The potential of anext exosomes in clinical applications.
Exosomes have received great attention in recent years as cell-free alternatives to stem cell-based products, especially exosomes derived from ESC, IPSC, HSC, MSC, NSC, and EPC, in part due to the pluripotency of their parent cells. After modified or unmodified production and purification, stem cell-derived exosomes show great potential for problems encountered in **surgical procedures. e.g., orthopedic disorders (e.g., fractures, osteoarthritis, and spinal cord injury); neurosurgery (e.g., ischemic stroke, traumatic brain injury, and Alzheimer's disease); plastic surgery (e.g., wound healing); general surgery (e.g., acute liver injury); cardiothoracic surgery (e.g., myocardial infarction); urology (e.g., chronic kidney disease); head and neck surgery (e.g., sensorineural hearing loss); Ophthalmology (e.g., acquired optic neuropathy) and** (e.g., primary ovarian insufficiency).
Mechanistically, the multiple roles of stem cell-derived exosomes are achieved through disease-specific cellular and tissue responses (e.g., tissue regeneration, anti-inflammatory, anti-cell death, immunomodulation, and antioxidative stress) and tissue-specific molecular signaling pathways (e.g., Wnt-Catenin, PTEN PI3K Akt HIF-1, MAPK, and Jak Stat pathways). Overall, stem cell-derived exosomes** have been shown to be an effective and versatile alternative to stem cells** in the surgical field.
The future focus of the clinical application of stem cell-derived exosomes should be on the various nodes of this ** pipeline. First, pre-large-scale production of exosomes requires high-throughput cell sources as well as reproducible and scalable production and isolation protocols. Dynamic systems in the form of bioreactors, such as hollow fiber bioreactors and stirred tank bioreactors, can improve efficiency by generating large numbers of cells and exosomes in a short period of time compared to static systems that grow monolayer cells. However, due to the physical and shear stresses encountered in the reactor, the phenotype of the parental cells and derived exosomes may change. Therefore, the operating parameters of the bioreactor must be optimized to facilitate the large-scale production of stem cell-derived exosomes.
Secondly, for the ** mode of exosomes, it is necessary to explore administration methods other than systemic administration. When delivered through the venous system, exosomes are rapidly cleared from the blood circulation and accumulate in the liver, spleen, and lungs, which can be overcome by local delivery. Recently, various biomaterials have been used to protect, assist, and enhance locally delivered exosomes to maximize their effects. These biomaterials can be designed based on their (e.g., natural, synthetic, and hybrid polymers), form (e.g., scaffolds, patches, sprays, and microneedles), and reactivity (e.g., temperature, pH, and protein) for disease-specific customization.
2024 Travel Guide Finally, for the indication of exosomes, future preclinical studies and clinical trials should include more diseases. For example, given the immunomodulatory effects of MSC-derived exosomes, conditions of airway inflammation such as allergic rhinitis and asthma may be suitable candidates for exosomes**. Diseases that work best with surgical implants, such as cochlear implants, intraocular lenses, and contraceptive intrauterine devices, can be performed in the form of implant-based local release of exosomes. In addition to the primary disease, secondary diseases, including complications associated with surgery and general anesthesia, such as cognitive impairment, wound paresthesias, and malignant hyperthermia, may be targets for exosomes. In conclusion, efforts to combine exosome production with multimodal exosome delivery will accelerate the clinical application of stem cell-derived exosomes in a rapidly expanding disease spectrum.