Advances in mesenchymal stem cell and exosome-based therapies for aging and age-related diseases

Mesenchymal stem/stromal cells (MSCs) and their exosomes (MSC-Exos) have great potential for tissue repair and regenerative medicine, which can improve the symptoms and prognosis of aging-related diseases and potentially slow the aging process through multiple pathways. This comprehensive review summarizes the characterization of MSCs and MSC-Exos from various tissue sources and their applications in treating diseases associated with aging, such as premature ovarian failure (POF), Alzheimer's disease (AD), atherosclerosis (AS), and osteoporosis (OP). MSCs exert therapeutic effects through multiple mechanisms, including differentiation into various cell types, secretion of bioactive molecules, and immune response regulation. MSC-Exos, which contain a diverse array of proteins, miRNAs, and other biomolecules, can deliver MSC-derived bioinformatics to target cells and demonstrate comparable therapeutic benefits to MSCs. This review highlights the signaling pathways and molecular mechanisms underlying the therapeutic efficacy of MSCs and MSC-Exos in age-related diseases, and further discusses the importance of MSC and MSC-Exo tissue source selection for specific disease applications and the potential of combination therapies and preconditioning strategies to enhance their therapeutic outcomes. Despite promising preclinical and clinical results, challenges such as uneven distribution, in vivo environmental maladaptation, apoptosis, and immune responses need to be addressed before widespread clinical application. Future research requires multidisciplinary collaboration to further elucidate the mechanisms of action and develop optimized therapeutic strategies for the prevention and treatment of age-related pathologies using MSCs and MSC-Exos.