• Exosomes derived from various cell types exhibit potent neuroprotective effects in preclinical SCI models, promoting functional recovery.
• The mechanisms of exosome action include neurogenesis, angiogenesis, preservation of the blood-spinal cord barrier, anti-apoptosis, and anti-inflammatory modulation.
• Exosome cargo, including miRNAs and proteins, modulates key signaling pathways involved in secondary injury cascade.
• Despite challenges, exosome-based therapies hold promise for translational application in SCI, offering targeted delivery and reduced side effects.