Pathological mechanisms and therapeutic potential of MSC-Exos in ischemic stroke management

Cerebral ischemia-reperfusion injury (CIRI) represents a critical pathological challenge in the management of ischemic stroke, substantially limiting the clinical efficacy and success rates of neurosurgical interventions, brain tissue therapies, and cell transplantation strategies. The complex pathological mechanisms underlying CIRI, which include inflammatory responses, oxidative stress, ferroptosis, apoptosis, and blood-brain barrier disruption, significantly hinder neurological recovery. Mesenchymal stem cells-derived exosomes (MSC-Exos) have emerged as a promising acellular therapeutic strategy owing to their low immunogenicity, ability to cross the blood-brain barrier, and multi-target regulatory properties. This review compares MSC-Exos derived from multiple sources and summarises their mechanisms of action and therapeutic potential in CIRI. Despite ongoing challenges in standardisation and safety evaluation, accumulating preclinical evidence highlights their potential for future clinical translation and precision regenerative medicine.