A comparative analysis of MSCs and their exosomes in osteoarthritis therapy: complementary roles and clinical...

There is presently no cure for osteoarthritis (OA). Despite the promise of mesenchymal stem cell (MSC) transplantation, issues such as low cell survival and engraftment have shifted research toward MSC-derived exosomes (MSC-EXOs). Because they mirror the immunomodulatory and tissue-regenerative actions of MSCs without the safety and logistical issues of cell-based therapies, MSC-EXOs constitute an emerging class of medicines. This paper compares and contrasts MSCs and MSC-EXOs for OA treatment.

A literature search was conducted in PubMed, Google Scholar, Web of Science, Scopus, and ClinicalTrials.gov from 2000 to 2025 using keywords related to MSCs, exosomes, and osteoarthritis.

Using data from clinical trials that consistently show symptomatic relief but inconsistent evidence of structural cartilage regeneration, we describe MSC characteristics and assess their therapeutic benefits and limitations. The review further examines pathways by which MSC-EXOs mediate reparative effects in injured joint tissue, noting that while preclinical results are encouraging, clinical confirmation is lacking. MSC-EXOs have less developed evidence bases and greater regulatory uncertainty than MSCs, but offer advantages in safety, targeting, and scalability. Standardizing EXO manufacturing and purification, identifying optimal dosing schedules, establishing long-term safety profiles, and engineering EXOs for improved targeting and efficacy remain key translational challenges.

MSC-EXO-based treatment demonstrates potential as a regenerative approach for OA.