Wang Biwu, Lyu Feng-Juan, Deng Zhantao, Zheng Qiujian, Ma Yuanchen, Peng Yujie, Guo Shujun, Lei Guihua, Lai Yonggang, Li Qingtian
Department of Orthopedics, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China.
Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, China.
J Orthop Translat. 2025 Apr 11;52:85-96. doi: 10.1016/j.jot.2025.03.007. eCollection 2025 May.
Artificial joint replacement is a widely recognized treatment for arthritis and other severe joint conditions. However, one of the primary causes of failure in joint replacements is the loosening of the prosthesis. After implantation, wear particles between the implant and the adjacent bone tissue are the principal contributors to this loosening. Recently, exosomes have garnered significant interest due to their low immunogenicity and effective membrane binding. They have shown potential in promoting bone regeneration via the paracrine pathway. This review examines the role and mechanisms of exosomes derived from mesenchymal stem cells (MSCs) in bone regeneration, their impact on the integration of various implants into surrounding bone tissue and current challenges and future directions for the clinical application of exosomes. The Translational Potential of this Article: Emerging evidence suggests that mesenchymal stem cell-derived exosomes may offer a promising therapeutic strategy for aseptic prosthesis loosening, potentially mediated through mechanisms such as modulation of inflammatory responses, suppression of osteoclastogenesis, enhancement of osteogenic differentiation and facilitation of bone regeneration. Preclinical studies further indicate that the therapeutic potential of these extracellular vesicles could be optimized through bioengineering strategies, including surface modification and cargo-loading techniques, warranting further investigation to advance their clinical translation.
人工关节置换是治疗关节炎和其他严重关节疾病的一种广泛认可的方法。然而，关节置换失败的主要原因之一是假体松动。植入后，植入物与相邻骨组织之间的磨损颗粒是导致这种松动的主要因素。近年来，外泌体因其低免疫原性和有效的膜结合能力而备受关注。它们已显示出通过旁分泌途径促进骨再生的潜力。本文综述了间充质干细胞（MSCs）来源的外泌体在骨再生中的作用和机制、它们对各种植入物与周围骨组织整合的影响以及外泌体临床应用的当前挑战和未来方向。本文的转化潜力：新出现的证据表明，间充质干细胞来源的外泌体可能为无菌性假体松动提供一种有前景的治疗策略，可能通过调节炎症反应、抑制破骨细胞生成、增强成骨分化和促进骨再生等机制介导。临床前研究进一步表明，这些细胞外囊泡的治疗潜力可以通过生物工程策略进行优化，包括表面修饰和载物技术，这需要进一步研究以推动其临床转化。
