Emerging Roles of Exosomes and Exosomal Antigens as Potential Diagnostic and Prognostic Agents for Mycobacterium tuberculosis Infection

Mohammad Muzaffar Mir^1,*, Rashid Mir^2,3, Badr A. Alsayed⁴, Mohammed M. Jalal³, Malik A. Altayar³, Hanan M. Aljammaz⁵, Zinab Alatawi⁶, Khalid A. Alfifi², Basmah M. Alenzi⁷, Mohammad Tanveer Khaji⁸, Umair Ismail⁹, Ghada Mohamed^10,11, Nada Zai Sageer¹², Abdullatif Taha Babakr¹³, Saba M. Mir¹⁴, Ulfat Jan¹⁵
1 Department of Clinical Biochemistry, College of Medicine, University of Bisha, Bisha, Saudi Arabia
2 Prince Fahd Bin Sultan Chair for Biomedical Research, University of Tabuk, Tabuk, Saudi Arabia
3 Department of Medical Lab Technology, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk, Saudi Arabia
4 Department of Internal Medicine, Faculty of Medicine, University of Tabuk, Tabuk, Saudi Arabia
5 Family Medicine Resident, Tabuk Health Cluster, Tabuk, Saudi Arabia
6 Department of Family Medicine, University of Tabuk, Tabuk, Saudi Arabia
7 Ministry of Health, Tabuk Region, Tabuk, Saudi Arabia
8 Microbiology Department, King Salman Armed Forces Hospital—Northwestern Region, Tabuk, Saudi Arabia
9 Molecular Biology Department, King Salman Armed Forces Hospital—Northwestern Region, Tabuk, Saudi Arabia
10 Pathology Department, National Cancer Institute, Cairo University, Cairo, Egypt
11 Histopathology Lab, King Fahad Specialist Hospital, Tabuk, Saudi Arabia
12 King Faisal Hospital, Ministry of Health, Makkah, Saudi Arabia
13 Department of Medical Biochemistry, Faculty of Medicine, Umm al-Qura University, Makkah, Saudi Arabia
14 Department of Microbiology, Government Medical College, Baramulla, India
15 Genome Diversity Unit, University of Tabuk, Tabuk, Saudi Arabia
* Corresponding Author: Mohammad Muzaffar Mir. Email: email

BIOCELL https://doi.org/10.32604/biocell.2026.077540

Received 11 December 2025; Accepted 13 March 2026; Published online 10 April 2026

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Abstract

The tuberculosis (TB) epidemic continues to be one of the largest public health challenges affecting people globally, especially due to late diagnosis, disease monitoring, and prognosis. Currently used diagnostic tools have variable sensitivity and accessibility, and many have limited ability to differentiate between latent and active TB. In case of TB, exosomes from cells infected with Mycobacterium tuberculosis (M. tuberculosis) have disease-specific antigens, microRNAs, and other molecular components, which make them potential diagnostic and prognostic biomarkers. This review focuses on previously published literature regarding the role of exosomes and exosomal antigens in TB screening and prognostication. It highlights their potential as non-conventional biomarkers due to their stability in biological fluids, specificity, and the availability of less invasive sampling techniques. Moreover, it covers recent developments in techniques for isolating and characterizing exosomes and also ways in which the gaps between exosome-based biomarkers have been challenged in real-world clinical settings. In the future, research needs to prioritize large validation studies, achievement-in-exosome-based assays, and incorporation of multi-omics techniques to improve their clinical relevance. The use of exosome-based biomarkers shows promise for improving diagnostic processes for tuberculosis and may support a worldwide campaign for tuberculosis control.