Mechanisms and potential of mesenchymal stem cell-derived exosomes for treating radiation-induced intestinal injury

Radiation-induced intestinal injury (RIII) is a prevalent complication of radiotherapy for abdominal and pelvic tumors, characterized by acute and chronic damage to intestinal tissues. Current treatments are primarily symptomatic, lacking effective targeted therapies. Mesenchymal stem cells (MSCs), due to their immunomodulatory and regenerative properties, and their derived exosomes, have emerged as promising therapeutic options for RIII. MSC-derived exosomes exhibit anti-inflammatory, antioxidant, and tissue-repairing properties, modulating immune responses and promoting intestinal barrier restoration. Engineering of exosomes further enhances their targeting and therapeutic efficiency. This review discusses the mechanisms and therapeutic potential of MSC-derived and engineered exosomes for RIII, emphasizing their role in reducing inflammation, promoting tissue repair, and maintaining microbial balance, while addressing future challenges and prospects for clinical translation.