutic purposes.
The use of magnetic beads in an immunoisolation technique is one important variation of this strategy for quick isolation of exosomes. Utilizing magnetic beads coated
with anti-EpCAM, this procedure was proven using exosomes secreted by LIM1863
colon cancer cells. To identify the concentration of the payload during immunoaffinity capture, researchers employ various techniques such as ELISA (enzyme-linked
immunosorbent assay) or Western blotting. These methods utilize specific antibodies
that can selectively bind to the target molecules of interest, allowing for quantification, and assessment of the payload concentration within the isolated exosomes.
Recent investigations identified a few improved isolation methods than ultracen
trifugation [9]. Size exclusion chromatography (SEC) separates particles according
to their size by using a porous column or resin through which the sample is passed.
In SEC, the sample is loaded onto a column or resin composed of a porous material
with specific pore sizes. The column is designed to allow smaller particles, such
as exosomes, to enter the pores and interact less with the resin, resulting in faster
elution. Larger particles, on the other hand, interact more with the resin and are
retained longer within the column. It has been observed that this approach offers
highly precise and reproducible outcomes when collecting exosomes. Nonetheless,
conducting this separation technique takes a considerable amount of time due to the
occurrence of gravity flow separation. Consequently, ultracentrifugation is often
utilized to further intensify the concentration of the exosome sample [14–16]. In
exosome isolation through size exclusion chromatography, the payload concentration
of exosomes can be determined by analyzing the eluted fractions collected during
the chromatographic process [17]. This can be done by quantifying specific cargo
molecules, such as proteins or nucleic acids, present in the collected samples. Various
analytical techniques like Western blotting, ELISA, or qPCR can be employed to
measure the concentration of these cargo molecules, providing an estimation of the
payload concentration in the isolated exosomes.
Polymer-based precipitation methods rely on the addition of polymers, such as
polyethylene glycol, to the sample to precipitate exosomes, thereby facilitating their
separation. A method of precipitating substances has been shown to potentially yield
higher levels of exosomal RNA and protein purity compared to the widely accepted
ultracentrifugation method. Exosomes isolated from ascites are the only source that
can prove this, yet [18]. Polymer-based precipitation methods were regarded as a
straightforward, quick, and scalable option to isolate and identify exosomes [11]. To
determine the payload concentration, additional analysis techniques such as spectroscopy, mass spectrometry, or ELISA assays can be employed, targeting specific
payloads of interest. These techniques can provide quantitative measurements and
help to determine the payload concentration in the isolated exosomes. It’s important
to note that the efficiency of polymer-based precipitation and the resulting payload
concentration can vary depending on the specific experimental conditions and the
quality of the starting sample.

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Microfluidics-based devices are designed with nanostructured surfaces or channels that can selectively trap exosomes based on their size or surface markers. This
technique allows for the isolation of exosomes without the need for extensive sample
preparation, enhancing efficiency and reducing contamination. Additionally, this
approach is more compatible with clinical laboratory practices than the exosome
isolation practices that are currently in use. Furthermore, exosomes from serum can
be separated using microfluidics devices in a single step as opposed to magnetic beadbased techniques [19]. To evaluate the payload concentration, microfluidics devices
often utilize techniques such as fluorescence-activated sorting or single-particle
analysis [20]. In fluorescence-activated sorting, the exosome sample is passed through
a microfluidic channel where fluorescently labeled exosomes are detected and sorted
based on their fluorescence intensity. This allows for the quantification of the payload
concentration within the isolated exosomes. Single-particle analysis involves imaging individual exosomes within the microfluidic device. By capturing images of the
exosomes, their cargo can be visually identified and analyzed. This provides insights
into the payload concentration and can be used to study the heterogeneity of the cargo
within the exosomes. These devices play a crucial role in the study of exosomes and
their cargo, opening up exciting possibilities for research and potential applications in
various fields such as diagnostics and therapeutics.
. Advancements in drug loading strategies for exosomes
Electroporation (electric pulses to produce transitory pores in the lipid bilayer)
facilitates the incorporation of therapeutic cargos such as drugs, nucleic acids, or
proteins in exosomes. The electric pulses create temporary openings in the exosome membrane, enabling the efficient loading of therapeutic molecules into the
exosomes. The therapeutic-loaded exosomes generated by electroporation methods
have shown promise in various therapeutic applications. For targeted drug delivery
applications, the loaded exosomes are engineered to specifically deliver therapeutic
cargos to desired cell types or tissues. Additionally, these exosomes can be utilized in
gene therapy, where exosomes with loaded nucleic acids can deliver genetic material
to target cells for therapeutic purposes. Greco et al., [21] revealed that Mesenchymal
stromal cells (MSC) and Human Embryonic Kidney 293 (HEK293) exosomes were
suspended in an electroporation buffer containing several forms of siRNA at a
specific concentration. Following that, the exosome-siRNA mixture was put into a
cuvette and electroporated with a Bio-Rad® Gene Pulse XCell electroporation equipment. The authors were able to measure the exosome loading efficiency using siRNA
that was allophycocyanin-labeled. The UMUC3 bladder cancer cells were incubated
with the exosomes for 6hours. They observed that the fluorescence intensity was
more than 28-fold higher in the siRNA-loaded exosome-containing cell population.
The enhanced fluorescence intensity demonstrated that electroporation was effective in transferring siRNA into exosomes, and consequently into the bladder cancer
cell. A modified calcium chloride transfection technique is capable of introducing
miRNA into exosomes [22]. This technique offers a versatile platform for loading a
wide range of therapeutics. However, there is a chance that this approach will result
in excessive aggregation or that the exosomes’ membrane integrity could be damaged. Electroporation also requires specific equipment to use, such as the Neon®
Transfection System [22, 23]. It is important to note that further research is required
to optimize electroporation methods for therapeutic loading in exosomes. Factors

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such as pulse parameters, cargo compatibility, and the impact of electroporation on
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exosome stability and functionality need to be carefully investigated.
Incubation methods for therapeutic loading in exosomes are another approach
that researchers have explored to enhance the therapeutic potential of exosomes.
This method involves incubating exosomes with therapeutic molecules, allowing
for the passive uptake of these molecules by exosomes through diffusion or other
mechanisms. The advantage of incubation methods is their simplicity and ease of
use. They do not require complicated equipment or specialized techniques, which
makes them accessible to a wide range of researchers. However, it is important to
consider the limitations of incubation methods. The loading efficiency achieved
through diffusion-based uptake can be relatively low, resulting in a fraction of
exosomes being loaded with therapeutic cargo [24]. Curcumin-loaded exosomes
have been used to demonstrate a simple incubation of exosomes with therapeutic
payload. Curcumin and exosomes were mixed in PBS and incubated at 22°C for
5min. The samples were subsequently centrifuged using a sucrose gradient for
1.5hours at 20,000×g, and HPLC analysis was used to determine the curcumin
concentration [25].
Incubation of donor cells is often used as a method for packaging therapeutic
cargo into exosomes. To load exosomes with therapeutic cargo, donor cells are first
incubated with the desired cargo molecules. This can be achieved by treating the cells
with specific drugs or by transfecting them with plasmids or viral vectors encoding
the cargo of interest. The uptake and packaging of therapeutic cargo into exosomes
occurs during the biogenesis of these vesicles. Mesenchymal stromal cells were treated
with low-dose paclitaxel for 24hours and then reseeded in new flasks. Exosomes
containing paclitaxel and having a therapeutic effect on pancreatic cancer cells
in
were isolated from media collected after growth [26]. Saponins are natural
vitro
compounds found in certain plants and have been shown to facilitate the loading of
therapeutic molecules into exosomes. This loading process involves incubating therapeutic agents together with exosomes and saponins, allowing them to interact and
promote the encapsulation of the cargo inside the exosomes. Since saponin is thought
to have a hemolytic impact, its concentration should be reduced to a minimum and,
preferably, purified from the final product [24, 27, 28]. In the sonication approach,
exosomes and cargo are sonicated using a homogenizer probe which leads to considerable deformation within the membrane, allowing for increased diffusion of drugs into
the exosome [29].
Numerous studies have demonstrated the efficacy of the sonication method; in
some instances, it has resulted in multiple layers of drug encapsulation, some of which
incorporate inside the exosome and some within the membrane, resulting in a twostage drug release, where the membrane-bound portion is released more quickly, and
the internalized drug is released over a longer period of time [30]. Despite the fact that
this approach may be advantageous for certain drugs, it has been shown to result in
the aggregation and/or degradation of nucleic acids [28, 29]. In the extrusion method,
exosomes are mixed with a drug, and the resultant mixture is passed through membranes ranging in size from 100 to 400nm at a regulated temperature. This leads to a
strong mixing of the exosomes and drug, resulting in membrane breakdown and drug
loading. The effects of the strong mechanical forces caused by extrusion on exosomes
are yet unknown [24, 29]. However, one study determined that exosome extrusion
caused an altered zeta potential and cytotoxicity, but other loading methods did not
cause cytotoxicity [27] for therapeutic loading in exosomes involve the use of specialized techniques to package therapeutic agents into exosomes, which are small vesicles
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