The promise of small particles: extracellular vesicles as biomarkers in liver pathology

Extracellular vesicles (EVs) are nanoscopic packages that are heterogeneous and bona fide players in hepatic physiology and pathology as they are involved in intercellular communication. EVs carrying bioactive cargoes rich in lipids, proteins, or nucleic acids are implicated in the onset and progression of liver diseases. Liver pathology using liver biopsy has been assessed for several intricate conditions such as viral hepatitis, alcoholic- and nonalcoholic fatty liver disease, hepatic malignancies, and drug-induced liver injury. The lacunae, however, lie in early diagnosis and timely treatment of the above conditions, underscoring the need for noninvasive, accurate diagnostic tools that could replace the gold standard method of tissue biopsy. In this regard, EVs have emerged as promising candidates that could serve as potential biomarkers. In the last two decades, EVs, owing to their multifaceted charm in bringing out cell-free therapeutic responses and the ability of their cargoes to be applied to novel biomarkers, have drawn the great attention of researchers with the advancement and clinical applications of liquid biopsy. In this review, we will recapitulate the role of EVs and provide insights into the promising role of these small packages as biomarkers in liver pathology. Abstract figure legend Extracellular vesicles (EVs) play a prominent role in the pathogenesis of liver diseases, including viral hepatitis, fatty liver disease, liver cancer, and drug-induced liver injury. EVs have been identified in major body fluids including blood, saliva, and urine and possess high stability, the ideal characteristics to be considered as an attractive tool for liquid biopsy. EVs are marked by their potential use as diagnostic and therapeutic biomarkers in liver pathobiology. Furthermore, EVs serve as promising therapeutic targets and delivery vehicles for the treatment of liver diseases. This article is protected by copyright. All rights reserved.