Radiolabeled exosomes for theranostics: Personalized tailored therapy through imaging

doi:10.4329/wjr.122678

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World Journal of Radiology

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1949-8470

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Radiol. Jul 28, 2026; 18(7): 122678
Published online Jul 28, 2026. doi: 10.4329/wjr.122678

Radiolabeled exosomes for theranostics: Personalized tailored therapy through imaging

Soumya Deep Phadikar, Aliza Hyder, Ramya Lakshmi Rajendran, Anand Krishnan, Chae Moon Hong, Prakash Gangadaran, Byeong-Cheol Ahn

Soumya Deep Phadikar, Department of Chemistry and Chemical Biology, Indian Institute of Technology (ISM), Dhanbad 826004, Jharkhand, India

Aliza Hyder, Department of Biological Sciences, Birla Institute of Technology and Science, Pilani (Hyderabad Campus), Hyderabad 500078, Telengana, India

Ramya Lakshmi Rajendran, BK21 FOUR KNU Convergence Educational Program of Biomedical Sciences for Creative Future Talents, Department of Biomedical Sciences, School of Medicine, Kyungpook National University, Daegu 41944, South Korea

Ramya Lakshmi Rajendran, Chae Moon Hong, Prakash Gangadaran, Byeong-Cheol Ahn, Department of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu 41944, South Korea

Ramya Lakshmi Rajendran, Chae Moon Hong, Prakash Gangadaran, Byeong-Cheol Ahn, Cardiovascular Research Institute, Kyungpook National University, Daegu 41944, South Korea

Anand Krishnan, Precision Medicine and Integrated Nano-Diagnostics (P-MIND) Research Laboratory, Department of Haematology and Cell Biology, School of Pathology, Faculty of Health Sciences, University of the Free State, Bloemfontein 9300, South Africa

Chae Moon Hong, Byeong-Cheol Ahn, Department of Nuclear Medicine, Kyungpook National University Hospital, Daegu 41944, South Korea

Co-first authors: Soumya Deep Phadikar and Aliza Hyder.

Co-corresponding authors: Prakash Gangadaran and Byeong-Cheol Ahn.

Author contributions: Phadikar SD, Hyder A, Rajendran RL, Krishnan A, Hong CM, Gangadaran P, and Ahn BC designed the overall concept and outline of the manuscript, contributed to the discussion and design of the manuscript, manuscript writing and editing, illustrations, and the literature review; Phadikar SD and Hyder A contributed equally to this work and are regarded as co-first authors; Gangadaran P and Ahn BC served as co-corresponding authors and contributed equally to the supervision, critical revision, and final approval of the manuscript.

AI contribution statement: An AI-based tools (Wordvice AI or ChatGPT by OpenAI, GPT-5.2, accessed June 2026) was used under author supervision in a limited manner to improve English expression, clarify structure, and adjust word count. The authors reviewed and edited the content independently and took full responsibility for the final manuscript.

Conflict-of-interest statement: The authors declare that there are no conflicts of interest regarding the publication of this paper.

Corresponding author: Byeong-Cheol Ahn, MD, PhD, Professor, Department of Nuclear Medicine, School of Medicine, Kyungpook National University, 680, Gukchaebosang ro, Jung gu, Daegu 41944, South Korea. abc2000@knu.ac.kr

Received: April 27, 2026
Revised: June 10, 2026
Accepted: June 23, 2026
Published online: July 28, 2026
Processing time: 91 Days and 0.2 Hours

Abstract

Radiolabeled exosomes have emerged as a transformative platform at the intersection of nanomedicine, molecular imaging, and precision theranostics. These nanoscale extracellular vesicles exhibit intrinsic biocompatibility, low immunogenicity, and inherent targeting capabilities, making them highly attractive for both diagnostic and therapeutic applications. The integration of radiochemistry with exosome biology enables noninvasive, real-time tracking of biodistribution, pharmacokinetics, and target engagement using advanced imaging modalities such as positron emission tomography and single-photon emission computed tomography. This minireview comprehensively summarizes current radiolabeling strategies for exosomes, including direct and indirect approaches, highlighting their advantages, limitations, and impact on vesicle integrity and imaging accuracy. Furthermore, we discuss key imaging platforms, in vivo biodistribution patterns, and pharmacokinetic profiles that influence therapeutic efficacy. Critical challenges such as rapid clearance by the mononuclear phagocyte system, labeling instability, and the lack of standardized protocols are also addressed. Finally, we outline future perspectives focusing on advanced bioengineering, multimodal imaging integration, and clinical translation frameworks. Radiolabeled exosomes represent a promising next-generation theranostic system with the potential to enable personalized, image-guided therapies across oncology and regenerative medicine.

Keywords: Radiolabeled exosomes; Extracellular vesicles; Theranostics; Positron emission tomography imaging; Single-photon emission computed tomography imaging; Biodistribution; Pharmacokinetics; Nanomedicine; Drug delivery

Core Tip: Radiolabeled exosomes offer a powerful theranostic platform that combines targeted drug delivery with real-time with noninvasive imaging. By enabling precise tracking of biodistribution and therapeutic response through positron emission tomography and single-photon emission computed tomography, they provide significant advantages over conventional nanocarriers. Despite challenges such as rapid systemic clearance and labeling instability, advances in radiochemistry and exosome engineering are accelerating their clinical translation toward personalized medicine.