# Systematic Review: Exosomes as Molecular Messengers in the Development of Obesity-Related Complications in Children

## TL;DR

This paper reviews how exosomes contribute to obesity-related complications in children and highlights their potential for diagnosis and treatment.

## Contribution

The paper systematically reviews the role of exosomes in linking pediatric obesity to multi-organ complications and their potential for early detection and therapy.

## Key findings

- Exosomes from adipose and endothelial cells carry bioactive cargo that worsens metabolic and vascular issues in obese children.
- Maternal obesity alters exosome composition in breast milk, potentially increasing offspring obesity risk.
- Exosomes may serve as early diagnostic and therapeutic targets for obesity-related diseases in children.

## Abstract

Emerging evidence highlights extracellular vesicles (EVs), especially exosomes, as critical molecular messengers linking pediatric obesity to multi-organ complications. This scoping review synthesizes current knowledge on EVs-mediated intercellular communication that exacerbates inflammation, insulin resistance, endothelial dysfunction and organ-specific damage. Data demonstrate that adipose- and endothelial-derived EVs carry bioactive cargo, microRNAs, proteins, and lipids, that modulate key pathways driving metabolic derangements and vascular injury, often preceding detectable clinical biomarkers. Notably, maternal obesity influences EVs composition in breast milk, shaping early-life metabolic programming and offspring risk of obesity. Recent studies underscore the diagnostic and therapeutic potential of EVs in obesity-related conditions such as metabolic-associated fatty liver disease (MAFLD), early renal injury, and cardiovascular dysfunction in children. Furthermore, EVs released in response to exercise or bariatric surgery may mediate systemic metabolic improvements, offering a novel window into personalized interventions. Despite promising findings, standardization of EV isolation and profiling in pediatric research is lacking, and large-scale longitudinal studies are urgently needed. By deepening our understanding of EVs biology, clinicians may advance early detection, risk stratification, and targeted therapies to interrupt the progression from childhood obesity to lifelong metabolic and cardiovascular disease.