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已发表论文
外泌体作为无细胞疗法治疗脊髓损伤的先进程度如何？
Authors Wu Y, Wang Y, Zhou J, Tang Z, Huang L, Liu S
Received 20 May 2025
Accepted for publication 9 September 2025
Published 22 September 2025 Volume 2025:20 Pages 11669—11683
DOI https://doi.org/10.2147/IJN.S536652
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 4
Editor who approved publication: Professor Farooq A. Shiekh
Yaqi Wu,1,* Yu Wang,1,* Jun Zhou,2 Zhijian Tang,1 Lulu Huang,3 Shengwen Liu1
1Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China; 2Institute of Material Polymer (IMP), University Claude Bernard Lyon 1, INSA Lyon, University Jean Monnet, CNRS UMR 5223, Villeurbanne Cedex F-69622, France; 3Department of ICON Pharma Development Solutions (IPD), ICON Public Limited Company (ICON Plc), Beijing, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Shengwen Liu, Department of Neurosurgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, Hubei, 430030, People’s Republic of China, Tel +86-27-83662448, Fax +(86) (27) 83646605, Email liushengwent047@163.com
Abstract: Spinal cord injury (SCI) remains a leading cause of disability worldwide, characterized by complex pathophysiological processes involving primary mechanical damage and secondary cascades of inflammation, oxidative stress, and gliosis. Current cell-based therapies face challenges such as low survival rates, tumorigenicity, and immune rejection. Emerging evidence highlights exosomes—nanoscale extracellular vesicles derived from various cell types—as promising cell-free therapeutic agents. These exosomes mediate intercellular communication by transferring bioactive cargo and exhibit advantages such as low immunogenicity, stability, and blood-spinal cord barrier permeability. This review explores the neuroprotective roles of exosomes from diverse cellular sources in SCI repair. Key mechanisms include regulation of macrophage/microglia polarization, suppression of pyroptosis, promotion of vascularization, inhibition of glial scar formation and enhancement of axonal growth. Challenges remain in optimizing exosome yield, standardization, and clinical translation. Future directions emphasize multi-target therapies, biomarker exploration, and hybrid approaches combining exosomes from multiple. A combination of exosomes with biomaterials or stem cells would amplify the therapeutic effects and reduce the dosage of exosomes. This review underscores the potential of exosome-based therapies to revolutionize SCI treatment by addressing its multifaceted pathophysiology while circumventing risks associated with cell transplantation.
Keywords: exosomes, neuroprotection, spinal cord injury, macrophage polarization, axonal regeneration
1Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China; 2Institute of Material Polymer (IMP), University Claude Bernard Lyon 1, INSA Lyon, University Jean Monnet, CNRS UMR 5223, Villeurbanne Cedex F-69622, France; 3Department of ICON Pharma Development Solutions (IPD), ICON Public Limited Company (ICON Plc), Beijing, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Shengwen Liu, Department of Neurosurgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, Hubei, 430030, People’s Republic of China, Tel +86-27-83662448, Fax +(86) (27) 83646605, Email liushengwent047@163.com
Abstract: Spinal cord injury (SCI) remains a leading cause of disability worldwide, characterized by complex pathophysiological processes involving primary mechanical damage and secondary cascades of inflammation, oxidative stress, and gliosis. Current cell-based therapies face challenges such as low survival rates, tumorigenicity, and immune rejection. Emerging evidence highlights exosomes—nanoscale extracellular vesicles derived from various cell types—as promising cell-free therapeutic agents. These exosomes mediate intercellular communication by transferring bioactive cargo and exhibit advantages such as low immunogenicity, stability, and blood-spinal cord barrier permeability. This review explores the neuroprotective roles of exosomes from diverse cellular sources in SCI repair. Key mechanisms include regulation of macrophage/microglia polarization, suppression of pyroptosis, promotion of vascularization, inhibition of glial scar formation and enhancement of axonal growth. Challenges remain in optimizing exosome yield, standardization, and clinical translation. Future directions emphasize multi-target therapies, biomarker exploration, and hybrid approaches combining exosomes from multiple. A combination of exosomes with biomaterials or stem cells would amplify the therapeutic effects and reduce the dosage of exosomes. This review underscores the potential of exosome-based therapies to revolutionize SCI treatment by addressing its multifaceted pathophysiology while circumventing risks associated with cell transplantation.
Keywords: exosomes, neuroprotection, spinal cord injury, macrophage polarization, axonal regeneration