مقالات پذیرفته شده در نهمین کنگره بین المللی زیست پزشکی
Exosomes as Cell-Free Therapeutic Agents for Diabetic Wound Healing: Mechanisms, Delivery Strategies, and Clinical Prospects
Exosomes as Cell-Free Therapeutic Agents for Diabetic Wound Healing: Mechanisms, Delivery Strategies, and Clinical Prospects
Mozhdeh Khamesi,1Davood Nasiry,2,*
1. Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran. 2. Professor Assistant of Anatomical Sciences, Amol School of Paramedical Sciences, Mazandaran University of Medical Sciences, Sari, Iran.
Introduction: Diabetic wounds represent a significant clinical challenge due to their chronic, non-healing nature, stemming from impaired angiogenesis, persistent inflammation, and deficient cellular proliferation. Traditional treatments often fall short in addressing the complex pathophysiology of these wounds, necessitating the exploration of novel therapeutic approaches.
Methods: Exosomes, nanoscale extracellular vesicles abundant in proteins, lipids, mRNA, and miRNA, have emerged as a highly promising cell-free therapy. They effectively transfer their bioactive cargo to recipient cells, modulating key processes critical for tissue repair.
Results: This comprehensive review elucidates the multifaceted mechanisms by which exosomes contribute to diabetic wound healing, including the promotion of angiogenesis, the modulation of inflammatory responses (e.g., M1 to M2 macrophage polarization), the enhancement of keratinocyte and fibroblast proliferation and migration, and the reduction of oxidative stress. We discuss various cellular sources of therapeutic exosomes, with a particular focus on those derived from mesenchymal stem cells (MSCs) and adipose-derived stem cells (ADSCs), highlighting their distinct advantages. Furthermore, the review explores advanced delivery strategies, such as the incorporation of exosomes into hydrogels, scaffolds, and other biomaterials, designed to improve their stability, bioavailability, and targeted release within the wound bed.
Conclusion: Finally, we address the current challenges in exosome isolation, purification, standardization, large-scale production, and clinical translation, while outlining future perspectives for developing engineered exosomes and combination therapies to maximize their therapeutic potential in diabetic wound management.