Exosome-mediated tendon-derived stem cell therapy strategies: potential and challenges

Tendon injuries are common disorders of the musculoskeletal system, and current treatments exhibit significant limitations in promoting effective regeneration. Recently, cell-based regenerative medicine has offered promising strategies for tendon repair. Among these, tendon-derived stem cells (TDSCs) have attracted substantial attention due to their robust self-renewal capacity and multilineage differentiation potential. Cell-free stem cell therapies, particularly those mediated by exosomes derived from stem cells, have emerged with significant therapeutic potential. This review summarizes the fundamental characteristics of TDSCs and their contributions to tendon repair, highlighting the pivotal roles of exosomes as critical mediators of intercellular communication. Furthermore, it outlines current methods for isolating and characterizing exosomes derived from TDSCs, evaluates their biological functions, and examines their therapeutic efficacy in animal models, emphasizing prospects for future clinical translation. Finally, this article addresses the advantages of exosome-based therapies regarding safety and efficacy, while discussing existing challenges and future perspectives in large-scale exosome production, quality control, and in-depth exploration of underlying mechanisms. Exosome-mediated TDSCs therapy represents a promising, emerging therapeutic approach.