Perspectives of Examination in Clinical Practice

One of the most important problems of molecular medicine is the diagnosis and treatment of pathological and oncological diseases. Studies have shown that cells of malignant tumors sometimes “throw” microtubules, releasing tiny particles of RNA, which, when they enter into healthy cells, convert them into cancer. These are extracellular vesicles, whose diameter is 35-90 nanometers, they are divided into intercellular space by cells of various tissues and organs. They are also found in the tissues of the body-in the serum of blood, urine, spinal cord blood and saliva. Their cavity has a cytoplasm and includes various types of proteins, micro-RNAs and lipids. These bubbles have been called “exo-somas” [1]. Of great interest is their potential role in the development of various diseases from cardiovascular to oncological. First, there are reasons to believe that the appearance of malignant neoplasms significantly increases the amount of exosomes in various biological fluids of man. Second, the analysis of the protein profile and RNA contained in the exosomes may allow judging by their tissue walking and pathological changes in a particular tissue. One can expect that the expansion of the methodical arsenal used today for the study of exosomes will allow for additional information on this new fundamentally biological phenomenon.


Introduction
One of the most important problems of molecular medicine is the diagnosis and treatment of pathological and oncological diseases. Studies have shown that cells of malignant tumors sometimes "throw" microtubules, releasing tiny particles of RNA, which, when they enter into healthy cells, convert them into cancer. These are extracellular vesicles, whose diameter is 35-90 nanometers, they are divided into intercellular space by cells of various tissues and organs. They are also found in the tissues of the body-in the serum of blood, urine, spinal cord blood and saliva.
Their cavity has a cytoplasm and includes various types of proteins, micro-RNAs and lipids. These bubbles have been called "exo-somas" [1]. Of great interest is their potential role in the development of various diseases -from cardiovascular to oncological. First, there are reasons to believe that the appearance of malignant neoplasms significantly increases the amount of exosomes in various biological fluids of man. Second, the analysis of the protein profile and RNA contained in the exosomes may allow judging by their tissue walking and pathological changes in a particular tissue. One can expect that the expansion of the methodical arsenal used today for the study of exosomes will allow for additional information on this new fundamentally biological phenomenon.
Exosomes were first described in 1983 when studying the differentiation of reticulocytes. In 1985, it was demonstrated that exosomes alter the structure of reticulocyte membranes by removing transferrin receptors.
Initially, the exosomes were seen as "reservoirs" -trash cans to remove excess cytoplasm and were perceived as a product of lifeaffluence of cells. In the late 1900s, it was shown that exosomes are involved in the regulation of immune responses in the body, indicating that they play an important role in providing intercellular interaction. In 2007, micro-RNAs and mRNAs were found in the vesicles that transpire genetic information to target cells. This greatly increased the interest in these extracellular vesicles. In the study of cultures of embryonic stem cells, it has been proved that the exosomes are capable of hormonal transfer of mRNA between cells. Exosomes transfer specific mRNAs to the blood cells of the blood, which leads to phenotypic changes in the recipient cells. It is now believed that nucleic acids transmitted by exosomes engage in epigenetic imitation, that is, hereditary changes in the phenotype or expression of genes caused by mechanisms that are not related to the change in the DNA sequence [1].
First, the exosomes are formed inside the cell -by the budding of the cavity, called the endosome. When a sufficient amount of exosomes is accumulated in this cavity, their further fraction depends on what lipids are labeled with the membrane of the endosome.
If the endosome is labeled with lysobisphosphatidylalcohol (phosphatidylinositol-3-phosphate) and contains ubiquitin proteins, then its contents will be destroyed: it will merge with the lysosome. If the membrane of the endosomes contains ceramides, it will merge with the surface membrane of the cell, and most of the exosomes will escape into the extracellular medium ( Figure 1) The path of education is an ecosome the mechanism of absorption by mammalian cells of exosomes is currently poorly understood.
The endocytosis process is negatively controlled by the caveolin-1 protein.

a) Intercellular Communication
Cells communicate with other cells using exosomes. In some cases, vesicles bind to adjacent cells and isolate micro-RNA in the middle of the cell [2].

b) Immunomodulating Function
Exosomes transport proteins of the main complex of histocompatibility -MHC Class I and II, necessary for the immune response in specialized T-lymphocytes. Also, on their membrane is a special HLA-G receptor, which provides an antigen presentation.
NK cells also secrete exosomes. They have substances that, when interacting with a cell membrane (cancer cells), cause its apoptosis [3].

c) Distribution of Viruses and Tumor cells
Tumors and viruses can spread through exosmosis. Vesicles of the tumor inhibit the immune response and provoke metastasis. In addition, they are able to deliver micro-RNA into a healthy cell, thereby changing the expression of genes and disrupting their adequate work.

d) Regenerative Function
Exosomes play an important role in restoring damaged organs.

b) Two-Dimensional Electrophoresis (2DE)
For 2DE, use the methodological approaches described earlier. The spectra are obtained in a mode of reflection, using approximately 50-100 laser shots throughout the target area. Total spectra are analyzed using special programs.The result of such an exosomal study is the formation of a protein profile, which allows identification and diagnosis of a particular tissue or organ [4].
Discussion Due to its high specificity, the exosomes can be used in clinical practice as conveyors for certain types of drugs, dostheming them to target cells, reducing the possibility of mutations, especially in cancer cases [5]. In addition, exosomes, which are in the plasma of blood, urine, saliva and other biologic environments, have the opportunity not only to diagnose the disease, but also to establish a stage of the disease that will allow the abandonment of the biopsy. Exosomes are isolated from hematopoietic stem cells that can protect damaged cells from death by stimulating the resumption of cell division, because on the surface of exotomy, growth antiapoptotic factors are synthesized that can be used in the treatment of acute ischemic stroke, myocardial infarction, ischemia of the lower extremities, and other serious diseases.

Conclusion
Thus, despite the fact that the functions of exosomes are at the research stage and have not been fully studied, it is necessary to conclude that with the help of exosomes in the nearest years significant steps will be taken in the diagnosis and therapy of cancer and other serious diseases.