Innovative Pathways in Burn Treatment: Exosomes and the New Era of Regenerative Medicine

Burn injuries remain one of the main causes of death and long-term disability globally. Although some treatments exist, complete recovery cannot be guaranteed, and prolonged illness, infection, or disfigurement due to scars or other aesthetic problems may occur. Exosomes are nanoscale vesicles released by cells, carrying proteins, lipids, and RNAs, and acting as cell-free therapeutics. Exosomes are related to the regenerative effects of their parent stem cells but have low immunogenicity, better stability and a reduced risk of tumour formation. Based on the above analysis, exosomes can promote the healing of burn injuries by activating cell migration, modulating the immune system and inhibiting excessive collagen accumulation to reduce scarring. To address the deficiencies of natural exosomes, some modification methods have been employed by researchers to date, such as preconditioning the source cells, genetically engineering exosomes to enrich their contents, or embedding them in hydrogels, scaffolds and microneedle patches. Although these advanced systems have shown promise in animal models, most of the data are still preclinical, and large-scale clinical trials have not been conducted. Here, we will introduce the current state of knowledge on exosome biology in burn injury, summarise key mechanisms and engineering innovations, discuss prospects for clinical application, and stress that stringent validation is absolutely required.