Mesenchymal Stem Cells-Derived Exosomes: Next-Generation Nanomedicines Toward Scarless Wound Healing

The process of wound healing is intricate and, once disrupted, results in scar formation. Scar formation has negative physiological and psychological impacts on patients in addition to impeding the restoration of skin integrity and function. Increasing evidence indicates that factors such as angiogenesis, ECM deposition, and inflammation are all associated with scar formation. Given their excellent immunomodulatory and regenerative properties, mesenchymal stem cell-derived exosomes (MSCs-Exos) are increasingly favored in inhibiting scar formation during wound healing. This review begins with a summary of the key mechanisms of wound healing and scar formation, followed by the application of MSCs-Exos in attenuating the pathological process of scar formation, as well as its potential mechanisms of action. In addition, the current status and development prospects of engineered exosomes and hydrogel-combined exosomes in scar inhibition are further discussed. Finally, we evaluate the current challenges of using exosomes for scarless wound healing, including manufacturing standardization, dosing, delivery systems, and the lack of large-scale clinical data, which hold the potential to bridge the gap between the laboratory and the clinical.