Utilization of Extracellular Vesicles for Treatment of Type 1 Diabetes Mellitus (T1DM) Along with Type 2 Diabetes Mellitus (T2DM) besides Complications Associated with Diabetes- A Systematic Review

We have earlier reviewed both etiopathogenesis along with therapy of both type1 diabetes mellitus (DM) (T1D) as well as (T2D) thoroughly along with advances in therapy. Despite that, there is no permanent cure and with the growing epidemic of obesity and thus the parallel enhancement of worldwide prevalence. Extracellular vesicles(ECV) by definition are physiologically bilayer vesicles that carry bioactive receptors, lipids, proteins as well as nucleic acids which cross-react with target cells, driving the modification of target cells. Maximum cells liberate ECV as well as recently have been shown to not only work as promising biomarkers for the disease but work as therapeutic agents for some diseases. ECV represent a heterogeneous population of small membrane vesicles (30-2000nm) liberated from various types of activated or apoptotic cells. In view of their ability of carrying out cell-cell communication , lot of significance has been given to them regarding their role as biomarkers or as utilization for therapy by trying to overtake cell-based therapy. DM T1D or T2D both if uncontrolled for long have the potential of causing a lot of complications like kidneys, cardiac, neuronal, eyes, feet problems ending with chronic end-stage kidney disease, blindness, stroke, myocardial infarction (MI) , erectile dysfunction, diabetic foot ulcers and gangrene , hence some permanent methods are sought to cure these. Here we conducted a systematic review utilizing the MeSH terms; Type1Diabetes mellitus; T2D; stem cells sources for DM therapy; exosomes; Extracellular vesicles; treatment potential in DM by utilizing the search engine Pubmed, Google Scholar, Web of science, Embase, Cochrane review library from 2000 to 2020. We found a total of 550 articles out of which we selected 128 articles for this review. No meta-analysis was carried out. Here we have tried to discuss the details of what are EVs, how they can be obtained, their contents, mechanism of actions in curing diabetes along with its complications like diabetic wound healing, diabetic retinopathy, diabetic nephropathy, stroke, diabetic peripheral neuropathy along with diabetic foot ulcers, erectile dysfunctions. Further the place clinically in trials we have reached in utilizing clinically as well as challenges faced in translation as well as bulk generation, methods utilized for their preservation. Hopefully, these will be overcome gradually and soon can get translated into clinical medicine.