Mesenchymal stem cell transplantation is undergoing extensive evaluation as a cellular therapy in human clinical trials. Because MSCs are easily isolated and amenable to culture expansion in vitro there is a natural desire to test MSCs in many diverse clinical indications. This is exemplified by the rapidly expanding literature base that includes many in vivo animal models. More recently, MSCderived extracellular vesicles (EVs), which include exosomes and microvesicles (MV), are being examined for their role in MSC-based cellular therapy. These vesicles are involved in cell-to-cell communication, cell signaling, and altering cell or tissue metabolism at short or long distances in the body. The exosomes and MVs can influence tissue responses to injury, infection, and disease. MSC-derived exosomes have a content that includes cytokines and growth factors, signaling lipids, mRNAs, and regulatory miRNAs. To the extent that MSC exosomes can be used for cell-free regenerative medicine, much will depend on the quality, reproducibility, and potency of their production, in the same manner that these parameters dictate the development of cell-based MSC therapies. However, the MSC exosome's contents are not static, but rather a product of the MSC tissue origin, its activities and the immediate intercellular neighbors of the MSCs. As such, the exosome content produced by MSCs appears to be altered when MSCs are cultured with tumor cells or in the in vivo tumor microenvironment. Therefore, careful attention to detail in producing MSC exosomes may provide a new therapeutic paradigm for cell-free MSC-based therapies with decreased risk. STEM CELLS 2017;35:851-858
SIGNIFICANCE STATEMENTMesenchymal stem/stromal cells (MSCs) are being exploited as an experimental therapy for a variety of human diseases. Current dogma indicates that MSCs ameliorate disease via secretion of paracrine acting factors that limit inflammation, reprogram immune cells, and activate endogenous repair pathways. Recent studies indicate that MSCs also produce extra-cellular vesicles of varying sizes including exosomes that carry as cargo mRNAs, microRNAs, and proteins, and that horizontal transfer of this cargo induces nonautonomous changes that are therapeutic. This manuscript reviews evidence that MSC-derived microvesicles/exosomes function as paracrine mediators in tissue repair and recapitulate to a large extent the therapeutic effects of parental MSCs. It also discusses their role in reprogramming endogenous MSCs to generate a self-reinforcing malignant niche.