Abstract

Adipose tissue derived exosomes are nanoscale extracellular vesicles released by adipocytes, stromal cells, and 
immune cells within fat depots. In obesity, their secretion rate and molecular cargo shift toward pro
inflammatory, lipotoxic, and oncogenic profiles that reprogram cancer cells and their microenvironments to 
favor growth, invasion, metastasis, and therapy resistance. At the same time, these vesicles possess inherent 
attributes biocompatibility, immune stealth, membrane complexity, and tissue tropism that can be redirected for 
therapeutic delivery of small molecules, biologics, and nucleic acids. This review synthesizes current 
understanding of the dual nature of adipose-derived exosomes in obesity-related malignancies. It outlines how 
obesity remodels exosome biogenesis and content, explains the mechanisms by which these vesicles drive tumor 
progression, and details strategies to engineer them as precision nanocarriers. The discussion covers isolation 
and manufacturing in dyslipidemic contexts, quality and safety controls that minimize pro-tumor risks, and 
translational frameworks for dosing, imaging, and clinical integration alongside metabolic and 
microenvironment-normalizing interventions. The goal is to convert a conduit of disease signaling into a 
clinically reliable delivery system tailored to high-BMI populations.