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World J Clin Cases. Aug 6, 2021; 9(22): 6218-6233
Published online Aug 6, 2021. doi: 10.12998/wjcc.v9.i22.6218
Mesenchymal stem cell-derived exosomes: An emerging therapeutic strategy for normal and chronic wound healing
Qin-Lu Zeng, De-Wu Liu
Qin-Lu Zeng, De-Wu Liu, Burns Institute, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
Qin-Lu Zeng, First Clinical Medical College, Nanchang University, Nanchang 330006, Jiangxi Province, China
Author contributions: Zeng QL contributed to the investigation, data curation, and original draft preparation; Zeng QL and Liu DW contributed to manuscript writing, review, and editing; Liu DW supervised this study.
Supported by National Natural Science Foundation of China, No. 81460293; and Innovation and Entrepreneurship Training Program of Nanchang University, China, No. 20190402184.
Conflict-of-interest statement: The authors declare that there is no conflict of interest related to this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: De-Wu Liu, MD, PhD, Chief Doctor, Professor, Burns Institute, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Donghu District, Nanchang 330006, Jiangxi Province, China. dewuliu@126.com
Received: February 8, 2021
Peer-review started: February 8, 2021
First decision: March 30, 2021
Revised: April 8, 2021
Accepted: June 22, 2021
Article in press: June 22, 2021
Published online: August 6, 2021
Processing time: 169 Days and 22.8 Hours
Abstract

Skin wound healing is a complex biological process. Mesenchymal stem cells (MSCs) play an important role in skin wound repair due to their multidirectional differentiation potential, hematopoietic support, promotion of stem cell implantation, self-replication, and immune regulation. Exosomes are vesicles with diameters of 40-100 nm that contain nucleic acids, proteins, and lipids and often act as mediators of cell-to-cell communication. Currently, many clinical scientists have carried out cell-free therapy for skin wounds, especially chronic wounds, using exosomes derived from MSCs. This review focuses on the latest research progress on the mechanisms of action associated with the treatment of wound healing with exosomes derived from different MSCs, the latest research progress on the combination of exosomes and other biological or nonbiological factors for the treatment of chronic skin wounds, and the new prospects and development goals of cell-free therapy.

Keywords: Mesenchymal stem cells; Exosomes; Mesenchymal stem cell-exosomes; Wound healing; Therapeutics

Core Tip: We have mainly sorted out the reported mechanisms by which different mesenchymal stem cells (MSC)-derived exosomes play a promoting role in the hemostatic stage, inflammatory stage, proliferative stage, and remodeling stage of skin wound healing. The clinical prospect of MSC-exosomes as a cell-free therapy, such as the addition of carriers, combination of drugs, combined physical treatment, and development as an immunosuppressive agent, is also summarized.