J Korean Orthop Assoc.  2023 Oct;58(5):374-383. 10.4055/jkoa.2023.58.5.374 .

Regenerative Treatment with Extracellular Vesicles for Spinal Cord Injury

• Park WT
• Lim YJ
• Lee GW

• KMID: 2546999
• DOI: http://doi.org/10.4055/jkoa.2023.58.5.374

Abstract

A spinal cord injury (SCI) is a serious condition and can cause permanent disability with a substantial loss of nerve functions (e.g., motor, sensory, etc.). SCI is associated with a mechanical insult (primary injury), followed by a cascade of significant inflammatory reactions and irreversible structural changes (secondary injury). The use of mesenchymal stem cells (MSCs) has been considered a therapeutic option for the treatment of SCI due to their anti-inflammatory and regenerative effects observed in animal models. However, the outcomes of the use of MSCs from these studies are heterogeneous, and the preparation process for MSCs has not yet been established. Moreover, there has been no consistent and standardized method for manufacturing a therapeutic agent with MSCs for clinical use. Therefore, identifying novel sources is of great importance. Extracellular vesicles (EVs) are receiving attention as novel sources in regenerative medicine. Since EVs possess nucleic acids, functional proteins, and bioactive lipids, they may be useful for the repair of damaged tissue, regulation of immune response, and reduction of inflammation. Compared to MSCs, EVs have significant advantages, including smaller size, and lower immunogenicity, and do not require additional procedures for culture expansion or delivery. Several studies have demonstrated that EVs exhibit significant neuroprotective, anti-inflammatory, and regenerative effects in animal SCI models. In the current study, therefore, we reviewed the pathophysiological mechanisms of SCI, the issues with MSCs, and research outcomes of using EVs for SCI and discussed the future perspectives with respect to EVs.

Keyword

extracellular vesicles; mesenchymal stem cells; inflammation; regeneration; spinal cord injuries