Exosome-based therapy for spinal cord injury: a narrative review

Currently, treatments such as stem cell transplantation, gene therapy, and anti-inflammatory approaches have shown some promise in addressing spinal cord injury. However, there is still a lack of more effective treatment options. Thus, improved strategies are needed to enhance efficacy and promote functional recovery. Exosome-based therapy has emerged as a promising strategy because exosomes can deliver bioactive molecules, modulate inflammation, and promote tissue regeneration. This review highlights recent advancements in the use of exosomes derived from various cell types, including mesenchymal stem cells and macrophages, for the treatment of spinal cord injury. Exosomes are nanoscale vesicles secreted by cells that are involved in transporting biomolecules, regulating intercellular communication, reducing inflammatory responses, promoting angiogenesis, and providing neuroprotection. The review article discusses the diagnostic, therapeutic, and prognostic roles of exosomes, along with various administration methods. It highlights the mechanisms by which exosomes from different cell types facilitate spinal cord injury repair, including promoting nerve regeneration, inhibiting apoptosis, and providing an antioxidant stress response. Additionally, emerging techniques such as engineered exosomes and targeted delivery systems are explored to enhance therapeutic efficacy and specificity. Although exosome therapy for spinal cord injury still faces challenges, such as the need for standardized preparation, precise delivery, and dose optimization, bioengineered exosomes show promising therapeutic potential. Overall, exosome-based therapy is an emerging technology in neuroscience that offers new perspectives and methods for treating spinal cord injury, with the potential to improve functional recovery in patients, thereby warranting future clinical translation.