Wang Bo, Chen Pinzhen, Li Wenyan, Chen Zhi
Department of Neurosurgery, The First Hospital Affiliated to Army Medical University, Chongqing, China.
Department of Radiology, The First Hospital Affiliated to Army Medical University, Chongqing, China.
Neural Regen Res. 2024 Dec 7;21(1):6-22. doi: 10.4103/NRR.NRR-D-24-00665.
Effective treatment methods for stroke, a common cerebrovascular disease with a high mortality rate, are still being sought. Exosome therapy, a form of acellular therapy, has demonstrated promising efficacy in various diseases in animal models; however, there is currently insufficient evidence to guide the clinical application of exosome in patients with stroke. This article reviews the progress of exosome applications in stroke treatment. It aims to elucidate the significant potential value of exosomes in stroke therapy and provide a reference for their clinical translation. At present, many studies on exosome-based therapies for stroke are actively underway. Regarding preclinical research, exosomes, as bioactive substances with diverse sources, currently favor stem cells as their origin. Due to their high plasticity, exosomes can be effectively modified through various physical, chemical, and genetic engineering methods to enhance their efficacy. In animal models of stroke, exosome therapy can reduce neuroinflammatory responses, alleviate oxidative stress damage, and inhibit programmed cell death. Additionally, exosomes can promote angiogenesis, repair and regenerate damaged white matter fiber bundles, and facilitate the migration and differentiation of neural stem cells, aiding the repair process. We also summarize new directions for the application of exosomes, specifically the exosome intervention through the ventricular-meningeal lymphatic system. The review findings suggest that the treatment paradigm for stroke is poised for transformation.
中风是一种常见且死亡率高的脑血管疾病，目前仍在寻找有效的治疗方法。外泌体疗法作为一种无细胞疗法，已在动物模型的各种疾病中显示出有前景的疗效；然而，目前尚无足够证据指导外泌体在中风患者中的临床应用。本文综述了外泌体在中风治疗中的应用进展。旨在阐明外泌体在中风治疗中的重大潜在价值，并为其临床转化提供参考。目前，许多基于外泌体的中风治疗研究正在积极开展。关于临床前研究，外泌体作为来源多样的生物活性物质，目前倾向于来源于干细胞。由于其高度可塑性，外泌体可以通过各种物理、化学和基因工程方法进行有效修饰以提高其疗效。在中风动物模型中，外泌体疗法可以减少神经炎症反应，减轻氧化应激损伤，并抑制程序性细胞死亡。此外，外泌体可以促进血管生成，修复和再生受损的白质纤维束，并促进神经干细胞的迁移和分化，辅助修复过程。我们还总结了外泌体应用的新方向，特别是通过脑室 - 脑膜淋巴系统进行外泌体干预。综述结果表明中风的治疗模式即将发生转变。
