Extracellular Vesicles as Surrogates for Drug Metabolism and Clearance: Promise vs. Reality

Extracellular vesicles (EVs) hold promise as non-invasive surrogates for assessing drug metabolism and clearance, potentially enhancing personalized medicine by reflecting tissue-specific enzyme and transporter activity. They carry drug-metabolizing enzymes (DMEs) and transporters, which can indicate individual drug metabolism and excretion capacities. However, challenges remain, such as inconsistent correlations between EV content and tissue enzyme levels, particularly for certain enzymes like CYP2D6. While EVs could improve drug dose optimization and predict drug resistance, further research is needed to address methodological limitations in EV isolation, analysis, and data normalization to fully validate their clinical utility.