Exosomes promise better bone regeneration

Evidence from laboratory and animal studies provides groundwork for understanding mechanisms and potential before human studies continue.

• Level A · Stronger Clinical Evidence
• Level B · Emerging clinical evidence with positive signals
• Level C · Early human research exploring benefits
• Level D · Scientific groundwork from lab and animal studies
• Emerging · Emerging topic under active research

Abstract (original English)

Fractures primarily result from high-energy trauma, leading to structural discontinuity of bone tissue. Contemporary therapeutic approaches continue to face persistent challenges including nonunion, infection, and inflammatory complications that pose significant clinical management difficulties. Emerging evidence demonstrates that extracellular vesicles (EVs), particularly exosomes, serve as critical mediators in diverse pathophysiological processes. Accumulating studies reveal that exosomal cargos enhance osteogenesis and angiogenesis through dynamic regulation of cellular components and molecular networks within the bone remodeling microenvironment, thereby potentiating fracture healing cascades. This comprehensive review systematically examines the mechanistic contributions of exosomes in coordinating osteoblastic differentiation, osteoclastic activity modulation, and neovascularization processes. In addition, we describe the role of exosomes from different cellular sources (e.g., mesenchymal stem cells, endothelial progenitor cells, and osteoblasts) in fracture repair. Finally, this paper elaborates on the potential challenges and future directions for the development of novel exosome-based therapeutic strategies for clinical fracture repair.

Evidence level

Evidence from laboratory and animal studies provides groundwork for understanding mechanisms and potential before human studies continue.

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