Exosomes in Osteoarthritis: Emerging Roles in Pathogenesis, Diagnosis, and Therapeutic Potential

Osteoarthritis (OA) is a leading cause of chronic pain and disability, particularly among the elderly. Despite its high global prevalence, the underlying mechanisms of OA are still not fully understood, and current treatments are largely limited to symptomatic relief. Exosomes, small extracellular vesicles involved in cell-to-cell communication, have recently gained attention for their diagnostic and therapeutic potential in OA. In particular, exosomes derived from Mesenchymal Stem Cells (MSCs) can modulate chondrocyte proliferation, apoptosis, autophagy, and inflammation. Emerging evidence also highlights the role of exosomal non-coding RNAs (ncRNAs), including miRNAs, lncRNAs, and circRNAs, in regulating cartilage degradation and subchondral bone remodeling. This review offers a comprehensive synthesis of current knowledge on the role of exosomes in OA, with a unique focus on their dual function as biomarkers and therapeutic tools. We further highlight the promise of exosome-based Drug Delivery Systems (DDSs) and propose future directions for integrating exosome technologies into OA treatment strategies. This work emphasizes the translational potential of exosomes as disease-modifying agents and regenerative tools in osteoarthritis.