Review Article

外泌体囊泡作为生物标志物在不同类型癌症中的应用

卷 24, 期 3, 2024

发表于: 18 April, 2023

页: [281 - 297] 页: 17

弟呕挨: 10.2174/1566524023666230320120419

价格: $65

Open Access Journals Promotions 2
摘要

与癌症作斗争的最大挑战之一是早期发现。早期诊断至关重要,但也存在一些障碍,如经济、文化和个人因素。考虑到放射成像技术或血清学分析方法用于癌症诊断的缺点,例如昂贵,需要专业知识,耗时,需要开发更快,更可靠,更具成本效益的诊断方法用于癌症诊断。外泌体是自然产生的生物纳米颗粒,其大小在30-120纳米之间,负责细胞间的通讯。由于它们所携带的货物,它们是一种潜在的生物标志物,可用于癌症的诊断。外泌体被定义为起源于内体的细胞外囊泡,在癌症的生长、进展、转移和耐药中起作用,肿瘤发展过程中微环境条件的变化会改变外泌体的分泌。由于肿瘤细胞具有较高的细胞活性,因此肿瘤细胞比健康细胞产生更多的外泌体。因此,与其他细胞相比,体液中的外泌体数量明显丰富,可以作为独立的诊断生物标志物。近年来,肿瘤源性外泌体在癌症的早期检测和治疗反应评价方面受到了广泛的关注。本文综述了在常见癌症类型(肺癌、肝癌、胰腺癌、卵巢癌、乳腺癌、结直肠癌)中检测到的外泌体的内容、性质和差异,这些癌症是癌症相关死亡的主要原因。我们还讨论了外泌体含量作为早期检测的生物标志物的潜在效用,这在靶向癌症治疗中是重要的。

关键词: 外泌体,癌症,生物标志物,miRNA,囊泡,乳腺癌,诊断。

Next »
[1]
Fitzmaurice C, Dicker D, Pain A, et al. Global burden of disease cancer collaboration. The global burden of cancer 2013. JAMA Oncol 2015; 1(4): 505-27.
[http://dx.doi.org/10.1001/jamaoncol.2015.0735] [PMID: 26181261]
[2]
Laird PW. Cancer epigenetics. Hum Mol Genet 2005; 14 (Suppl. 1): R65-76.
[http://dx.doi.org/10.1093/hmg/ddi113] [PMID: 15809275]
[3]
Schiffman JD, Fisher PG, Gibbs P. Early detection of cancer: Past, present, and future. Am Soc Clin Oncol Educ Book 2015; 35(35): 57-65.
[http://dx.doi.org/10.14694/EdBook_AM.2015.35.57] [PMID: 25993143]
[4]
Colombo M, Raposo G, Théry C. Biogenesis, secretion, and intercellular interactions of exosomes and other extracellular vesicles. Annu Rev Cell Dev Biol 2014; 30(1): 255-89.
[http://dx.doi.org/10.1146/annurev-cellbio-101512-122326] [PMID: 25288114]
[5]
Lässer C, Seyed Alikhani V, Ekström K, et al. Human saliva, plasma and breast milk exosomes contain RNA: Uptake by macrophages. J Transl Med 2011; 9(1): 9.
[http://dx.doi.org/10.1186/1479-5876-9-9] [PMID: 21235781]
[6]
Keller S, Rupp C, Stoeck A, et al. CD24 is a marker of exosomes secreted into urine and amniotic fluid. Kidney Int 2007; 72(9): 1095-102.
[http://dx.doi.org/10.1038/sj.ki.5002486] [PMID: 17700640]
[7]
Admyre C, Johansson SM, Qazi KR, et al. Exosomes with immune modulatory features are present in human breast milk. J Immunol 2007; 179(3): 1969-78.
[http://dx.doi.org/10.4049/jimmunol.179.3.1969] [PMID: 17641064]
[8]
Frydrychowicz M, Kolecka-Bednarczyk A, Madejczyk M, Yasar S, Dworacki G. Exosomes-structure, biogenesis and biological role in non-small-cell lung cancer. Scand J Immunol 2015; 81(1): 2-10.
[http://dx.doi.org/10.1111/sji.12247] [PMID: 25359529]
[9]
Théry C, Zitvogel L, Amigorena S. Exosomes: Composition, biogenesis and function. Nat Rev Immunol 2002; 2(8): 569-79.
[http://dx.doi.org/10.1038/nri855] [PMID: 12154376]
[10]
Ostrowski M, Carmo NB, Krumeich S, et al. Rab27a and Rab27b control different steps of the exosome secretion pathway Nat Cell Biol 2010; 12(1): 19-30 1--13.
[http://dx.doi.org/10.1038/ncb2000] [PMID: 19966785]
[11]
Kahraman T, Gíiçlíiler G. Gürsel İ.Exosomes: Natural nanovesicle candidates used in the diagnosis and treatment. Turkish J Immunol 2014; 2(2): 34-40.
[http://dx.doi.org/10.5606/tji.2014.323]
[12]
Greening DW, Gopal SK, Xu R, Simpson RJ, Chen W. Exosomes and their roles in immune regulation and cancer. Semin Cell Dev Biol 2015; 40: 72-81.
[http://dx.doi.org/10.1016/j.semcdb.2015.02.009] [PMID: 25724562]
[13]
Pegtel DM, Cosmopoulos K, Thorley-Lawson DA, et al. Functional delivery of viral miRNAs via exosomes. Proc Natl Acad Sci USA 2010; 107(14): 6328-33.
[http://dx.doi.org/10.1073/pnas.0914843107] [PMID: 20304794]
[14]
Skog J, Würdinger T, van Rijn S, et al. Glioblastoma microvesicles transport RNA and proteins that promote tumour growth and provide diagnostic biomarkers. Nat Cell Biol 2008; 10(12): 1470-6.
[http://dx.doi.org/10.1038/ncb1800] [PMID: 19011622]
[15]
Zhang X, Yuan X, Shi H, Wu L, Qian H, Xu W. Exosomes in cancer: Small particle, big player. J Hematol Oncol 2015; 8(1): 83.
[http://dx.doi.org/10.1186/s13045-015-0181-x] [PMID: 26156517]
[16]
Roma-Rodrigues C, Fernandes AR, Baptista PV. Exosome in tumour microenvironment: Overview of the crosstalk between normal and cancer cells. BioMed Res Int 2014; 2014: 1-10.
[http://dx.doi.org/10.1155/2014/179486] [PMID: 2496347]
[17]
Barcellos-Hoff MH, Lyden D, Wang TC. The evolution of the cancer niche during multistage carcinogenesis. Nat Rev Cancer 2013; 13(7): 511-8.
[http://dx.doi.org/10.1038/nrc3536] [PMID: 23760023]
[18]
Skokos D, Botros HG, Demeure C, et al. Mast cell-derived exosomes induce phenotypic and functional maturation of dendritic cells and elicit specific immune responses in vivo. J Immunol 2003; 170(6): 3037-45.
[http://dx.doi.org/10.4049/jimmunol.170.6.3037] [PMID: 12626558]
[19]
Rabinowits G, Gerçel-Taylor C, Day JM, Taylor DD, Kloecker GH. Exosomal microRNA: A diagnostic marker for lung cancer. Clin Lung Cancer 2009; 10(1): 42-6.
[http://dx.doi.org/10.3816/CLC.2009.n.006] [PMID: 19289371]
[20]
Melo SA, Sugimoto H, O’Connell JT, et al. Cancer exosomes perform cell-independent microRNA biogenesis and promote tumorigenesis. Cancer Cell 2014; 26(5): 707-21.
[http://dx.doi.org/10.1016/j.ccell.2014.09.005] [PMID: 25446899]
[21]
Shenouda SK, Alahari SK. MicroRNA function in cancer: Oncogene or a tumor suppressor? Cancer Metastasis Rev 2009; 28(3-4): 369-78.
[http://dx.doi.org/10.1007/s10555-009-9188-5] [PMID: 20012925]
[22]
Xu K, Zhang C, Du T, et al. Progress of exosomes in the diagnosis and treatment of lung cancer. Biomed Pharmacother 2021; 134: 111111.
[http://dx.doi.org/10.1016/j.biopha.2020.111111] [PMID: 33352449]
[23]
Xiao H, Lässer C, Shelke GV, et al. Mast cell exosomes promote lung adenocarcinoma cell proliferation-role of KIT-stem cell factor signaling. Cell Commun Signal 2014; 12(1): 64.
[PMID: 25311367]
[24]
Li C, Ni YQ, Xu H, et al. Roles and mechanisms of exosomal non-coding RNAs in human health and diseases. Signal Transduct Target Ther 2021; 6(1): 383.
[http://dx.doi.org/10.1038/s41392-021-00779-x] [PMID: 34753929]
[25]
Cai Z, Yang F, Yu L, et al. Activated T cell exosomes promote tumor invasion via Fas signaling pathway. J Immunol 2012; 188(12): 5954-61.
[http://dx.doi.org/10.4049/jimmunol.1103466] [PMID: 22573809]
[26]
Wu H, Zhou J, Mei S, et al. Circulating exosomal microRNA-96 promotes cell proliferation, migration and drug resistance by targeting LMO7. J Cell Mol Med 2017; 21(6): 1228-36.
[http://dx.doi.org/10.1111/jcmm.13056] [PMID: 28026121]
[27]
Yamashita T, Kamada H, Kanasaki S, et al. Epidermal growth factor receptor localized to exosome membranes as a possible biomarker for lung cancer diagnosis. Pharmazie 2013; 68(12): 969-73.
[PMID: 24400444]
[28]
Li Y, Zhang Y, Qiu F, Qiu Z. Proteomic identification of exosomal LRG1: A potential urinary biomarker for detecting NSCLC. Electrophoresis 2011; 32(15): 1976-83.
[http://dx.doi.org/10.1002/elps.201000598] [PMID: 21557262]
[29]
Park JO, Choi DY, Choi DS, et al. Identification and characterization of proteins isolated from microvesicles derived from human lung cancer pleural effusions. Proteomics 2013; 13(14): 2125-34.
[http://dx.doi.org/10.1002/pmic.201200323] [PMID: 23585444]
[30]
Asakura K, Kadota T, Matsuzaki J, et al. A miRNA-based diagnostic model predicts resectable lung cancer in humans with high accuracy. Commun Biol 2020; 3(1): 134.
[http://dx.doi.org/10.1038/s42003-020-0863-y] [PMID: 32193503]
[31]
Cazzoli R, Buttitta F, Di Nicola M, et al. microRNAs derived from circulating exosomes as noninvasive biomarkers for screening and diagnosing lung cancer. J Thorac Oncol 2013; 8(9): 1156-62.
[http://dx.doi.org/10.1097/JTO.0b013e318299ac32] [PMID: 23945385]
[32]
Silva J, García V, Zaballos A, et al. Vesicle-related microRNAs in plasma of nonsmall cell lung cancer patients and correlation with survival. Eur Respir J 2011; 37(3): 617-23.
[http://dx.doi.org/10.1183/09031936.00029610] [PMID: 20595154]
[33]
Crissien AM, Frenette C. Current management of hepatocellular carcinoma. Gastroenterol Hepatol (N Y) 2014; 10(3): 153-61.
[PMID: 24829542]
[34]
Wetmore BA, Brees DJ, Singh R, et al. Quantitative analyses and transcriptomic profiling of circulating messenger RNAs as biomarkers of rat liver injury. Hepatology 2010; 51(6): 2127-39.
[http://dx.doi.org/10.1002/hep.23574] [PMID: 20235334]
[35]
Wang H, Hou L, Li A, Duan Y, Gao H, Song X. Expression of serum exosomal microRNA-21 in human hepatocellular carcinoma. BioMed Res Int 2014; 2014: 1-5.
[http://dx.doi.org/10.1155/2014/864894] [PMID: 24963487]
[36]
Sohn W, Kim J, Kang SH, et al. Serum exosomal microRNAs as novel biomarkers for hepatocellular carcinoma. Exp Mol Med 2015; 47(9): e184-4.
[http://dx.doi.org/10.1038/emm.2015.68] [PMID: 26380927]
[37]
Fornari F, Ferracin M, Trerè D, et al. Circulating microRNAs, miR-939, miR-595, miR-519d and miR-494, identify cirrhotic patients with HCC. PLoS One 2015; 10(10): e0141448.
[http://dx.doi.org/10.1371/journal.pone.0141448] [PMID: 26509672]
[38]
Liu W, Ren L, Wang X, et al. Combination of exosomes and circulating microRNAs may serve as a promising tumor marker complementary to alpha-fetoprotein for early-stage hepatocellular carcinoma diagnosis in rats. J Cancer Res Clin Oncol 2015; 141(10): 1767-78.
[http://dx.doi.org/10.1007/s00432-015-1943-0] [PMID: 25724413]
[39]
Ko SF, Yip HK, Zhen YY, et al. Adipose-derived mesenchymal stem cell exosomes suppress hepatocellular carcinoma growth in a rat model: apparent diffusion coefficient, natural killer T-cell responses, and histopathological features. Stem Cells Int 2015; 2015: 1-11.
[http://dx.doi.org/10.1155/2015/853506] [PMID: 26345219]
[40]
Conigliaro A, Costa V, Lo Dico A, et al. CD90+ liver cancer cells modulate endothelial cell phenotype through the release of exosomes containing H19 lncRNA. Mol Cancer 2015; 14(1): 155.
[http://dx.doi.org/10.1186/s12943-015-0426-x] [PMID: 26272696]
[41]
Lin XJ, Fang JH, Yang XJ, et al. Hepatocellular carcinoma cell-secreted exosomal microRNA-210 promotes angiogenesis in vitro and in vivo. Mol Ther Nucleic Acids 2018; 11: 243-52.
[http://dx.doi.org/10.1016/j.omtn.2018.02.014] [PMID: 29858059]
[42]
Conde-Vancells J, Rodriguez-Suarez E, Gonzalez E, et al. Candidate biomarkers in exosome-like vesicles purified from rat and mouse urine samples. Proteomics Clin Appl 2010; 4(4): 416-25.
[http://dx.doi.org/10.1002/prca.200900103] [PMID: 20535238]
[43]
Li S, Yao J, Xie M, Liu Y, Zheng M. Exosomal miRNAs in hepatocellular carcinoma development and clinical responses. J Hematol Oncol 2018; 11(1): 54.
[http://dx.doi.org/10.1186/s13045-018-0579-3] [PMID: 29642941]
[44]
Luo W, Yang G, Luo W, et al. Novel therapeutic strategies and perspectives for metastatic pancreatic cancer: vaccine therapy is more than just a theory. Cancer Cell Int 2020; 20(1): 66.
[http://dx.doi.org/10.1186/s12935-020-1147-9] [PMID: 32158356]
[45]
Lorenzon L, Blandino G. Glypican-1 exosomes: Do they initiate a new era for early pancreatic cancer diagnosis? Transl Gastroenterol Hepatol 2016; 1: 8.
[http://dx.doi.org/10.21037/tgh.2016.01.07] [PMID: 28164166]
[46]
Melo SA, Luecke LB, Kahlert C, et al. Glypican-1 identifies cancer exosomes and detects early pancreatic cancer. Nature 2015; 523(7559): 177-82.
[http://dx.doi.org/10.1038/nature14581] [PMID: 26106858]
[47]
Yang S, Che SPY, Kurywchak P, et al. Detection of mutant KRAS and TP53 DNA in circulating exosomes from healthy individuals and patients with pancreatic cancer. Cancer Biol Ther 2017; 18(3): 158-65.
[http://dx.doi.org/10.1080/15384047.2017.1281499] [PMID: 28121262]
[48]
Allenson K, Castillo J, San Lucas FA, et al. High prevalence of mutantKRAS in circulating exosome-derived DNA from early-stage pancreatic cancer patients. Ann Oncol 2017; 28(4): 741-7.
[http://dx.doi.org/10.1093/annonc/mdx004] [PMID: 28104621]
[49]
Madhavan B, Yue S, Galli U, et al. Combined evaluation of a panel of protein and miRNA serum-exosome biomarkers for pancreatic cancer diagnosis increases sensitivity and specificity. Int J Cancer 2015; 136(11): 2616-27.
[http://dx.doi.org/10.1002/ijc.29324] [PMID: 25388097]
[50]
Machida T, Tomofuji T, Maruyama T, et al. miR-1246 and miR-4644 in salivary exosome as potential biomarkers for pancreatobiliary tract cancer. Oncol Rep 2016; 36(4): 2375-81.
[http://dx.doi.org/10.3892/or.2016.5021] [PMID: 27573701]
[51]
von Ahrens D, Bhagat TD, Nagrath D, Maitra A, Verma A. The role of stromal cancer-associated fibroblasts in pancreatic cancer. J Hematol Oncol 2017; 10(1): 76.
[http://dx.doi.org/10.1186/s13045-017-0448-5] [PMID: 28351381]
[52]
Yu Z, Zhao S, Ren L, et al. Pancreatic cancer-derived exosomes promote tumor metastasis and liver pre-metastatic niche formation. Oncotarget 2017; 8(38): 63461-83.
[http://dx.doi.org/10.18632/oncotarget.18831] [PMID: 28969005]
[53]
Chen D, Wu X, Xia M, et al. Upregulated exosomic miR-23b-3p plays regulatory roles in the progression of pancreatic cancer. Oncol Rep 2017; 38(4): 2182-8.
[http://dx.doi.org/10.3892/or.2017.5919] [PMID: 28849236]
[54]
Steinbichler TB, Dudás J, Riechelmann H, Skvortsova II. The role of exosomes in cancer metastasis. Semin Cancer Biol 2017; 44: 170-81.
[http://dx.doi.org/10.1016/j.semcancer.2017.02.006] [PMID: 28215970]
[55]
Costa-Silva B, Aiello NM, Ocean AJ, et al. Pancreatic cancer exosomes initiate pre-metastatic niche formation in the liver. Nat Cell Biol 2015; 17(6): 816-26.
[http://dx.doi.org/10.1038/ncb3169] [PMID: 25985394]
[56]
Jónsdóttir B, Lomnytska M, Poromaa IS, Silins I, Stålberg K. The peritoneal cancer index is a strong predictor of incomplete cytoreductive surgery in ovarian cancer. Ann Surg Oncol 2021; 28(1): 244-51.
[http://dx.doi.org/10.1245/s10434-020-08649-6] [PMID: 32472412]
[57]
Zhu JW, Charkhchi P, Akbari MR. Potential clinical utility of liquid biopsies in ovarian cancer. Mol Cancer 2022; 21(1): 114.
[http://dx.doi.org/10.1186/s12943-022-01588-8] [PMID: 35545786]
[58]
Liang B, Peng P, Chen S, et al. Characterization and proteomic analysis of ovarian cancer-derived exosomes. J Proteomics 2013; 80: 171-82.
[http://dx.doi.org/10.1016/j.jprot.2012.12.029] [PMID: 23333927]
[59]
Pink RC, Samuel P, Massa D, Caley DP, Brooks SA, Carter DRF. The passenger strand, miR-21-3p, plays a role in mediating cisplatin resistance in ovarian cancer cells. Gynecol Oncol 2015; 137(1): 143-51.
[http://dx.doi.org/10.1016/j.ygyno.2014.12.042] [PMID: 25579119]
[60]
Weiner-Gorzel K, Dempsey E, Milewska M, et al. Overexpression of the microRNA miR-433 promotes resistance to paclitaxel through the induction of cellular senescence in ovarian cancer cells. Cancer Med 2015; 4(5): 745-58.
[http://dx.doi.org/10.1002/cam4.409] [PMID: 25684390]
[61]
Enriquez VA, Cleys ER, Da Silveira JC, Spillman MA, Winger QA, Bouma GJ. High LIN28A expressing ovarian cancer cells secrete exosomes that induce invasion and migration in HEK293 cells. BioMed Res Int 2015; 2015: 1-13.
[http://dx.doi.org/10.1155/2015/701390] [PMID: 26583126]
[62]
Cho JA, Park H, Lim EH, et al. Exosomes from ovarian cancer cells induce adipose tissue-derived mesenchymal stem cells to acquire the physical and functional characteristics of tumor-supporting myofibroblasts. Gynecol Oncol 2011; 123(2): 379-86.
[http://dx.doi.org/10.1016/j.ygyno.2011.08.005] [PMID: 21903249]
[63]
Keller S, König AK, Marmé F, et al. Systemic presence and tumor-growth promoting effect of ovarian carcinoma released exosomes. Cancer Lett 2009; 278(1): 73-81.
[http://dx.doi.org/10.1016/j.canlet.2008.12.028] [PMID: 19188015]
[64]
Runz S, Keller S, Rupp C, et al. Malignant ascites-derived exosomes of ovarian carcinoma patients contain CD24 and EpCAM. Gynecol Oncol 2007; 107(3): 563-71.
[http://dx.doi.org/10.1016/j.ygyno.2007.08.064] [PMID: 17900673]
[65]
Szajnik M, Derbis M, Lach M, et al. Exosomes in plasma of patients with ovarian carcinoma: Potential biomarkers of tumor progression and response to therapy. Gynecol Obstet (Sunnyvale) 2013; 29 (Suppl. 4): 3.
[66]
Meng X, Müller V, Milde-Langosch K, Trillsch F, Pantel K, Schwarzenbach H. Diagnostic and prognostic relevance of circulating exosomal miR-373, miR-200a, miR-200b and miR-200c in patients with epithelial ovarian cancer. Oncotarget 2016; 7(13): 16923-35.
[http://dx.doi.org/10.18632/oncotarget.7850] [PMID: 26943577]
[67]
Sun YS, Zhao Z, Yang ZN, et al. Risk factors and preventions of breast cancer. Int J Biol Sci 2017; 13(11): 1387-97.
[http://dx.doi.org/10.7150/ijbs.21635] [PMID: 29209143]
[68]
Berman AT, Thukral AD, Hwang WT, Solin LJ, Vapiwala N. Incidence and patterns of distant metastases for patients with early-stage breast cancer after breast conservation treatment. Clin Breast Cancer 2013; 13(2): 88-94.
[http://dx.doi.org/10.1016/j.clbc.2012.11.001] [PMID: 23218473]
[69]
O’Brien K, Rani S, Corcoran C, et al. Exosomes from triple-negative breast cancer cells can transfer phenotypic traits representing their cells of origin to secondary cells. Eur J Cancer 2013; 49(8): 1845-59.
[http://dx.doi.org/10.1016/j.ejca.2013.01.017] [PMID: 23453937]
[70]
Shi J, Ren Y, Zhen L, Qiu X. Exosomes from breast cancer cells stimulate proliferation and inhibit apoptosis of CD133+ cancer cells in vitro. Mol Med Rep 2015; 11(1): 405-9.
[http://dx.doi.org/10.3892/mmr.2014.2749] [PMID: 25338648]
[71]
Yu S, Liu C, Su K, et al. Tumor exosomes inhibit differentiation of bone marrow dendritic cells. J Immunol 2007; 178(11): 6867-75.
[http://dx.doi.org/10.4049/jimmunol.178.11.6867] [PMID: 17513735]
[72]
Gorczynski RM, Erin N, Zhu F. Serum‐derived exosomes from mice with highly metastatic breast cancer transfer increased metastatic capacity to a poorly metastatic tumor. Cancer Med 2016; 5(2): 325-36.
[http://dx.doi.org/10.1002/cam4.575] [PMID: 26725371]
[73]
Yang M, Chen J, Su F, et al. Microvesicles secreted by macrophages shuttle invasion-potentiating microRNAs into breast cancer cells. Mol Cancer 2011; 10(1): 117.
[http://dx.doi.org/10.1186/1476-4598-10-117] [PMID: 21939504]
[74]
Lv M, Zhu X, Chen W, et al. Exosomes mediate drug resistance transfer in MCF-7 breast cancer cells and a probable mechanism is delivery of P-glycoprotein. Tumour Biol 2014; 35(11): 10773-9.
[http://dx.doi.org/10.1007/s13277-014-2377-z] [PMID: 25077924]
[75]
Boelens MC, Wu TJ, Nabet BY, et al. Exosome transfer from stromal to breast cancer cells regulates therapy resistance pathways. Cell 2014; 159(3): 499-513.
[http://dx.doi.org/10.1016/j.cell.2014.09.051] [PMID: 25417103]
[76]
Eichelser C, Stückrath I, Müller V, et al. Increased serum levels of circulating exosomal microRNA-373 in receptor-negative breast cancer patients. Oncotarget 2014; 5(20): 9650-63.
[http://dx.doi.org/10.18632/oncotarget.2520] [PMID: 25333260]
[77]
Hannafon BN, Trigoso YD, Calloway CL, et al. Plasma exosome microRNAs are indicative of breast cancer. Breast Cancer Res 2016; 18(1): 90.
[http://dx.doi.org/10.1186/s13058-016-0753-x] [PMID: 27608715]
[78]
Thanikachalam K, Khan G. Colorectal cancer and nutrition. Nutrients 2019; 11(1): 164.
[http://dx.doi.org/10.3390/nu11010164] [PMID: 30646512]
[79]
Qiu M, Hu J, Yang D, Cosgrove DP, Xu R. Pattern of distant metastases in colorectal cancer: A SEER based study. Oncotarget 2015; 6(36): 38658-66.
[http://dx.doi.org/10.18632/oncotarget.6130] [PMID: 26484417]
[80]
Asangani IA, Rasheed S A K, Nikolova DA, et al. MicroRNA-21 (miR-21) post-transcriptionally downregulates tumor suppressor Pdcd4 and stimulates invasion, intravasation and metastasis in colorectal cancer. Oncogene 2008; 27(15): 2128-36.
[http://dx.doi.org/10.1038/sj.onc.1210856] [PMID: 17968323]
[81]
Webber JP, Spary LK, Sanders AJ, et al. Differentiation of tumour-promoting stromal myofibroblasts by cancer exosomes. Oncogene 2015; 34(3): 290-302.
[http://dx.doi.org/10.1038/onc.2013.560] [PMID: 24441045]
[82]
Ogata-Kawata H, Izumiya M, Kurioka D, et al. Circulating exosomal microRNAs as biomarkers of colon cancer. PLoS One 2014; 9(4): e92921.
[http://dx.doi.org/10.1371/journal.pone.0092921] [PMID: 24705249]
[83]
Komatsu S, Ichikawa D, Takeshita H, et al. Circulating miR-18a: A sensitive cancer screening biomarker in human cancer. In Vivo 2014; 28(3): 293-7.
[PMID: 24815829]
[84]
Teng Y, Ren Y, Hu X, et al. MVP-mediated exosomal sorting of miR-193a promotes colon cancer progression. Nat Commun 2017; 8(1): 14448.
[http://dx.doi.org/10.1038/ncomms14448] [PMID: 28211508]
[85]
Matsumura T, Sugimachi K, Iinuma H, et al. Exosomal microRNA in serum is a novel biomarker of recurrence in human colorectal cancer. Br J Cancer 2015; 113(2): 275-81.
[http://dx.doi.org/10.1038/bjc.2015.201] [PMID: 26057451]
[86]
Wang RJ, Zheng YH, Wang P, Zhang JZ. Serum miR-125a-5p, miR-145 and miR-146a as diagnostic biomarkers in non-small cell lung cancer. Int J Clin Exp Pathol 2015; 8(1): 765-71.
[PMID: 25755772]
[87]
Munagala R, Aqil F, Gupta RC. Exosomal miRNAs as biomarkers of recurrent lung cancer. Tumour Biol 2016; 37(8): 10703-14.
[http://dx.doi.org/10.1007/s13277-016-4939-8] [PMID: 26867772]
[88]
Sandfeld-Paulsen B, Jakobsen KR, Bæk R, et al. Exosomal proteins as diagnostic biomarkers in lung cancer. J Thorac Oncol 2016; 11(10): 1701-10.
[http://dx.doi.org/10.1016/j.jtho.2016.05.034] [PMID: 27343445]
[89]
Li W, Hu Y, Jiang T, et al. Rab27A regulates exosome secretion from lung adenocarcinoma cells A549: Involvement of EPI64. Acta Pathol Microbiol Scand Suppl 2014; 122(11): n/a..
[http://dx.doi.org/10.1111/apm.12261] [PMID: 24673604]
[90]
Fabbri M, Paone A, Calore F, et al. MicroRNAs bind to Toll-like receptors to induce prometastatic inflammatory response. Proc Natl Acad Sci USA 2012; 109(31): E2110-6.
[http://dx.doi.org/10.1073/pnas.1209414109] [PMID: 22753494]
[91]
Li J, Li Z, Jiang P, et al. Circular RNA IARS (circ-IARS) secreted by pancreatic cancer cells and located within exosomes regulates endothelial monolayer permeability to promote tumor metastasis. J Exp Clin Cancer Res 2018; 37(1): 177.
[http://dx.doi.org/10.1186/s13046-018-0822-3] [PMID: 30064461]
[92]
Yao X, Mao Y, Wu D, et al. Exosomal circ_0030167 derived from BM-MSCs inhibits the invasion, migration, proliferation and stemness of pancreatic cancer cells by sponging miR-338-5p and targeting the Wif1/Wnt8/β-catenin axis. Cancer Lett 2021; 512: 38-50.
[http://dx.doi.org/10.1016/j.canlet.2021.04.030] [PMID: 33971282]
[93]
An M, Lohse I, Tan Z, et al. Quantitative proteomic analysis of serum exosomes from patients with locally advanced pancreatic cancer undergoing chemoradiotherapy. J Proteome Res 2017; 16(4): 1763-72.
[http://dx.doi.org/10.1021/acs.jproteome.7b00024] [PMID: 28240915]
[94]
Buscail E, Chauvet A, Quincy P, et al. CD63-GPC1-positive exosomes coupled with CA19-9 offer good diagnostic potential for resectable pancreatic ductal adenocarcinoma. Transl Oncol 2019; 12(11): 1395-403.
[http://dx.doi.org/10.1016/j.tranon.2019.07.009] [PMID: 31400579]
[95]
Lai X, Wang M, McElyea SD, Sherman S, House M, Korc M. A microRNA signature in circulating exosomes is superior to exosomal glypican-1 levels for diagnosing pancreatic cancer. Cancer Lett 2017; 393: 86-93.
[http://dx.doi.org/10.1016/j.canlet.2017.02.019] [PMID: 28232049]
[96]
Nilsson J, Skog J, Nordstrand A, et al. Prostate cancer-derived urine exosomes: A novel approach to biomarkers for prostate cancer. Br J Cancer 2009; 100(10): 1603-7.
[http://dx.doi.org/10.1038/sj.bjc.6605058] [PMID: 19401683]
[97]
Chen K, Wang Q, Kornmann M, Tian X, Yang Y. The role of exosomes in pancreatic cancer from bench to clinical application: An updated review. Front Oncol 2021; 11: 644358.
[http://dx.doi.org/10.3389/fonc.2021.644358] [PMID: 33718244]
[98]
Que R, Ding G, Chen J, Cao L. Analysis of serum exosomal microRNAs and clinicopathologic features of patients with pancreatic adenocarcinoma. World J Surg Oncol 2013; 11(1): 219.
[http://dx.doi.org/10.1186/1477-7819-11-219] [PMID: 24007214]
[99]
He Y, Ye M, Zhou L, et al. High Rab11-FIP4 expression predicts poor prognosis and exhibits tumor promotion in pancreatic cancer. Int J Oncol 2017; 50(2): 396-404.
[http://dx.doi.org/10.3892/ijo.2016.3828] [PMID: 28035375]
[100]
Ying X, Wu Q, Wu X, et al. Epithelial ovarian cancer-secreted exosomal miR-222-3p induces polarization of tumor-associated macrophages. Oncotarget 2016; 7(28): 43076-87.
[http://dx.doi.org/10.18632/oncotarget.9246] [PMID: 27172798]
[101]
Beach A, Zhang HG, Ratajczak MZ, Kakar SS. Exosomes: An overview of biogenesis, composition and role in ovarian cancer. J Ovarian Res 2014; 7(1): 14.
[http://dx.doi.org/10.1186/1757-2215-7-14] [PMID: 24460816]
[102]
An T, Qin S, Xu Y, et al. Exosomes serve as tumour markers for personalized diagnostics owing to their important role in cancer metastasis. J Extracell Vesicles 2015; 4(1): 27522.
[http://dx.doi.org/10.3402/jev.v4.27522] [PMID: 26095380]
[103]
Shimizu A, Sawada K, Kobayashi M, et al. Exosomal CD47 plays an essential role in immune evasion in ovarian cancer. Mol Cancer Res 2021; 19(9): 1583-95.
[http://dx.doi.org/10.1158/1541-7786.MCR-20-0956] [PMID: 34016744]
[104]
Taylor DD, Gercel-Taylor C. MicroRNA signatures of tumor-derived exosomes as diagnostic biomarkers of ovarian cancer. Gynecol Oncol 2008; 110(1): 13-21.
[http://dx.doi.org/10.1016/j.ygyno.2008.04.033] [PMID: 18589210]
[105]
Kobayashi M, Salomon C, Tapia J, Illanes SE, Mitchell MD, Rice GE. Ovarian cancer cell invasiveness is associated with discordant exosomal sequestration of Let-7 miRNA and miR-200. J Transl Med 2014; 12(1): 4.
[http://dx.doi.org/10.1186/1479-5876-12-4] [PMID: 24393345]
[106]
Cappellesso R, Tinazzi A, Giurici T, et al. Programmed cell death 4 and microRNA 21 inverse expression is maintained in cells and exosomes from ovarian serous carcinoma effusions. Cancer Cytopathol 2014; 122(9): 685-93.
[http://dx.doi.org/10.1002/cncy.21442] [PMID: 24888238]
[107]
Zhou J, Gong G, Tan H, et al. Urinary microRNA-30a-5p is a potential biomarker for ovarian serous adenocarcinoma. Oncol Rep 2015; 33(6): 2915-23.
[http://dx.doi.org/10.3892/or.2015.3937] [PMID: 25962395]
[108]
Gao L, Nie X, Gou R, et al. Exosomal ANXA2 derived from ovarian cancer cells regulates epithelial‐mesenchymal plasticity of human peritoneal mesothelial cells. J Cell Mol Med 2021; 25(23): 10916-29.
[http://dx.doi.org/10.1111/jcmm.16983] [PMID: 34725902]
[109]
Shender VO, Pavlyukov MS, Ziganshin RH, et al. Proteome-metabolome profiling of ovarian cancer ascites reveals novel components involved in intercellular communication. Mol Cell Proteomics 2014; 13(12): 3558-71.
[http://dx.doi.org/10.1074/mcp.M114.041194] [PMID: 25271300]
[110]
Yu D, Wu Y, Shen H, et al. Exosomes in development, metastasis and drug resistance of breast cancer. Cancer Sci 2015; 106(8): 959-64.
[http://dx.doi.org/10.1111/cas.12715] [PMID: 26052865]
[111]
Chen Y, Wang L, Zhu Y, et al. Breast cancer resistance protein (BCRP)-containing circulating microvesicles contribute to chemoresistance in breast cancer. Oncol Lett 2015; 10(6): 3742-8.
[http://dx.doi.org/10.3892/ol.2015.3806] [PMID: 26788201]
[112]
Li XJ, Ren ZJ, Tang JH, Yu Q. Exosomal MicroRNA MiR-1246 promotes cell proliferation, invasion and drug resistance by targeting CCNG2 in breast cancer. Cell Physiol Biochem 2017; 44(5): 1741-8.
[http://dx.doi.org/10.1159/000485780] [PMID: 29216623]
[113]
Zhao Q, Deng S, Wang G, et al. A direct quantification method for measuring plasma MicroRNAs identified potential biomarkers for detecting metastatic breast cancer. Oncotarget 2016; 7(16): 21865-74.
[http://dx.doi.org/10.18632/oncotarget.7990] [PMID: 26967564]
[114]
Baroni S, Romero-Cordoba S, Plantamura I, et al. Exosome-mediated delivery of miR-9 induces cancer-associated fibroblast-like properties in human breast fibroblasts. Cell Death Dis 2016; 7(7): e2312-.
[http://dx.doi.org/10.1038/cddis.2016.224] [PMID: 27468688]
[115]
Zhou W, Fong MY, Min Y, et al. Cancer-secreted miR-105 destroys vascular endothelial barriers to promote metastasis. Cancer Cell 2014; 25(4): 501-15.
[http://dx.doi.org/10.1016/j.ccr.2014.03.007] [PMID: 24735924]
[116]
Tominaga N, Kosaka N, Ono M, et al. Brain metastatic cancer cells release microRNA-181c-containing extracellular vesicles capable of destructing blood–brain barrier. Nat Commun 2015; 6(1): 6716.
[http://dx.doi.org/10.1038/ncomms7716] [PMID: 25828099]
[117]
Le MTN, Hamar P, Guo C, et al. miR-200–containing extracellular vesicles promote breast cancer cell metastasis. J Clin Invest 2014; 124(12): 5109-28.
[http://dx.doi.org/10.1172/JCI75695] [PMID: 25401471]
[118]
Suetsugu A, Honma K, Saji S, Moriwaki H, Ochiya T, Hoffman RM. Imaging exosome transfer from breast cancer cells to stroma at metastatic sites in orthotopic nude-mouse models. Adv Drug Deliv Rev 2013; 65(3): 383-90.
[http://dx.doi.org/10.1016/j.addr.2012.08.007] [PMID: 22921594]
[119]
Luga V, Zhang L, Viloria-Petit AM, et al. Exosomes mediate stromal mobilization of autocrine Wnt-PCP signaling in breast cancer cell migration. Cell 2012; 151(7): 1542-56.
[http://dx.doi.org/10.1016/j.cell.2012.11.024] [PMID: 23260141]
[120]
Silva P, Mendoza P, Rivas S, et al. Hypoxia promotes Rab5 activation, leading to tumor cell migration, invasion and metastasis. Oncotarget 2016; 7(20): 29548-62.
[http://dx.doi.org/10.18632/oncotarget.8794] [PMID: 27121131]
[121]
Maji S, Chaudhary P, Akopova I, et al. Exosomal annexin II promotes angiogenesis and breast cancer metastasis. Mol Cancer Res 2017; 15(1): 93-105.
[http://dx.doi.org/10.1158/1541-7786.MCR-16-0163] [PMID: 27760843]
[122]
Sakwe AM, Koumangoye R, Guillory B, Ochieng J. Annexin A6 contributes to the invasiveness of breast carcinoma cells by influencing the organization and localization of functional focal adhesions. Exp Cell Res 2011; 317(6): 823-37.
[http://dx.doi.org/10.1016/j.yexcr.2010.12.008] [PMID: 21185831]
[123]
Yang S, Wang D, Li J, et al. Predictive role of GSTP1-containing exosomes in chemotherapy-resistant breast cancer. Gene 2017; 623: 5-14.
[http://dx.doi.org/10.1016/j.gene.2017.04.031] [PMID: 28438694]
[124]
Anfossi S, Giordano A, Gao H, et al. High serum miR-19a levels are associated with inflammatory breast cancer and are predictive of favorable clinical outcome in patients with metastatic HER2+ inflammatory breast cancer. PLoS One 2014; 9(1): e83113.
[http://dx.doi.org/10.1371/journal.pone.0083113] [PMID: 24416156]
[125]
Yuan X, Qian N, Ling S, et al. Breast cancer exosomes contribute to pre-metastatic niche formation and promote bone metastasis of tumor cells. Theranostics 2021; 11(3): 1429-45.
[http://dx.doi.org/10.7150/thno.45351] [PMID: 33391543]
[126]
Khan S, Bennit HF, Turay D, et al. Early diagnostic value of survivin and its alternative splice variants in breast cancer. BMC Cancer 2014; 14(1): 176.
[http://dx.doi.org/10.1186/1471-2407-14-176] [PMID: 24620748]
[127]
Fang S, Tian H, Li X, et al. Clinical application of a microfluidic chip for immunocapture and quantification of circulating exosomes to assist breast cancer diagnosis and molecular classification. PLoS One 2017; 12(4): e0175050.
[http://dx.doi.org/10.1371/journal.pone.0175050] [PMID: 28369094]
[128]
Galindo-Hernandez O, Villegas-Comonfort S, Candanedo F, et al. Elevated concentration of microvesicles isolated from peripheral blood in breast cancer patients. Arch Med Res 2013; 44(3): 208-14.
[http://dx.doi.org/10.1016/j.arcmed.2013.03.002] [PMID: 23506723]
[129]
Rodríguez M, Silva J, Herrera A, et al. Exosomes enriched in stemness/metastatic-related mRNAS promote oncogenic potential in breast cancer. Oncotarget 2015; 6(38): 40575-87.
[http://dx.doi.org/10.18632/oncotarget.5818] [PMID: 26528758]
[130]
Zheng R, Zhang K, Tan S, et al. Exosomal circLPAR1 functions in colorectal cancer diagnosis and tumorigenesis through suppressing BRD4 via METTL3–eIF3h interaction. Mol Cancer 2022; 21(1): 49.
[http://dx.doi.org/10.1186/s12943-021-01471-y] [PMID: 35164758]
[131]
Min L, Zhu S, Chen L, et al. Evaluation of circulating small extracellular vesicles derived miRNAs as biomarkers of early colon cancer: a comparison with plasma total miRNAs. J Extracell Vesicles 2019; 8(1): 1643670.
[http://dx.doi.org/10.1080/20013078.2019.1643670] [PMID: 31448068]
[132]
Liu T, Zhang X, Gao S, et al. Exosomal long noncoding RNA CRNDE-h as a novel serum-based biomarker for diagnosis and prognosis of colorectal cancer. Oncotarget 2016; 7(51): 85551-63.
[http://dx.doi.org/10.18632/oncotarget.13465] [PMID: 27888803]
[133]
Campanella C, Rappa F, Sciumè C, et al. Heat shock protein 60 levels in tissue and circulating exosomes in human large bowel cancer before and after ablative surgery. Cancer 2015; 121(18): 3230-9.
[http://dx.doi.org/10.1002/cncr.29499] [PMID: 26060090]
[134]
Sun B, Li Y, Zhou Y, et al. Circulating exosomal CPNE3 as a diagnostic and prognostic biomarker for colorectal cancer. J Cell Physiol 2019; 234(2): 1416-25.
[http://dx.doi.org/10.1002/jcp.26936] [PMID: 30078189]
[135]
Wang G, Liu W, Zou Y, et al. Three isoforms of exosomal circPTGR1 promote hepatocellular carcinoma metastasis via the miR449a–MET pathway. EBioMedicine 2019; 40: 432-45.
[http://dx.doi.org/10.1016/j.ebiom.2018.12.062] [PMID: 30630697]
[136]
Guo S, Hu C, Zhai X, Sun D. Circular RNA 0006602 in plasma exosomes: A new potential diagnostic biomarker for hepatocellular carcinoma. Am J Transl Res 2021; 13(6): 6001-15.
[PMID: 34306340]
[137]
Xue X, Wang X, Zhao Y, Hu R, Qin L. Exosomal miR-93 promotes proliferation and invasion in hepatocellular carcinoma by directly inhibiting TIMP2/TP53INP1/CDKN1A. Biochem Biophys Res Commun 2018; 502(4): 515-21.
[http://dx.doi.org/10.1016/j.bbrc.2018.05.208] [PMID: 29859935]
[138]
Shi M, Jiang Y, Yang L, Yan S, Wang YG, Lu XJ. Decreased levels of serum exosomal miR‐638 predict poor prognosis in hepatocellular carcinoma. J Cell Biochem 2018; 119(6): 4711-6.
[http://dx.doi.org/10.1002/jcb.26650] [PMID: 29278659]
[139]
Xu H, Dong X, Chen Y, Wang X. Serum exosomal hnRNPH1 mRNA as a novel marker for hepatocellular carcinoma. Clin Chem Lab Med[CCLM] 2018; 56(3): 479-84.
[http://dx.doi.org/10.1515/cclm-2017-0327] [PMID: 29252188]
[140]
Arbelaiz A, Azkargorta M, Krawczyk M, et al. Serum extracellular vesicles contain protein biomarkers for primary sclerosing cholangitis and cholangiocarcinoma. Hepatology 2017; 66(4): 1125-43.
[http://dx.doi.org/10.1002/hep.29291] [PMID: 28555885]
[141]
Qu JL, Qu XJ, Zhao MF, et al. Gastric cancer exosomes promote tumour cell proliferation through PI3K/Akt and MAPK/ERK activation. Dig Liver Dis 2009; 41(12): 875-80.
[http://dx.doi.org/10.1016/j.dld.2009.04.006] [PMID: 19473897]
[142]
Yang L, Wu XH, Wang D, Luo CL, Chen LX. Bladder cancer cell-derived exosomes inhibit tumor cell apoptosis and induce cell proliferation in vitro. Mol Med Rep 2013; 8(4): 1272-8.
[http://dx.doi.org/10.3892/mmr.2013.1634] [PMID: 23969721]
[143]
Sento S, Sasabe E, Yamamoto T. Application of a persistent heparin treatment inhibits the malignant potential of oral squamous carcinoma cells induced by tumor cell-derived exosomes. PLoS One 2016; 11(2): e0148454.
[http://dx.doi.org/10.1371/journal.pone.0148454] [PMID: 26849680]
[144]
Kalluri R. The biology and function of fibroblasts in cancer. Nat Rev Cancer 2016; 16(9): 582-98.
[http://dx.doi.org/10.1038/nrc.2016.73] [PMID: 27550820]
[145]
Shi R, Wang PY, Li XY, et al. Exosomal levels of miRNA-21 from cerebrospinal fluids associated with poor prognosis and tumor recurrence of glioma patients. Oncotarget 2015; 6(29): 26971-81.
[http://dx.doi.org/10.18632/oncotarget.4699] [PMID: 26284486]
[146]
Santangelo A, Imbrucè P, Gardenghi B, et al. A microRNA signature from serum exosomes of patients with glioma as complementary diagnostic biomarker. J Neurooncol 2018; 136(1): 51-62.
[http://dx.doi.org/10.1007/s11060-017-2639-x] [PMID: 29076001]
[147]
Li Q, Shao Y, Zhang X, et al. Plasma long noncoding RNA protected by exosomes as a potential stable biomarker for gastric cancer. Tumour Biol 2015; 36(3): 2007-12.
[http://dx.doi.org/10.1007/s13277-014-2807-y] [PMID: 25391424]
[148]
Huang TY, Wang CY, Chen KY, Huang LT. Urinary Exosomal thyroglobulin in thyroid cancer patients with post-ablative therapy: A new biomarker in thyroid cancer. Front Endocrinol (Lausanne) 2020; 11: 382.
[http://dx.doi.org/10.3389/fendo.2020.00382] [PMID: 32612576]
[149]
Gu X, Wang C, Deng H, et al. Exosomal piRNA profiling revealed unique circulating piRNA signatures of cholangiocarcinoma and gallbladder carcinoma. Acta Biochim Biophys Sin (Shanghai) 2020; 52(5): 475-84.
[http://dx.doi.org/10.1093/abbs/gmaa028] [PMID: 32369104]
[150]
Chung IM, Rajakumar G, Venkidasamy B, Subramanian U, Thiruvengadam M. Exosomes: Current use and future applications. Clin Chim Acta 2020; 500: 226-32.
[http://dx.doi.org/10.1016/j.cca.2019.10.022] [PMID: 31678573]
[151]
Rezaie J, Feghhi M, Etemadi T. A review on exosomes application in clinical trials: Perspective, questions, and challenges. Cell Commun Signal 2022; 20(1): 145.
[http://dx.doi.org/10.1186/s12964-022-00959-4] [PMID: 36123730]
[152]
Preethi KA, Selvakumar SC, Ross K, Jayaraman S, Tusubira D, Sekar D. Liquid biopsy: Exosomal microRNAs as novel diagnostic and prognostic biomarkers in cancer. Mol Cancer 2022; 21(1): 54.
[http://dx.doi.org/10.1186/s12943-022-01525-9] [PMID: 35172817]
[153]
Han L, Zhao Z, Yang K, et al. Application of exosomes in the diagnosis and treatment of pancreatic diseases. Stem Cell Res Ther 2022; 13(1): 153.
[http://dx.doi.org/10.1186/s13287-022-02826-y] [PMID: 35395948]
[154]
Hsu MT, Wang YK, Tseng YJ. Exosomal proteins and lipids as potential biomarkers for lung cancer diagnosis, prognosis, and treatment. Cancers (Basel) 2022; 14(3): 732.
[http://dx.doi.org/10.3390/cancers14030732] [PMID: 35158999]
[155]
Yu D, Li Y, Wang M, et al. Exosomes as a new frontier of cancer liquid biopsy. Mol Cancer 2022; 21(1): 56.
[http://dx.doi.org/10.1186/s12943-022-01509-9] [PMID: 35180868]
[156]
Hanjani NA, Esmaelizad N, Zanganeh S, et al. Emerging role of exosomes as biomarkers in cancer treatment and diagnosis. Crit Rev Oncol Hematol 2022; 169: 103565.
[http://dx.doi.org/10.1016/j.critrevonc.2021.103565] [PMID: 34871719]
[157]
Yu W, Hurley J, Roberts D, et al. Exosome-based liquid biopsies in cancer: Opportunities and challenges. Ann Oncol 2021; 32(4): 466-77.
[http://dx.doi.org/10.1016/j.annonc.2021.01.074] [PMID: 33548389]
[158]
Yu S, Huang M, Wang J, Zheng Y, Xu H. Extracellular vesicles in tumor diagnosis: A mini-review. Curr Mol Med 2021; 21(7): 596-606.
[http://dx.doi.org/10.2174/1573405616666201209103154] [PMID: 33297914]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy