Advances in stem cell-derived exosome therapy for radiation-induced skin injury

Radiation-induced skin injury (RISI) represents a significant clinical challenge, affecting up to 95% of radiotherapy patients and often resulting in both acute and chronic complications that can severely impact quality of life. While conventional treatments show limited efficacy, stem cell-derived exosomes have emerged as a promising cell-free therapeutic approach. These nanoscale vesicles, which harbor bioactive chemicals derived from their progenitor stem cells, exhibit significant potential in facilitating tissue healing while mitigating the risks associated with cell-based therapies. This article reviews the therapeutic processes of exosomes produced from stem cells in the treatment of RISI, including their roles in reducing cellular senescence, promoting angiogenesis, modulating inflammation, and enhancing tissue regeneration. We examine 12 preclinical data and five clinical trials, assessing the efficacy of exosomes sourced from several stem cell types: mesenchymal, embryonic, and induced pluripotent stem cells. The review also addresses current challenges in exosome therapy development, including manufacturing scalability, characterization standards, and delivery optimization. Recent advances in clinical translation suggest that exosome-based treatments could revolutionize RISI management, offering a safer and potentially more effective alternative to existing therapies. As the field progresses toward standardized therapeutic applications, stem cell-derived exosomes represent a paradigm shift in regenerative medicine approaches to radiation injury treatment.