Stem cell-derived exosomes for ischemic stroke: a conventional and network meta-analysis based on animal models

Area of Science:

• Regenerative Medicine
• Neuroscience
• Biotechnology

Background:

• Ischemic stroke poses a significant global health challenge with limited effective treatments.
• Stem cell-derived exosomes (SC-Exos) show therapeutic potential for ischemic stroke.
• Optimal administration strategies for SC-Exos remain to be determined.

Purpose of the Study:

• To evaluate the efficacy of SC-Exos in treating ischemic stroke.
• To identify the optimal administration route, exosome type, and immune compatibility for SC-Exos therapy.
• To guide preclinical research for SC-Exos in stroke treatment.

Main Methods:

• Comprehensive literature search of PubMed, Web of Science, Embase, Cochrane Library, and Scopus databases up to December 31, 2023.
• Inclusion of 38 randomized controlled animal experiments.
• Conventional and network meta-analyses were performed using cerebral infarct volume and modified neurological severity score (mNSS) as primary outcomes.

Main Results:

• Intravenous (IV) administration significantly reduced infarct volume and mNSS.
• Bone marrow mesenchymal stem cell-derived exosomes (BMSC-Exos) demonstrated superior efficacy among various SC-Exos types when administered IV.
• Allogeneic exosomes were more effective in reducing infarct volume, while xenogeneic exosomes excelled in improving mNSS.

Conclusions:

• Intravenous administration of BMSC-Exos represents the most promising strategy for ischemic stroke treatment based on current evidence.
• Allogeneic and xenogeneic exosomes offer distinct therapeutic advantages for infarct volume reduction and neurological recovery, respectively.
• Further high-quality comparative studies are warranted to solidify optimal SC-Exos administration strategies for ischemic stroke.