Department of Periodontology, University of Bern, Bern, Switzerland.
Advanced PRF Education, Venice, Florida, USA.
Periodontol 2000. 2024 Feb;94(1):415-482. doi: 10.1111/prd.12557. Epub 2024 Mar 28.
Exosomes are the smallest subset of extracellular signaling vesicles secreted by most cells with the ability to communicate with other tissues and cell types over long distances. Their use in regenerative medicine has gained tremendous momentum recently due to their ability to be utilized as therapeutic options for a wide array of various diseases. Over 5000 publications are currently being published on this topic yearly, many of which in the dental space. This extensive review article is the first scoping review aimed at summarizing all therapeutic uses of exosomes in regenerative dentistry. A total of 944 articles were identified as using exosomes in the dental field for either their regenerative/therapeutic potential or for diagnostic purposes derived from the oral cavity. In total, 113 research articles were selected for their regenerative potential (102 in vitro, 60 in vivo, 50 studies included both). Therapeutic exosomes were most commonly derived from dental pulps, periodontal ligament cells, gingival fibroblasts, stem cells from exfoliated deciduous teeth, and the apical papilla which have all been shown to facilitate the regenerative potential of a number of tissues including bone, cementum, the periodontal ligament, nerves, aid in orthodontic tooth movement, and relieve temporomandibular joint disorders, among others. Results demonstrate that the use of exosomes led to positive outcomes in 100% of studies. In the bone field, exosomes were found to perform equally as well or better than rhBMP2 while significantly reducing inflammation. Periodontitis animal models were treated with simple gingival injections of exosomes and benefits were even observed when the exosomes were administered intravenously. Exosomes are much more stable than growth factors and were shown to be far more resistant against degradation by periodontal pathogens found routinely in a periodontitis environment. Comparative studies in the field of periodontal regeneration found better outcomes for exosomes even when compared to their native parent stem cells. In total 47 diagnostic studies revealed a role for salivary/crevicular fluid exosomes for the diagnosis of birth defects, cardiovascular disease, diabetes, gingival recession detection, gingivitis, irritable bowel syndrome, neurodegenerative disease, oral lichen planus, oral squamous cell carcinoma, oropharyngeal cancer detection, orthodontic root resorption, pancreatic cancer, periodontitis, peri-implantitis, Sjögren syndrome, and various systemic diseases. Hence, we characterize the exosomes as possessing "remarkable" potential, serving as a valuable tool for clinicians with significant advantages.
外泌体是大多数细胞分泌的最小细胞外信号小泡，具有与其他组织和细胞类型进行长距离通讯的能力。由于其可作为治疗多种疾病的选择，因此它们在再生医学中的应用最近得到了极大的推动。目前每年有超过 5000 篇关于这个主题的出版物，其中许多都在牙科领域。这篇广泛的综述文章是第一篇旨在总结外泌体在再生牙科中所有治疗用途的范围综述。共有 944 篇文章被确定为在口腔领域使用外泌体，无论是用于其再生/治疗潜力还是用于从口腔衍生的诊断目的。总共，有 113 篇研究文章因其再生潜力而被选中（102 篇在体外，60 篇在体内，50 项研究同时包含两者）。治疗性外泌体最常源自牙髓、牙周韧带细胞、牙龈成纤维细胞、脱落乳牙的干细胞和根尖乳头，所有这些都已被证明可以促进包括骨、牙骨质、牙周韧带、神经在内的许多组织的再生潜力，有助于正畸牙齿移动，并缓解颞下颌关节紊乱等。结果表明，在 100%的研究中，使用外泌体导致了积极的结果。在骨领域，发现外泌体的表现与 rhBMP2 一样好或更好，同时显著减少炎症。牙周炎动物模型用简单的牙龈注射外泌体治疗，甚至当外泌体静脉内给药时也观察到益处。外泌体比生长因子更稳定，并且在牙周炎环境中常规发现的牙周病原体降解方面表现出更高的抗性。牙周再生领域的比较研究发现，即使与外泌体的天然母干细胞相比，外泌体也能带来更好的结果。总共 47 项诊断研究揭示了唾液/龈沟液外泌体在诊断出生缺陷、心血管疾病、糖尿病、牙龈退缩检测、牙龈炎、肠易激综合征、神经退行性疾病、口腔扁平苔藓、口腔鳞状细胞癌、口咽癌检测、正畸根吸收、胰腺癌、牙周炎、种植体周围炎、干燥综合征和各种全身性疾病中的作用。因此，我们将外泌体描述为具有“显著”的潜力，作为临床医生的有价值的工具，具有显著的优势。
