The Role of Exosomes in Oral Lichen Planus

Abstract

Background: Oral lichen planus (OLP) is a chronic immune-mediated inflammatory disease of the oral mucosa characterized by persistent T-cell-mediated injury, keratinocyte apoptosis, and recurrent inflammatory activity. Although topical and systemic corticosteroids remain the mainstay of treatment, their prolonged use may be associated with relapse, mucosal atrophy, candidiasis, and systemic adverse effects, highlighting the need for safer and more targeted therapeutic approaches. Exosomes, also referred to as small extracellular vesicles, are nanosized lipid bilayer-bound particles, approximately 30–150 nm in diameter, that originate from the endosomal pathway and mediate intercellular communication through the transfer of proteins, lipids, messenger RNA, microRNA, and other biologically active molecules. Emerging evidence suggests that exosomes participate in the immunopathogenesis of OLP by regulating communication between epithelial and immune cells, promoting inflammatory-cell recruitment, antigen presentation, cytokine signaling, and keratinocyte apoptosis. Conversely, mesenchymal stem cell-derived exosomes may exert therapeutic effects by suppressing pro-inflammatory cytokines, modulating macrophage polarization, restoring immune homeostasis, reducing epithelial injury, and enhancing angiogenesis and tissue regeneration. Exosomal microRNAs detected in saliva, plasma, and oral tissues may also serve as non-invasive biomarkers for diagnosis and assessment of disease severity. This review discusses the biological role, pathogenic mechanisms, diagnostic potential, therapeutic applications, safety advantages, current limitations, and future perspectives of exosomes in OLP.