Mesenchymal Stem Cell–Derived Exosomes: A Potential Therapeutic Avenue in Knee Osteoarthritis

Abstract

Knee osteoarthritis is the leading cause of functional disability in adults. The goals of knee osteoarthritis management are directed toward symptomatic pain relief along with the attainment of the functional quality of life. The treatment strategy ranges from conservative to surgical management with reparative and restorative techniques. The emergence of cell-based therapies has paved the way for the usage of mesenchymal stem cells (MSCs) in cartilage disorders. Currently, global researchers are keen on their research on nanomedicine and targeted drug delivery. MSC-derived exosomes act as a directed therapy to halt the disease progression and to provide a pain-free range of movements with increased quality of cartilage on regeneration. International Society for Extracellular Vesicles and the European Network on Microvesicles and Exosomes in Health and Disease have formed guidelines to foster the use of the growing therapeutic potential of exosomal therapy in osteoarthritis. Although regenerative therapies with MSC are being seen to hold a future in the management of osteoarthritis, extracellular vesicle–based technology holds the key to unlock the potential toward knee preservation and regeneration. The intricate composition and uncertain functioning of exosomes are inquisitive facets warranting further exploration.

Exosomal therapy—a new frontier in regenerative medicine

“…The exosomes derived from mesenchymal stem cells (MSCs) are of prime importance due to the greater therapeutic and regenerative potential as shown in Figure 4. Due to the challenges faced in isolating exosomes from various body fluids, regenerative and translational medicine experts used MSC-derived exosomes for treating various disorders (2). MSCs derived exosomal cargo exhibit intracellular signaling and communications to targeted tissues.…”

“…MSCs derived exosomal cargo exhibit intracellular signaling and communications to targeted tissues. The key sources of exosomes derived from the MSCs include bone marrow, adipose tissue, placental cells, umbilical cells, endometrial fluid, and amniotic fluid (2,100).…”

“…Exosomes of MSC origin have cell surface markers such as CD 29, CD 44, and CD 73 embedded in them (100). They play a vital role in the biomechanisms involved in the repair and regeneration, bioenergetics, immunoregulation, intracellular communication, and tissue metabolism (2,101).…”

“…Any novel therapy or a drug being developed is dependent on the strategies to standardize the process to focus on validating the proposed technology. There are currently no Food and Drug Administration (FDA)- approved exosome products for human use in the USA (2,111). According to the FDA, exosomes are classified as a 351 product that requires studies effectively showing safety and efficacy, along with the purity of the product and its potency in treating the condition (112).…”

“…According to the FDA, exosomes are classified as a 351 product that requires studies effectively showing safety and efficacy, along with the purity of the product and its potency in treating the condition (112). Therapies using the exosomes are under the Investigational New Drug (IND) developmental phase and need the approval of the regulatory agencies before initiating the clinical trial (2,113).…”