Clinical applications of stem cell-derived exosomes

Abstract

Although stem cell-based therapy has demonstrated considerable potential to manage certain diseases more successfully than conventional surgery, it nevertheless comes with inescapable drawbacks that might limit its clinical translation. Compared to stem cells, stem cell-derived exosomes possess numerous advantages, such as non-immunogenicity, non-infusion toxicity, easy access, effortless preservation, and freedom from tumorigenic potential and ethical issues. Exosomes can inherit similar therapeutic effects from their parental cells such as embryonic stem cells and adult stem cells through vertical delivery of their pluripotency or multipotency. After a thorough search and meticulous dissection of relevant literature from the last five years, we present this comprehensive, up-to-date, specialty-specific and disease-oriented review to highlight the surgical application and potential of stem cell-derived exosomes. Exosomes derived from stem cells (e.g., embryonic, induced pluripotent, hematopoietic, mesenchymal, neural, and endothelial stem cells) are capable of treating numerous diseases encountered in orthopedic surgery, neurosurgery, plastic surgery, general surgery, cardiothoracic surgery, urology, head and neck surgery, ophthalmology, and obstetrics and gynecology. The diverse therapeutic effects of stem cells-derived exosomes are a hierarchical translation through tissue-specific responses, and cell-specific molecular signaling pathways. In this review, we highlight stem cell-derived exosomes as a viable and potent alternative to stem cell-based therapy in managing various surgical conditions. We recommend that future research combines wisdoms from surgeons, nanomedicine practitioners, and stem cell researchers in this relevant and intriguing research area.

Fig. 1

Illustration of the upstream measures of exosome therapy (figure generated using Autodesk 3ds Max 2023). a production and purification of exosomes (MSCs and NSCs are used as examples for multipotent stem cells). b content of natural exosomes. c modification of exosomes. (BM bone marrow, DC dendritic cell, IAC immunoaffinity chromatography, iPSC induced pluripotent stem cell, MHC major histocompatibility complex, miRNA microRNA, MSC mesenchymal stem cell, MVB multivesicular body, NSC neural stem cell, SEC size-exclusion chromatography, UC umbilical cord)

Fig. 2

Illustration of the downstream surgical applications of exosome therapy (figure generated using Adobe Photoshop 2023 and Adobe Illustrator 2023). The therapeutic effects of exosomes are a hierarchical translation through disease-specific tissue responses, tissue-specific cellular alterations, and cell-specific molecular signaling pathways

Fig. 3

Mechanisms of stem cell-derived exosome therapy (figure generated using Adobe Photoshop 2023 and Adobe Illustrator 2023). a activation and regulation of various signaling pathways. b disease-specific cellular and tissue responses