Exploring the potential of mesenchymal stem/stromal cell-derived extracellular vesicles as cell-free therapy for osteoarthritis: a narrative review

Introduction

Mesenchymal stem/stromal cell (MSC)-based therapies in cartilage repair and osteoarthritis (OA) treatment have gained attention. Recently, there has been increasing evidence to suggest that MSCs secrete a wide range of trophic factors to modulate the injured tissue environment. Extracellular vesicles (EVs) have been suggested to explain the positive and sometimes curative effect, through the paracrine stimulation of the resident progenitor cells to aid in repair.

Objectives

To give a narrative review of the current evidence for MSC-derived EV’s potential therapeutic effects and future perspectives for the treatment of OA.

Methods

A literature search was conducted using the MEDLINE databases in November 2023. A total of 24 animal studies describing EV, including exosomes utilized in cartilage and OA treatments were identified and analyzed.

Results

Preclinical animal studies indicated that EVs could enhance the therapeutic effects for the treatment of OA, although the purification methods for EVs and their cell sources would be highly relevant to therapeutic efficacy. In contrast, there have been no published clinical studies regarding EVs for the treatment of OA, and thus, properly controlled clinical trials and regulations are essential steps in future clinical applications.

Conclusions

The current evidences suggest that the administration of MSC-derived EVs into damaged joints could effectively reduce cartilage loss and alleviate the progression of OA. In contrast, there are still several potential problems to be solved, including their classification, safety and toxicity in clinical use, as well as optimal dosage and frequency for human administration.