Mesenchymal stem cell-derived exosomes: emerging therapeutic strategies for cutaneous wound regeneration

The skin serves as the primary biological barrier protecting the organism from external environmental damage, including physical, chemical, and biohazardous agents such as ultraviolet radiation, mechanical trauma, pathogens, and radioactive substances. However, systemic diseases like diabetes can impede cutaneous regeneration, leading to delayed wound healing, which underscores the urgent need for novel therapeutic strategies. Exosomes, endogenous nanoscale vesicles, exhibit multifaceted biological functions, including intercellular communication, immunomodulation, tissue repair, and drug delivery. Notably, mesenchymal stem cells-derived exosomes (MSCs-Exo) have emerged as a promising candidate for cutaneous wound repair due to their low immunogenicity, absence of tumorigenic risk, and high accessibility. Current evidence indicates that MSCs-Exo and their engineered derivatives promote the healing of radiation-induced skin injuries by modulating macrophage polarization and suppressing inflammatory responses. Furthermore, their synergistic application with advanced biomaterials significantly enhances therapeutic efficacy. This review systematically summarizes recent advancements in exosome-based strategies for skin regeneration, highlights their integration with innovative biomaterials, and critically analyzes existing challenges and future translational research directions.