Exosomes in oncofertility: emerging roles in chemotherapy-induced reproductive damage and fertility preservation

Sep 23, 2026

Uploaded by Sarah

Oncofertility addresses reproductive challenges for cancer patients, especially those receiving chemotherapy, which commonly causes gonadotoxicity and long-term infertility. Chemotherapy can alter exosome cargo, increasing cellular stress, oxidative damage, and bystander effects in gonadal tissues. In contrast, exosomes from regenerative sources such as mesenchymal stem cells and iPSCs may restore ovarian and testicular function by reducing apoptosis, enhancing angiogenesis, and supporting germ cell survival. Translational progress is limited by source heterogeneity, isolation methods, safety, and regulatory barriers.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages27

Reading Time1 h 8 min

AccessFree to download

Abstract

Lay summary

Keywords

Introduction

Fertility preservation strategies

Rationale for exosomes in oncofertility

Reproduction & Fertility (2026) 7 RAF250149 [https://doi.org/10.1530/RAF-25-0149](https://doi.org/10.1530/RAF-25-0149) REVIEW Received 26 September 2025 Accepted 7 April 2026 Available online 9 April 2026 Version of Record published 21 April 2026 Exosomes in oncofertility: emerging roles in chemotherapy-induced reproductive damage and fertility preservation Mariam M Abady1,2, Budur Alshehri3, Kholoud Aldakhil3, Alanoud Alqassim3 and Islam M Saadeldin􀀁3 1Center for Gene and Cell Therapy, Korea Research Institute of Bioscience and Biotechnology (KRIBB), Daejeon 34141, Republic of Korea 2Nutrition and Food Science Department, National Research Centre, Dokki, Giza, Egypt 3Research Laboratories, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia Correspondence should be addressed to I M Saadeldin: islamsaad82@gmail.com or to [imohamed@kfshrc.edu.sa](imohamed@kfshrc.edu.sa) This paper forms part of a special collection on Immune Regulation and Inﬂammatory Mechanisms in Reproductive Health and Disease. The collection editors were Erin Greaves, Christiane Pleuger, and Erick JR Silva. Abstract Oncofertility has emerged as a critical interdisciplinary ﬁeld addressing the reproductive challenges faced by cancer patients, particularly those undergoing chemotherapy. While chemotherapeutic agents remain indispensable in cancer therapy, their gonadotoxic effects frequently result in diminished ovarian reserve, impaired spermatogenesis, and long-term infertility. Exosomes – small extracellular vesicles enriched with nucleic acids, proteins, and lipids – are increasingly recognized as key mediators of intercellular communication in both pathological and regenerative contexts. Recent evidence suggests that chemotherapy alters exosome cargo, thereby amplifying cellular stress responses, oxidative damage, and bystander effects in gonadal tissues. Conversely, exosomes derived from mesenchymal stem cells, induced pluripotent stem cells (iPSCs), and other regenerative sources demonstrate the ability to restore ovarian and testicular function by reducing apoptosis, enhancing angiogenesis, and supporting germ cell survival. This dual role positions exosomes as both contributors to reproductive toxicity and promising therapeutic agents in fertility preservation strategies. However, clinical translation remains hindered by challenges including source heterogeneity, isolation methods, safety concerns, and regulatory barriers. This review highlights the emerging roles of exosomes in chemotherapy-induced reproductive damage, explores their regenerative potential, and outlines future directions for their integration into oncofertility practice. Lay summary Cancer treatments such as chemotherapy save lives, but they often damage the ovaries and testes. This can lead to infertility in both women and men, which is one of the most difﬁcult problems for cancer survivors. Finding ways to protect or restore fertility is, therefore, an important part of cancer care. Our work looks at very small particles called exosomes. These are natural messengers that carry proteins and genetic material between cells. We explain how chemotherapy changes these exosomes in a way that increases damage to reproductive organs. At the same time, we show that exosomes from stem cells may help repair this damage. In laboratory studies, they have been shown to protect eggs and sperm and reduce cell death of the reproductive organs during chemotherapy. Exosomes can also act as Published by Bioscientiﬁca Ltd. [https://raf.bioscienti](https://raf.bioscienti)ﬁ[ca.com](ca.com) © 2026 the author(s) This work is licensed under a Creative Commons Attribution 4 .0 International License. M M Abady et al. Reproduction & Fertility (2026) 7 RAF250149 [https://doi.org/10.1530/RAF-25-0149](https://doi.org/10.1530/RAF-25-0149) simple blood-based tests to detect damage and monitor recovery. This research is important because it points to

FAQs

Why is oncofertility important for cancer patients?

Oncofertility focuses on preventing or mitigating reproductive damage caused by cancer treatment. Chemotherapy can reduce ovarian reserve, impair spermatogenesis, and lead to infertility in survivors.

How do exosomes relate to chemotherapy-induced reproductive damage?

Chemotherapy can change exosome cargo, which can amplify stress responses, oxidative damage, and bystander effects in gonadal tissues.

What evidence supports exosomes as potential fertility-preserving therapies?

Exosomes from regenerative sources such as mesenchymal stem cells and iPSCs may restore reproductive function by reducing apoptosis, enhancing angiogenesis, and supporting germ cell survival.

Sep 23, 2026

Uploaded by Sarah