Exosomes for the Management of Rotator Cuff Injuries: A Systematic Review.

Abstract

Rotator cuff injuries (RCIs) are a common musculoskeletal disability affecting daily activities and work performance for millions globally. Current conservative therapies are riddled with limitations. Therefore, this study aims to review the regenerative effects of exosomes derived from mesenchymal stem cells (MSCs) on RCIs and catalogue ongoing clinical trials investigating their effects. The main aim of this study is to compile findings from in vitro, preclinical, and clinical research articles that evaluate the regenerative potential of exosomes derived from different MSCs on injuries to the rotator cuff. Additionally, the secondary objective is to catalogue ongoing clinical trials registered in various clinical trial databases that explore the impact of exosomes on rotator cuff injuries. A systematic search across four extensive online journal databases until March 2024 was conducted following PRISMA guidelines. The search focused on articles in English using specific terms related to exosomes and RCIs. Eligible studies, including basic science, preclinical, and clinical research, and were assessed by two independent reviewers. Additionally, registered trials were identified from three international clinical trial databases. Four basic science, one basic science and preclinical, and twelve preclinical studies were included in this review. The studies demonstrated that exosomes derived from various stem cells have a strong regenerative capability, whose effects may be further enhanced by adding growth factors, glycoproteins, or other pro-regenerative markers. In vitro and preclinical studies reveal exosomes' regenerative potential for RCIs. Further research, including clinical trials, is needed to assess exosomes' safety and efficacy in RCI management.