The Potential of Neural Stem Cell-derived Exosomes for the Treatment of Ischemic Stroke

Ischemic stroke is one of the leading causes of disability and mortality worldwide, posing a significant threat to human health. Neural stem cells possess the remarkable capabilities of self-renewal and differentiation into diverse neural cell types, endowing them with significant potential for the restoration of damaged neural tissues and functions. Exosomes, which carry a multitude of bioactive substances, serve as crucial tools for intercellular communication. Neural stem cell-derived exosomes are capable of engaging in the modulation of various physiological functions, presenting a highly promising novel approach for the treatment of ischemic stroke. This paper elaborates on the pathophysiological mechanisms of ischemic stroke, the engineering strategies for exosomes, and the prospects and limitations of neural stem cell transplantation therapies. It systematically reviews the potential roles of neural stem cell-derived exosomes in the treatment of ischemic stroke. Studies have shown that neural stem cell-derived exosomes can contribute to brain targeting, promote neural regeneration and angiogenesis, suppress neuroinflammation, and enhance the integrity of the blood-brain barrier in the treatment of ischemic stroke. However, their efficacy is constrained by insufficient targeting precision and limited cargo content. To improve the therapeutic efficacy of neural stem cell-derived exosomes, strategies such as surface modification and cargo loading can be employed. These include attaching targeting peptides, proteins, and antibodies to the exosome surface via chemical modification and genetic engineering, as well as loading small-molecule drugs and nanomaterials. Furthermore, accelerating the clinical translation of exosomes requires strict adherence to Good Manufacturing Practices. Neural stem cell-derived exosomes hold substantial potential in the treatment of ischemic stroke, which is expected to promote the development of the field of neural regeneration and bring new hope for more central nervous system diseases.