Chu Chung-Hua, Lee Ru-Ping, Wu Wen-Tien, Chen Ing-Ho, Yeh Kuang-Ting, Wang Chen-Chie
Department of Orthopedic Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231016, Taiwan.
Department of Biomedical Engineering, National Taiwan University, Taipei 106216, Taiwan.
Biomedicines. 2024 Oct 28;12(11):2478. doi: 10.3390/biomedicines12112478.
BACKGROUND/OBJECTIVES: Osteoarthritis (OA) is a prevalent and debilitating joint disorder characterized by progressive cartilage degradation and inflammation, for which traditional treatments offer only symptomatic relief without halting disease progression. Exosomes, cell-free vesicles derived from mesenchymal stem cells, have emerged as a promising alternative therapy owing to their regenerative and anti-inflammatory properties.
This review synthesizes findings from recent studies (2017-2023) on the therapeutic potential of exosomes in OA treatment, highlighting their ability to modulate the joint microenvironment, reduce inflammation, and promote cartilage repair by delivering bioactive molecules such as cytokines, growth factors, and regulatory ribonucleic acids.
We explore the integration of exosomes with biomaterials, such as hydrogels and scaffolds, to enhance their delivery and therapeutic efficacy, and we address the critical challenges associated with their clinical application, including standardization of isolation and characterization methods, scalability of production, mechanistic understanding, and long-term safety. Despite these challenges, exosome-based therapies offer several advantages over traditional and cell-based treatments, including lower immunogenicity, ease of handling, and targeted delivery of therapeutic agents to damaged tissues.
We provide an analytical perspective on the current state of exosome research in OA, emphasizing the need for standardized production methods, deeper mechanistic insights, and rigorous long-term safety assessments. Future directions should focus on optimizing delivery systems, exploring personalized medicine approaches, and conducting comparative effectiveness studies to fully realize the potential of exosome therapies for OA treatment. Addressing these gaps will be crucial for translating exosome therapies from bench to bedside and achieving a transformative impact on OA management.
背景/目的：骨关节炎（OA）是一种常见且使人衰弱的关节疾病，其特征为软骨进行性退化和炎症，传统治疗方法仅能缓解症状，无法阻止疾病进展。外泌体是源自间充质干细胞的无细胞囊泡，因其具有再生和抗炎特性，已成为一种有前景的替代疗法。
本综述综合了近期研究（2017 - 2023年）关于外泌体在OA治疗中的治疗潜力的研究结果，强调了外泌体通过递送细胞因子、生长因子和调节性核糖核酸等生物活性分子来调节关节微环境、减轻炎症和促进软骨修复的能力。
我们探讨了外泌体与生物材料（如水凝胶和支架）的整合，以增强其递送和治疗效果，并解决了与其临床应用相关的关键挑战，包括分离和表征方法的标准化、生产的可扩展性、作用机制的理解以及长期安全性。尽管存在这些挑战，但基于外泌体的疗法相对于传统和基于细胞的治疗方法具有几个优势，包括较低的免疫原性、易于操作以及将治疗剂靶向递送至受损组织。
我们对外泌体在OA研究中的现状提供了一个分析视角，强调了标准化生产方法、更深入的作用机制见解以及严格的长期安全性评估的必要性。未来的方向应集中在优化递送系统、探索个性化医疗方法以及进行比较有效性研究，以充分实现外泌体疗法在OA治疗中的潜力。解决这些差距对于将外泌体疗法从实验室转化到临床实践以及对OA管理产生变革性影响至关重要。
