Sgaglione Jonathan, Neufeld Eric V, Swami Pooja, Grande Daniel A
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
Department of Orthopaedic Surgery, Northwell Health, Long Island Jewish Medical Center/North Shore University Hospital, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
HSS J. 2025 Aug 16:15563316251362179. doi: 10.1177/15563316251362179.
Nano-sized extracellular vesicles enclosed by a lipid bilayer and secreted by various cell types including mesenchymal stem cells, exosomes act as natural transporters, carrying bioactive molecules such as proteins, lipids, and nucleic acids that mediate intercellular communication. Exosomes influence a range of cellular processes, including immune modulation, tissue repair, and disease progression. Compared to whole-cell therapies, exosomes provide anti-inflammatory, immunosuppressive, and regenerative effects with reduced risks linked to cellular components, such as infusion toxicity, immunogenicity, and tumorigenic phenomena. This article reviews isolation, modification, characterization, and storage techniques, challenges in clinical translation, and innovative engineering strategies to enhance targeting and efficacy. It also examines preliminary evidence suggesting that exosomes may have potential in managing degenerative disorders such as osteoarthritis, intervertebral disc degeneration, osteoporosis, osteonecrosis, and tendinopathy, as well as non-degenerative disorders such as sciatic nerve injury, fractures, and soft tissue trauma.
外泌体是由脂质双分子层包裹的纳米级细胞外囊泡，由包括间充质干细胞在内的多种细胞类型分泌，作为天然转运体，携带蛋白质、脂质和核酸等生物活性分子，介导细胞间通讯。外泌体影响一系列细胞过程，包括免疫调节、组织修复和疾病进展。与全细胞疗法相比，外泌体具有抗炎、免疫抑制和再生作用，同时降低了与细胞成分相关的风险，如输注毒性、免疫原性和致瘤现象。本文综述了外泌体的分离、修饰、表征和储存技术、临床转化面临的挑战以及增强靶向性和疗效的创新工程策略。还研究了初步证据，表明外泌体在治疗退行性疾病如骨关节炎、椎间盘退变、骨质疏松症、骨坏死和肌腱病，以及非退行性疾病如坐骨神经损伤、骨折和软组织创伤方面可能具有潜力。
