From Biointelligence to Biointerference: Exosomes as Bioengineered Cellular Communicators Transforming Regenerative Medicine

Exosomes are nanoscale extracellular vesicles that facilitate intercellular communication by transporting regulatory molecules, such as microRNAs, proteins, and lipids. Acting as "software updates" for cells, exosomes influence gene expression and cellular behavior without altering the genetic code. Their emerging roles in tissue repair, immune modulation, and age-related rejuvenation have positioned them as promising tools in regenerative and aesthetic medicine. The authors of this systematic review aim to explore the therapeutic potential of natural and bioengineered exosomes, focusing on their mechanisms of action and applications in regenerative therapies and aesthetic interventions. A structured literature search was conducted across PubMed, Scopus, and Web of Science, including English-language studies available online as of April 2025. Eligible studies consisted of original in vitro, in vivo, and clinical research examining exosome-based applications in tissue regeneration, wound healing, and anti-aging therapies. Studies were thematically grouped by exosome origin, engineering strategy, and therapeutic context. A narrative synthesis approach was employed because of methodological heterogeneity. Exosomes represent a novel class of therapeutic agents capable of modulating biological processes critical to repair and regeneration. In addition to mammalian-derived vesicles, plant-based and hybrid systems offer scalable, biocompatible platforms for targeted molecular delivery. The integration of exosome-based therapies with advances in cellular reprogramming and bioelectric signaling may further expand their clinical utility. However, broader clinical adoption will require continued research addressing safety, manufacturing scalability, regulatory challenges, and ethical considerations. Level of Evidence: 3 (Therapeutic).