The role of MSC-derived exosomes in immune modulation and regenerative medicine

Background: Mesenchymal stem cell (MSC)-derived exosomes have emerged as promising cell-free therapeutic agents in immunomodulation and regenerative medicine. These extracellular vesicles transport bioactive lipids, proteins, and nucleic acids that mediate intercellular communication. Methods: This narrative review summarizes current strategies for isolating MSC-derived exosomes, including ultracentrifugation, size-exclusion chromatography, and immunoaffinity capture, and evaluates their functional cargo and therapeutic applications. Results: MSC-derived exosomes exhibit potent immunomodulatory effects, including suppression of pro-inflammatory cytokines, expansion of regulatory T cells, and promotion of anti-inflammatory microenvironments. They demonstrate therapeutic potential across autoimmune, cardiovascular, oncologic, and neurodegenerative disease models. Engineered exosomes further show promise as targeted drug-delivery systems, particularly in oncology, by enhancing drug bioavailability and overcoming chemoresistance. Compared with MSC-based therapies, exosomes offer advantages such as reduced safety concerns and improved stability. Conclusion: By integrating cargo-specific immune modulation with organ-specific regenerative outcomes, MSC-derived exosomes represent a versatile therapeutic platform. Standardized purification methods and further clinical studies are essential to advance their translational and clinical applications.