Background

Degenerative diseases in orthopaedics have become a significant global public health issue with the aging of the population worldwide. The traditional medical interventions, including physical therapy, pharmacological therapy and even surgery, hardly work to modify degenerative progression. Stem cell–based therapy is widely accepted to treat degenerative orthopaedic disease effectively but possesses several limitations, such as the need for strict monitoring of production and storage and the potential risks of tumorigenicity and immune rejection in clinical translation. Furthermore, the ethical issues surrounding the acquisition of embryonic stem cells are also broadly concerned. Exosome-based therapy has rapidly grown in popularity in recent years and is regarded as an ideal alternative to stem cell–based therapy, offering a promise to achieve ‘cell-free’ tissue regeneration.

Methods

Traditionally, the native exosomes extracted from stem cells are directly injected into the injured site to promote tissue regeneration. Recently, several modified exosome–based strategies were developed to overcome the limitations of native exosomes, which include mainly exogenous molecule loading and exosome delivery through scaffolds. In this paper, a systematic review of the exosome-based strategy for degenerative disease in orthopaedics is presented.

Results

Treatment strategies based on the native exosomes are effective but with several disadvantages such as rapid diffusion and insufficient and fluctuating functional contents. The modified exosome–based strategies can better match the requirements of the regeneration in some complex healing processes.

Conclusion

Exosome-based strategies hold promise to manage degenerative disease in orthopaedics prior to patients reaching the advanced stage of disease in the future. The timely summary and highlights offered herein could provide a research perspective to promote the development of exosome-based therapy, facilitating the clinical translation of exosomes in orthopaedics.

Translational potential of this article

Exosome-based therapy is superior in anti-senescence and anti-inflammatory effects and possesses lower risks of tumorigenicity and immune rejection relative to stem cell–based therapy. Exosome-based therapy is regarded as an ideal alternative to stem cell–based therapy, offering a promise to achieve ‘cell-free’ tissue regeneration.

中文翻译：

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基于外泌体的骨科退行性疾病策略：最新进展和展望

背景

随着全球人口老龄化，骨科退行性疾病已成为一个重要的全球公共卫生问题。传统的医学干预，包括物理治疗、药物治疗甚至手术，几乎无法改变退行性进展。基于干细胞的疗法被广泛接受以有效治疗退行性骨科疾病，但具有一些局限性，例如需要严格监测生产和储存以及临床转化中的致瘤性和免疫排斥的潜在风险。此外，围绕获得胚胎干细胞的伦理问题也受到广泛关注。近年来，基于外泌体的疗法迅速普及，被认为是干细胞疗法的理想替代方案，

方法

传统上，从干细胞中提取的天然外泌体直接注入受伤部位以促进组织再生。最近，开发了几种改进的基于外泌体的策略来克服天然外泌体的局限性，其中主要包括外源分子加载和通过支架传递外泌体。在本文中，系统评价了基于外泌体的骨科退行性疾病策略。

结果

基于天然外泌体的治疗策略是有效的，但存在一些缺点，例如快速扩散和功能含量不足和波动。修改后的基于外泌体的策略可以更好地匹配一些复杂愈合过程中的再生要求。

结论

基于外泌体的策略有望在患者未来达到疾病晚期之前管理骨科中的退行性疾病。本文提供的及时总结和亮点可以为促进基于外泌体的疗法的发展提供研究视角，促进外泌体在骨科中的临床转化。

本文的转化潜力

与基于干细胞的疗法相比，基于外泌体的疗法在抗衰老和抗炎作用方面具有优势，并且具有更低的致瘤性和免疫排斥风险。基于外泌体的疗法被认为是基于干细胞的疗法的理想替代方案，有望实现“无细胞”组织再生。