Mesenchymal stem cells’ “garbage bags” at work: Treating radial nerve injury with mesenchymal stem cell-derived exosomes

Abstract

Unlike central nervous system injuries, peripheral nerve injuries (PNIs) are often characterized by more or less successful axonal regeneration. However, structural and functional recovery is a senile process involving multifaceted cellular and molecular processes. The contemporary treatment options are limited, with surgical intervention as the gold-standard method; however, each treatment option has its associated limitations, especially when the injury is severe with a large gap. Recent advancements in cell-based therapy and cell-free therapy approaches using stem cell-derived soluble and insoluble components of the cell secretome are fast-emerging therapeutic approaches to treating acute and chronic PNI. The recent pilot study is a leap forward in the field, which is expected to pave the way for more enormous, systematic, and well-designed clinical trials to assess the therapeutic efficacy of mesenchymal stem cell-derived exosomes as a bio-drug either alone or as part of a combinatorial approach, in an attempt synergize the best of novel treatment approaches to address the complexity of the neural repair and regeneration.

Keywords: Exosome; Mesenchymal stem cells; Nerve injury; Stem cells; Secretome; Regeneration

Core Tip: The extracellular vesicles constituting the insoluble component of the secretome were once considered cell’s garbage bags. They have become a hot area of research since realizing their significance as an essential means of intracellular communication. They have shown promise for therapeutic applications for repairing and regenerating the damaged tissues via delivering their payload to the resident reparative cells and supporting them in the intrinsic repair process. Although stem cell-derived exosomes have been extensively studied for peripheral nerve injury repair in experimental animal models, their use for radial nerve injury repair in a patient, as the pilot study by Civelek et al, is expected to pave the way for assessment in future clinical trials.