Salivary Extracellular Vesicles as Early Biomarkers of Autoimmune Oral Diseases

Abstract

Salivary extracellular vesicles (sEVs), including exosomes and microvesicles, have emerged as promising non-invasive biomarkers for the early detection and monitoring of autoimmune oral diseases. These nanoscale vesicles contain diverse biological cargo, including proteins, lipids, messenger RNAs, microRNAs, and other regulatory molecules that reflect physiological and pathological changes occurring within oral and systemic tissues. Their presence in saliva provides an accessible opportunity to identify molecular alterations associated with immune dysregulation before substantial clinical manifestations develop. In autoimmune conditions such as primary Sjögren’s syndrome, systemic lupus erythematosus, and rheumatoid arthritis, disease-associated changes in extracellular vesicle composition may provide valuable information regarding inflammation, salivary gland dysfunction, tissue injury, and disease activity. Advances in extracellular vesicle isolation, molecular profiling, multi-omics analysis, and artificial intelligence may facilitate the identification of highly specific biomarker signatures and improve diagnostic accuracy. Salivary EVs may also support disease monitoring, treatment-response assessment, and personalized clinical management. However, variability in saliva collection, EV isolation, characterization, molecular heterogeneity, and biomarker validation remains a major barrier to routine clinical implementation. Standardized methodologies and large-scale prospective studies are therefore required to establish clinically reliable diagnostic panels. Overall, salivary extracellular vesicles represent a promising foundation for minimally invasive, precision-oriented diagnosis of autoimmune oral diseases.