Harnessing exosomal mediators for advanced wound healing: Mechanisms and therapeutic potential in angiogenesis

Angiogenesis is critical for effective wound healing, supplying oxygen and nutrients to regenerating tissues. In chronic conditions like diabetes, impaired angiogenesis leads to delayed healing, chronic wounds, and significant healthcare burdens. Exosomes, nano-sized extracellular vesicles derived from cells such as mesenchymal stem cells (MSCs), amniotic epithelial cells, and keratinocytes, have emerged as key mediators in promoting angiogenesis. Laden with bioactive cargos-including microRNAs, proteins, and lipids-exosomes orchestrate endothelial cell proliferation, migration, and extracellular matrix remodeling to enhance vascularization. This review explores the molecular mechanisms by which exosomes drive angiogenesis, highlighting their role in modulating signaling pathways and immune responses critical for tissue repair. We evaluate the therapeutic promise of exosome-based delivery systems, integrating insights from biological, pharmaceutical, and cell-based approaches. By leveraging these advancements, exosomal therapies offer transformative potential for managing chronic wounds and ischemic conditions, paving the way for innovative regenerative medicine strategies.