Research progress and prospects of exosomes from diverse cellular sources in the treatment of knee osteoarthritis: a narrative review

TL;DR

This review explores how exosomes from different cell sources may help treat knee osteoarthritis by promoting cartilage repair and reducing inflammation.

Contribution

The paper provides a systematic review of exosome-based therapies for knee osteoarthritis from diverse cellular sources.

Findings

Exosomes can promote chondrocyte survival and cartilage matrix homeostasis.

They suppress inflammation and modulate subchondral bone remodeling.

Exosome-based therapies show promise but require further clinical validation.

Abstract

Knee osteoarthritis (KOA) is a highly prevalent degenerative joint disease characterized by osteophyte formation at joint margins, subchondral bone sclerosis, and progressive degeneration of the articular cartilage. In advanced stages, it can result in severe functional impairment of the knee joint, imposing a substantial burden on patients’ quality of life and on healthcare systems. Conventional intra-articular treatments, such as hyaluronic acid and corticosteroid injections, provide temporary pain relief but fail to achieve true tissue repair or regeneration. In recent years, several novel biological agents with regenerative potential have been introduced, yet their efficacy and safety remain debated. Exosomes, nanoscale vesicles secreted by cells, play essential roles in the pathophysiology of OA by mediating intercellular communication and regulating inflammatory and metabolic processes within the joint microenvironment. Exosomes derived from various cellular sources have been shown to promote chondrocyte proliferation and survival, suppress inflammation, maintain cartilage matrix homeostasis, and modulate subchondral bone remodeling and angiogenesis, demonstrating significant therapeutic promise for KOA. This review systematically summarizes current research on the mechanisms and therapeutic potential of exosomes derived from diverse cell types in KOA, highlighting recent advances and ongoing challenges. It aims to provide a theoretical foundation and reference framework for future basic studies and clinical translation of exosome-based therapies.

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