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Review
. 2025 Jul 16:30:389-402.
doi: 10.1016/j.reth.2025.06.020. eCollection 2025 Dec.

Exosomes promise better bone regeneration

Shuaiwen Hu  1 , Shaogeng Wang  2   3 , Xiaomao Yang  1 , Ping Li  1 , Zhiguo Li  1 , Bin Luo  1 , Yujie Liang  2   3 , Xiaohua Pan  2   3
Affiliations
Review

Exosomes promise better bone regeneration

Shuaiwen Hu et al. Regen Ther. .

Abstract

Fractures primarily result from high-energy trauma, leading to structural discontinuity of bone tissue. Contemporary therapeutic approaches continue to face persistent challenges including nonunion, infection, and inflammatory complications that pose significant clinical management difficulties. Emerging evidence demonstrates that extracellular vesicles (EVs), particularly exosomes, serve as critical mediators in diverse pathophysiological processes. Accumulating studies reveal that exosomal cargos enhance osteogenesis and angiogenesis through dynamic regulation of cellular components and molecular networks within the bone remodeling microenvironment, thereby potentiating fracture healing cascades. This comprehensive review systematically examines the mechanistic contributions of exosomes in coordinating osteoblastic differentiation, osteoclastic activity modulation, and neovascularization processes. In addition, we describe the role of exosomes from different cellular sources (e.g., mesenchymal stem cells, endothelial progenitor cells, and osteoblasts) in fracture repair. Finally, this paper elaborates on the potential challenges and future directions for the development of novel exosome-based therapeutic strategies for clinical fracture repair.

Keywords: Exosomes; Extracellular vesicles; Fracture repair; Regeneration.

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Conflict of interest statement

The authors declare no conflicts of interests that could have appeared to influence the work reported in this paper.

Figures

Image 1
Graphical abstract
Fig. 1
Fig. 1
The biological journey of exosome: from biogenesis to uptake and its structural composition.
Fig. 2
Fig. 2
The process of human fracture repair and the mechanism of Exosomes in fracture repair. (The "arrow" indicates the next stage of fracture healing process and the indicative role of extracellular vesicles from different sources on fracture healing).
See this image and copyright information in PMC

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