Key Takeaways & Executive Findings
- •• Exosomes combined with biomaterials enhance targeted delivery and therapeutic efficiency for spinal cord injury repair. • The combination regulates neuroinflammation, promotes axonal regeneration, and alleviates oxidative stress. • Biomaterials provide structural support and anti-inflammatory properties, overcoming limitations of exosome therapy alone. • Current evidence is limited to preclinical studies; clinical trials are needed to validate efficacy and safety.
Abstract
BACKGROUND: Combining exosomes with biomaterials such as hydrogels and biological scaffolds enables targeted delivery, providing effective support for damaged tissue and significantly enhancing the therapeutic efficiency of exosomes, thus positively impacting spinal cord injury repair. OBJECTIVE: To review the action mechanisms and research progress of exosomes combined with biomaterials in spinal cord injury. METHODS: Databases including CNKI, PubMed, and Web of Science were searched using the Chinese and English search terms “spinal cord injury, exosomes, hydrogel, biological scaffold, neuroinflammation, oxidative stress, axonal regeneration, angiogenesis.” Based on the inclusion criteria, 106 articles were finally included in this review. RESULTS AND CONCLUSION: Current research focuses on the repair of secondary injury after spinal cord injury, and how to better alleviate the damage caused by secondary injury is a key research question. Exosomes combined with biomaterials treat spinal cord injury mainly through regulating neuroinflammation, promoting axonal regeneration, and alleviating oxidative stress. This approach avoids immune rejection, solves the problem of low bioavailability of exosomes, and provides effective tissue support, thereby alleviating secondary symptoms after spinal cord injury. Most studies on exosome-loaded biomaterials for spinal cord injury are limited to cell and animal experiments, lacking clinical trial data. Future research should focus on further mechanistic studies, safety evaluations, and related clinical trials.
1. Introduction
Spinal cord injury (SCI) is a highly disabling neurological disorder that leads to motor and sensory dysfunction. Secondary injury, characterized by oxidative stress, ischemia-hypoxia, inflammation, and apoptosis, exacerbates the condition and worsens prognosis. The major clinical challenge is to mitigate secondary damage and promote neural recovery.
Exosomes, natural nanovesicles secreted by cells, carry proteins, mRNAs, miRNAs, and lipids, and can cross the blood-spinal cord barrier to modulate neuronal activity and tissue repair. They exhibit low immunogenicity and anti-inflammatory properties, but their therapeutic efficacy is limited by low bioavailability. Combining exosomes with biomaterials such as hydrogels and scaffolds offers a promising strategy to enhance their delivery and retention at the injury site.
Biomaterials provide a three-dimensional support for axonal regeneration and exhibit anti-inflammatory properties. They can also be loaded with therapeutic factors to modulate the local microenvironment. Therefore, the combination of exosomes and biomaterials holds great potential for improving functional recovery after SCI. This review summarizes the mechanisms and research progress of this combined approach.
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Zheng Ying, Li Mengyao, Zheng Fanfan, He Zhao, Zhang Ning, Zou Jialun, Li Youlei, Gao Feng (2026). Mechanism of action of extracellular vesicles loaded with biomaterials in repairing spinal cord injury. Chinese Journal of Tissue Engineering Research. https://doi.org/10.12307/2026.21600
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Frequently Asked Questions
What is the role of exosomes in spinal cord injury repair?
Exosomes carry bioactive molecules that modulate inflammation, promote angiogenesis, and protect the blood-spinal cord barrier, thereby aiding neural repair. However, their low bioavailability limits their efficacy.
How do biomaterials enhance exosome therapy for spinal cord injury?
Biomaterials such as hydrogels and scaffolds provide structural support, prolong exosome retention, and enable targeted delivery, thereby improving therapeutic outcomes.
What are the main mechanisms of exosome-loaded biomaterials in treating spinal cord injury?
The main mechanisms include regulation of neuroinflammation, promotion of axonal regeneration, and alleviation of oxidative stress, which collectively reduce secondary injury and enhance functional recovery.
What are the current limitations of this therapeutic approach?
Current evidence is based on preclinical studies; clinical trials are lacking. Further research is needed to elucidate precise molecular mechanisms, ensure safety, and translate findings to clinical practice.
What future directions are suggested for this field?
Future research should focus on mechanistic studies, long-term safety evaluations, and well-designed clinical trials to validate the efficacy of exosome-loaded biomaterials for spinal cord injury.
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