Adipose-derived stem cell exosomes: mechanisms and therapeutic potentials in wound healing

Abstract Wound healing is a complex, multi-stage process that restores skin integrity through coordinated cellular and molecular interactions. Among the emerging therapeutic strategies, adipose-derived stem cell exosomes (ADSC-Exos) attract significant attention due to their potent regenerative capabilities. ADSC-Exos contribute to wound repair by modulating inflammatory responses, promoting cellular proliferation and migration, stimulating angiogenesis, and facilitating collagen remodeling. These exosomes carry a diverse array of bioactive molecules including cytokines, non-coding RNAs (ncRNAs), and proteins, that are delivered to target cells, thereby orchestrating the intricate processes involved in tissue regeneration. Recent advancements in exosome engineering, such as genetic modification, pharmacological preconditioning, hypoxic treatment, and incorporation with biomaterials, markedly improve the therapeutic efficacy of ADSC-Exos. This review summarizes the underlying mechanisms and therapeutic potential of ADSC-Exos in wound healing, offering new perspectives for developing exosome-based regenerative therapies. Nevertheless, challenges persist regarding the large-scale production, standardized isolation, and clinical translation of ADSC-Exos. Future research should aim to enhance exosome yield and purity, elucidate the mechanisms governing exosome biogenesis, and validate their clinical efficacy through well-designed trials.