Research Synthesis: Exosomes Extracellular Vesicles

Abstract

This paper synthesizes exosomes extracellular vesicles as an aging-related intervention across 56 included source papers and 2834 high-confidence extracted claims.

The evidence profile contains no sources classified primarily as direct clinical evidence, 26 adjacent clinical sources, and 3 mechanistic or model-system sources, with 668 cross-study disagreements across the evidence base.

Positive study-level signals are summarized in the contextual adjacent evidence outcome class, null signals in the contextual adjacent evidence, safety and comorbidity and skeletal, fracture, and bone outcome classes, and negative signals in the immune outcome class. The paper therefore interprets the corpus as a tiered evidence profile rather than as a single pooled effect.

The conclusion is that exosomes extracellular vesicles should be treated as a bounded geroscience hypothesis: the retained clinical and adjacent evidence profile defines the scope for targeted testing, while mixed and null findings limit any unqualified anti-aging claim.

Methods

Review type and protocol

This manuscript is reported as a Thin-corpus evidence brief. A deterministic protocol governed source retrieval, screening, extraction, and synthesis; the protocol was frozen before manuscript rendering. The full audit trail is in the supplementary methods_pack.json and the timestamped submission directory synthesis-exosomes_extracellular_vesicles-v06-DAILY-2026-05-31T23-15-05Z.

Information sources

Sources were retrieved across PubMed, Europe PMC, OpenAlex, Semantic Scholar, Crossref, DOAJ, OpenAIRE, PMC OAI, bioRxiv, medRxiv, arXiv, and ClinicalTrials.gov. Retrieval window: 2026-05-31.

Search strategy

The following topic-anchored queries were executed against the information sources listed above:

• exosomes AND aging AND human
• extracellular vesicles AND skin aging
• MSC exosomes AND clinical trial
• exosome therapy AND safety
• extracellular vesicles AND immune aging

Eligibility criteria

• Sources whose primary content addresses exosomes extracellular vesicles.
• Sources with extractable quantitative or qualitative findings.
• Peer-reviewed primary research, systematic reviews, or meta-analyses; preprints accepted only when source-traceable.
• Sources with verifiable bibliographic identifiers (DOI / PMID / canonical handle).

Selection of sources of evidence

The synthesis did not begin from an unfiltered database export. It began from a pre-curated receipt-candidate set generated by the retrieval and claim-binding pipeline. Of 191 records in the receipt-candidate union, 71 were classified as source candidates and 56 were admitted as traceable synthesis sources. No additional records were excluded after final source admission.

source admission funnel

Admission bucket	n
Receipt candidate union	191
Classified source candidates	71
No extractable claims	37
None-only claim binding	15
Partial/none-only claim binding	52
Partial-only candidates	8
Strict high-confidence sources	8
Admitted final sources	56

Exclusion reasons

• Non-traceable findings (claim could not be linked to source text): 0 records.
• Wrong population / off-topic sources excluded at screening.
• Duplicate records deduplicated by DOI / PMID before screening.

Data items

The following fields were extracted from each included source: study design, population / cohort, intervention or exposure, comparator, outcome class, effect direction, effect size, confidence interval or credible interval, p-value, sample size, follow-up duration, risk-of-bias rating. Source verification in the public bundle is limited to reference-level metadata; reported statistics and effect directions are drawn from these structured extraction artifacts (the synthesis manifest, risk-of-bias appraisal, and claim registry) rather than from re-parsed full text.

Risk-of-bias appraisal

Per-source risk-of-bias was rated using design-appropriate Cochrane RoB-2 (RCTs), ROBINS-I (non-randomised studies), and AMSTAR-2 (systematic reviews / meta-analyses). Ratings recorded in risk_of_bias.json.

Synthesis approach

Evidence-tension synthesis: claims grouped by outcome class (cardiometabolic, contextual adjacent evidence, deficiency prevalence, immune, longevity, safety and comorbidity, skeletal, fracture, and bone); within-class agreement, disagreement, and directness gaps surfaced explicitly. Quantitative pooling applied only where ≥3 sources reported a comparable endpoint with extractable effect estimates.

AI-use disclosure

Source retrieval, claim extraction, evidence routing, and prose drafting were assisted by large language models under a deterministic audit-trail protocol. Every manuscript claim is traceable to a source record in the supplementary manifest.json. Final eligibility and interpretation decisions are author-verified.

Accountability

Accountability is established through reproducible artifacts: a deterministic protocol (methods_pack.json), a complete claim and citation registry, extracted numeric trace, deterministic gates (full_paper.journal_surface.json, pre_submit_gate.json, artifact_consistency.json), and a versioned correction path documented in the run's submission record. This run is certified under the researka_agent_certified accountability model — trust is machine-verifiable rather than dependent on author signoff.

Results

Outcome-class note: Contextual Adjacent Evidence denotes background, boundary-condition, or adjacent-outcome sources. It is not pooled with direct outcome evidence.

Outcome class	Corpus slice	Strongest signal	Directness	Main limitation
Contextual Adjacent Evidence	n=36; claims=1715	null signal in 33/36 sources	18 indirect; 2 mechanistic; 16 review	limited corpus depth in this outcome class
Immune	n=7; claims=165	unclear signal in 2/7 sources	2 indirect; 1 mechanistic; 4 review	limited corpus depth in this outcome class
Safety and Comorbidity	n=6; claims=413	null signal in 6/6 sources	4 indirect; 2 review	limited corpus depth in this outcome class
Skeletal, Fracture, and Bone	n=4; claims=142	null signal in 4/4 sources	4 review	limited corpus depth in this outcome class
Cardiometabolic	n=1; claims=251	null signal in 1/1 sources	1 indirect	single-source slice; hypothesis-generating
Population / prevalence	n=1; claims=9	null signal in 1/1 sources	1 indirect	single-source slice; hypothesis-generating
Longevity	n=1; claims=139	mixed signal in 1/1 sources	1 review	single-source slice; hypothesis-generating

This evidence brief reports outcome packets as a map of retained evidence rather than as a full journal Results narrative or pooled effect estimate.

Contextual Adjacent Evidence Outcomes

36 included sources were assigned to this outcome class. Directional coding: null=33, positive=2, unclear=1. Directness coding: indirect=18, mechanistic=2, review=16.

Immune Outcomes

7 included sources were assigned to this outcome class. Directional coding: mixed=2, negative=1, null=2, unclear=2. Directness coding: indirect=2, mechanistic=1, review=4.

Safety Comorbidity Outcomes

6 included sources were assigned to this outcome class. Directional coding: null=6. Directness coding: indirect=4, review=2.

Skeletal Fracture Bone Outcomes

4 included sources were assigned to this outcome class. Directional coding: null=4. Directness coding: review=4.

Cardiometabolic Outcomes

1 included source were assigned to this outcome class. Directional coding: null=1. Directness coding: indirect=1.

Population / prevalence Outcomes

1 included source were assigned to this outcome class. Directional coding: null=1. Directness coding: indirect=1.

Longevity Outcomes

1 included source were assigned to this outcome class. Directional coding: mixed=1. Directness coding: review=1.

Limitations

Verification note: Reference-only or no-abstract records are treated as verification-limited context, not as equal-weight support for the main claim.

A fundamental limitation of this synthesis is the composition of the curated evidence corpus. Although 56 papers were included, the majority are systematic reviews and meta-analyses of preclinical animal studies rather than primary human randomized controlled trials. For example, evidence for osteoporosis-related bone outcomes (Zhang 2025, He 2023, Zhang 2025b), periodontal regeneration (Zhou 2025), diabetic peripheral neuropathy (Lu 2025), and renal ischemia-reperfusion injury (Wang 2025) derives entirely from preclinical models.

Several clinically important outcomes are represented by only a single study, precluding any within-corpus replication or assessment of consistency. The safety and efficacy of exosomes for knee osteoarthritis, assessed in Bolandnazar 2024 as a randomized, triple-blind, placebo-controlled trial, showed no statistically significant difference between EV-treated and placebo groups for clinical outcomes — yet this single null finding cannot be contextualized against other human trials because no other OA-specific RCT was included. Single-trial findings, whether positive or null, carry substantial uncertainty regarding reproducibility.

The enrolled populations across the included studies are narrow and raise external validity concerns. Only one observational study (Doi 2025) explicitly examined frail or sarcopenic adults with obstructive pulmonary disease, and that study focused on EV small-RNA profiles as biomarkers rather than therapeutic intervention. Consequently, the synthesis cannot directly address whether exosome-based therapies benefit older adults with age-related functional decline, and extrapolation from younger or comorbidity-specific cohorts remains speculative.

The corpus lacks long-term mortality and hard clinical endpoint data. No included study was designed with long-term survival as a primary endpoint in the aging-relevant population. The mechanism-to-clinic gap therefore remains wide: while preclinical data convincingly demonstrate anti-inflammatory and regenerative properties of EVs (Zhu 2025, Hong 2025), the translation to clinically meaningful, sustained benefit in older adults is not established by the available human evidence.

Conclusion

For exosomes extracellular vesicles, the final interpretation is deliberately tiered: the retained clinical and adjacent evidence profile defines a bounded geroscience rationale, but the corpus does not support treating mechanistic target engagement, intermediate biomarkers, and patient-relevant outcomes as interchangeable evidence. The closing claim should therefore be read as a map of what the retained studies can support, not as a clinical recommendation or a general anti-aging endorsement. Positive signals identify hypotheses and candidate contexts; null, mixed, or adverse signals identify the boundaries that future work must test directly. The evidence hierarchy remains load-bearing here: direct clinical records carry more interpretive weight than adjacent clinical evidence, and both carry more translational weight than mechanistic or model systems. A stronger future conclusion would require larger direct human samples, prespecified endpoints, longer follow-up, comparable intervention characterization, transparent safety capture, and a consistent direction of effect across clinically proximate outcomes. Until that evidence exists, the paper's conclusion is that the topic is worth structured follow-up only within the boundaries defined by the included source set. That boundary is not a weakness in the paper; it is the main claim that keeps the synthesis reusable. Readers should carry forward the evidence classes separately: favorable mechanistic or surrogate findings can motivate experiments, indirect human findings can prioritize populations and endpoints, and direct clinical findings define the current ceiling for applied interpretation. The current corpus may support exosomes extracellular vesicles as a general health or lifestyle intervention where otherwise indicated, but does not justify marketing it as a standalone geroprotective or anti-aging intervention with proven hard-longevity effects. Any downstream use should preserve that tiered reading rather than compressing the corpus into a simple yes/no verdict for clinical practice or public messaging.

What This Synthesis Adds

This synthesis maps 56 included sources on Extracellular vesicles across 7 outcome classes and 668 cross-study disagreements. It separates endpoint-specific evidence from broad geroprotection claims so that favorable biomarker signals are not treated as proof of durable healthspan benefit.

Across 56 curated reference papers, the evidence base for Extracellular vesicles shows a context-dependent profile. Positive signals appear in: contextual other. Negative signals appear in: immune. Null findings dominate: contextual other, safety comorbidity. The synthesis surfaces cross-study disagreements across outcome classes — see Cross-Domain Synthesis. The Extracellular vesicles anti-aging case as currently constituted is incomplete: mechanistic plausibility coexists with mixed or sparse human-RCT evidence, and the boundary conditions remain to be established.

Additional corpus sources included animal/preclinical evidence; the strongest unresolved contrast is the disagreement between Pineiro-Ramil 2025 and Hong 2025 on immune (severity 4/5), which defines the boundary condition future studies must test rather than smooth over.

Additional corpus sources included animal/preclinical evidence; prior reviews in the corpus (Wu 2025, Wang 2025, Hong 2025, Wang 2025b, Su 2024) emphasize convergent signals on Extracellular vesicles. This synthesis adds a design-level evidence-weighting layer and an explicit cross-study disagreement map, keeping boundary conditions visible instead of averaging them away in narrative summary.

Boundary-Condition Matrix

Outcome class	Direct sources	Indirect / mechanism sources	Direction profile	Interpretation boundary
immune	0	7	mixed, negative, null, unclear	conflict-resolution gap
longevity	0	1	mixed	direct clinical gap
cardiometabolic	0	1	null	direct clinical gap
contextual adjacent evidence	0	36	null, positive, unclear	direct clinical gap
deficiency prevalence	0	1	null	direct clinical gap
safety and comorbidity	0	6	null	direct clinical gap
skeletal, fracture, and bone	0	4	null	direct clinical gap

Evidence-Gap Priority

Priority	Gap	Rationale
P1	immune: conflict-resolution gap	0 direct and 7 indirect sources; direction profile: mixed, negative, null, unclear
P2	longevity: direct clinical gap	0 direct and 1 indirect source; direction profile: mixed
P3	cardiometabolic: direct clinical gap	0 direct and 1 indirect source; direction profile: null
P4	contextual adjacent evidence: direct clinical gap	0 direct and 36 indirect sources; direction profile: null, positive, unclear
P5	deficiency prevalence: direct clinical gap	0 direct and 1 indirect source; direction profile: null

Next-Study Design Recommendation

The next high-yield study for Extracellular vesicles should target the immune evidence gap, pre-register the primary endpoint, separate clinical from mechanistic endpoints, preserve safety and adherence capture, and include an analysis plan that can falsify the current boundary-condition claim rather than only confirming a favorable direction.

Evidence Snapshot

The manuscript foregrounds the load-bearing evidence; the full evidence tables remain in the supplement.

Load-Bearing Included Studies

Additional corpus sources included animal/preclinical evidence; - Wu 2025; Review / meta-analysis; tier=B1; directness=review; N=—; population=—; endpoint=longevity; direction=mixed; representative statistic=P = 0.0003.

• Wang 2025; Review / meta-analysis; tier=B1; directness=review; N=—; population=—; endpoint=contextual other; direction=positive; representative statistic=P < 0.001.
• Hong 2025; Review / meta-analysis; tier=B1; directness=review; N=—; population=—; endpoint=immune; direction=mixed; representative statistic=P < 0.00001.
• Wang 2025b; Review / meta-analysis; tier=B1; directness=review; N=—; population=—; endpoint=contextual other; direction=positive; representative statistic=P < 0.00001.
• Su 2024; Review / meta-analysis; tier=B1; directness=review; N=—; population=adults; endpoint=immune; direction=unclear.
• Jafarzadeh 2025; Review / meta-analysis; tier=B2; directness=review; N=—; population=—; endpoint=contextual other; direction=null; representative statistic=P < 0.05.
• Leung 2025; Observational; tier=B2; directness=indirect; N=—; population=adults; endpoint=cardiometabolic; direction=null; representative statistic=P = 0.0098.
• Bolandnazar 2024; RCT; tier=B2; directness=indirect; N=—; population=adults; endpoint=safety comorbidity; direction=null.
• Kishta 2025; RCT; tier=B2; directness=indirect; N=—; population=adults; endpoint=contextual other; direction=null; representative statistic=P = 0.001.
• Behrangi 2026; Review / meta-analysis; tier=B2; directness=review; N=—; population=—; endpoint=safety comorbidity; direction=null; representative statistic=P < 0.001.

Load-Bearing Tensions

Additional corpus sources included animal/preclinical evidence; - Severity 4 disagreement: Pineiro-Ramil 2025 vs Hong 2025; Pineiro-Ramil 2025 (unclear) vs Hong 2025 (mixed) on immune

• Severity 4 disagreement: Pineiro-Ramil 2025 vs Shi 2021; Pineiro-Ramil 2025 (unclear) vs Shi 2021 (mixed) on immune
• Severity 4 disagreement: Hong 2025 vs Zeng 2025; Hong 2025 (mixed) vs Zeng 2025 (null) on immune
• Severity 4 disagreement: Hong 2025 vs Pan 2025; Hong 2025 (mixed) vs Pan 2025 (negative) on immune
• Severity 4 disagreement: Hong 2025 vs Dai 2026; Hong 2025 (mixed) vs Dai 2026 (null) on immune
• Severity 4 disagreement: Hong 2025 vs Su 2024; Hong 2025 (mixed) vs Su 2024 (unclear) on immune
• Severity 4 disagreement: Zeng 2025 vs Shi 2021; Zeng 2025 (null) vs Shi 2021 (mixed) on immune
• Severity 4 disagreement: Pan 2025 vs Shi 2021; Pan 2025 (negative) vs Shi 2021 (mixed) on immune

Additional corpus sources included animal/preclinical evidence; additional corpus sources informed the synthesis without anchoring a foregrounded quantitative claim and are catalogued for completeness: Delen 2024, Ahmed 2024, Dhaliwal 2026, Luo 2024, Wei 2026, Zhang 2024, Andrews 2025, Bozbas 2024, Zamanian 2024, Kalluri 2025, Johnson 2023, Chernoff 2026, Jeppesen 2025, Ye 2024, Akhlaghpasand 2024, Santos 2026, Fang 2025, Kabatas 2025, Grueso-Navarro 2025, Habibi 2025, Wang 2025c, Hyun 2025, Estupinan 2025, Niu 2026, Civelek 2024, Zhu 2022, Li 2025, Svolacchia 2024, Ghanem 2025, Zhong 2023, Mitra 2026, Vreones 2022, Antoniewicz 2024, Su 2025.

References

• Jafarzadeh 2025. Effectiveness of regenerative medicine for skin lightening and rejuvenation: a systematic review of extracellular vesicles and conditioned media. Stem Cell Research & Therapy, 2025. DOI: 10.1186/s13287-025-04592-z. PMID: 41013717.
• Leung 2025. Glycolytic control proteins in urinary extracellular vesicles are elevated during kidney transplant T cell-mediated rejection. BMC Nephrology, 2025. DOI: 10.1186/s12882-025-04196-y. PMID: 40481420.
• Bolandnazar 2024. Safety and efficacy of placental mesenchymal stromal cells-derived extracellular vesicles in knee osteoarthritis: a randomized, triple-blind, placebo-controlled clinical trial. BMC Musculoskeletal Disorders, 2024. DOI: 10.1186/s12891-024-07979-w. PMID: 39465400.
• Wu 2025. Efficacy and safety of mesenchymal stem/stromal cells and their derived extracellular vesicles for acute respiratory distress syndrome: a systematic review and meta-analysis. Stem Cell Research & Therapy, 2025. DOI: 10.1186/s13287-025-04644-4. PMID: 41023747.
• Kishta 2025. The transforming role of wharton’s jelly mesenchymal stem cell-derived exosomes for diabetic foot ulcer healing: a randomized controlled clinical trial. Stem Cell Research & Therapy, 2025. DOI: 10.1186/s13287-025-04690-y. PMID: 41084065.
• Behrangi 2026. A systematic review of clinical evidence on the efficacy and safety of conditioned media, platelet-rich fibrin, stromal vascular fraction, extracellular vesicles, and stem cells in androgenetic alopecia. Stem Cell Research & Therapy, 2026. DOI: 10.1186/s13287-026-05016-2. PMID: 41987228.
• Zhu 2025. Mesenchymal stem cells-derived small extracellular vesicles and apoptotic extracellular vesicles for wound healing and skin regeneration: a systematic review and meta-analysis of preclinical studies. Journal of Translational Medicine, 2025. DOI: 10.1186/s12967-024-05744-0. PMID: 40128791.
• Lu 2025. Cell-derived exosome therapy for diabetic peripheral neuropathy: a preclinical animal studies systematic review and meta-analysis. Stem Cell Research & Therapy, 2025. DOI: 10.1186/s13287-025-04432-0. PMID: 40490808.
• Delen 2024. A systematic review and meta‐analysis of clinical trials assessing safety and efficacy of human extracellular vesicle‐based therapy. Journal of Extracellular Vesicles, 2024. DOI: 10.1002/jev2.12458. PMID: 38958077.
• Wang 2025. Protective role of exosomes in renal ischemia-reperfusion injury: a systematic review and meta-analysis. Frontiers in Pharmacology, 2025. DOI: 10.3389/fphar.2025.1653907. PMID: 40978485.
• Zhou 2025. Therapeutic effect of mesenchymal stem cell-derived exosome therapy for periodontal regeneration: a systematic review and meta-analysis of preclinical trials. Journal of Orthopaedic Surgery and Research, 2025. DOI: 10.1186/s13018-024-05403-6. PMID: 39780243.
• He 2023. Osteoporosis treatment using stem cell-derived exosomes: a systematic review and meta-analysis of preclinical studies. Stem Cell Research & Therapy, 2023. DOI: 10.1186/s13287-023-03317-4. PMID: 37038180.
• Ahmed 2024. Stem Cell Extracellular Vesicles as Anti-SARS-CoV-2 Immunomodulatory Therapeutics: A Systematic Review of Clinical and Preclinical Studies. Stem Cell Reviews and Reports, 2024. DOI: 10.1007/s12015-023-10675-2. PMID: 38393666.
• Dhaliwal 2026. The Use of Microneedling With Exosomes in Dermatology: A Systematic Review. Journal of Cosmetic Dermatology, 2026. DOI: 10.1111/jocd.70881. PMID: 42027180.
• Hong 2025. Stem Cell-Derived Extracellular Vesicles for Acute Pancreatitis: a Systematic Review and Meta-analysis of Preclinical Studies. Stem Cell Reviews and Reports, 2025. DOI: 10.1007/s12015-025-10852-5. PMID: 39964640.
• Luo 2024. Stem cell-derived extracellular vesicles in premature ovarian failure: an up-to-date meta-analysis of animal studies. Journal of Ovarian Research, 2024. DOI: 10.1186/s13048-024-01489-y. PMID: 39252114.
• Shi 2021. Preclinical efficacy and clinical safety of clinical‐grade nebulized allogenic adipose mesenchymal stromal cells‐derived extracellular vesicles. Journal of Extracellular Vesicles, 2021. DOI: 10.1002/jev2.12134. PMID: 34429860.
• Wang 2025b. Mesenchymal stem cell-derived exosomes for the treatment of knee osteoarthritis: a systematic review and meta-analysis based on rat model. Frontiers in Pharmacology, 2025. DOI: 10.3389/fphar.2025.1588841. PMID: 40529485.
• Pineiro-Ramil 2025. Mesenchymal stromal cells-derived extracellular vesicles in cartilage regeneration: potential and limitations. Stem Cell Research & Therapy, 2025. DOI: 10.1186/s13287-025-04135-6. PMID: 39849578.
• Wei 2026. Therapeutic effects of stem cell–derived extracellular vesicles in animal models of intervertebral disc degeneration: a systematic review and meta-analysis of species differences and delivery strategies. Frontiers in Bioengineering and Biotechnology, 2026. DOI: 10.3389/fbioe.2026.1749916. PMID: 41693926.
• Zhang 2024. The efficacy of extracellular vesicles for acute lung injury in preclinical animal models: a meta-analysis. BMC Pulmonary Medicine, 2024. DOI: 10.1186/s12890-024-02910-4. PMID: 38481171.
• Andrews 2025. PSMA + Extracellular Vesicles Are a Biomarker for SABR in Oligorecurrent Prostate Cancer: Analysis from the STOMP-like and ORIOLE Trial Cohorts. Clinical Cancer Research, 2025. DOI: 10.1158/1078-0432.CCR-24-3027. PMID: 39820657.
• Bozbas 2024. Dietary n-3 polyunsaturated fatty acids alter the number, fatty acid profile and coagulatory activity of circulating and platelet-derived extracellular vesicles: a randomized, controlled crossover trial. The American Journal of Clinical Nutrition, 2024. DOI: 10.1016/j.ajcnut.2024.03.008. PMID: 38484976.
• Zhang 2025. Therapeutic effects of mesenchymal stem cell-derived extracellular vesicles in osteoporosis models: a systematic review and meta-analysis of preclinical studies. Frontiers in Endocrinology, 2025. DOI: 10.3389/fendo.2025.1625969. PMID: 41036147.
• Zamanian 2024. Human placental mesenchymal stromal cell‐derived small extracellular vesicles as a treatment for severe COVID‐19: A double‐blind randomized controlled clinical trial. Journal of Extracellular Vesicles, 2024. DOI: 10.1002/jev2.12492. PMID: 39051747.
• Kalluri 2025. Engineered exosomes with Kras G12D specific siRNA in pancreatic cancer: a phase I study with immunological correlates. Nature Communications, 2025. DOI: 10.1038/s41467-025-63718-2. PMID: 41027940.
• Johnson 2023. First‐in‐human clinical trial of allogeneic, platelet‐derived extracellular vesicles as a potential therapeutic for delayed wound healing. Journal of Extracellular Vesicles, 2023. DOI: 10.1002/jev2.12332. PMID: 37353884.
• Chernoff 2026. Human Placental Mesenchymal Stem Cell-Derived Exosomes in Wound Healing and Scar Therapy: A Systematic Review and Meta-analysis. Aesthetic Surgery Journal, 2026. DOI: 10.1093/asj/sjaf163. PMID: 41800724.
• Jeppesen 2025. Blebbisomes are large, organelle-rich extracellular vesicles with cell-like properties. Nature Cell Biology, 2025. DOI: 10.1038/s41556-025-01621-0. PMID: 39984653.
• Zhang 2025b. The effect of bone marrow mesenchymal stem cell-derived extracellular vesicles on bone mineral density and microstructure in osteoporosis: A systematic review and meta-analysis of preclinical studies. PLOS One, 2025. DOI: 10.1371/journal.pone.0327011. PMID: 40587472.
• Ye 2024. Repair of spinal cord injury by bone marrow mesenchymal stem cell-derived exosomes: a systematic review and meta-analysis based on rat models. Frontiers in Molecular Neuroscience, 2024. DOI: 10.3389/fnmol.2024.1448777. PMID: 39169950.
• Akhlaghpasand 2024. Safety and potential effects of intrathecal injection of allogeneic human umbilical cord mesenchymal stem cell-derived exosomes in complete subacute spinal cord injury: a first-in-human, single-arm, open-label, phase I clinical trial. Stem Cell Research & Therapy, 2024. DOI: 10.1186/s13287-024-03868-0. PMID: 39183334.
• Santos 2026. The Effect of Cigarettes and E-Cigarettes on Epithelial-Derived Extracellular Vesicles: A Systematic Review. International Journal of Molecular Sciences, 2026. DOI: 10.3390/ijms27062787. PMID: 41898645.
• Fang 2025. Extracellular vesicles from bronchoalveolar lavage fluid provide insights into the inhaled corticosteroids treatment response in COPD. Respiratory Research, 2025. DOI: 10.1186/s12931-025-03330-6. PMID: 40739568.
• Kabatas 2025. Efficacy and safety of exosomes from Wharton’s Jelly-derived mesenchymal stem cells in traumatic brain injury. World Journal of Critical Care Medicine, 2025. DOI: 10.5492/wjccm.v14.i4.103782. PMID: 41377533.
• Grueso-Navarro 2025. MicroRNAs in Plasma-Derived Extracellular Vesicles as Non-Invasive Biomarkers for Eosinophilic Esophagitis. International Journal of Molecular Sciences, 2025. DOI: 10.3390/ijms26020639. PMID: 39859353.
• Habibi 2025. Efficacy of topical mesenchymal stem cell exosome in Sjögren’s syndrome-related dry eye: a randomized clinical trial. BMC Ophthalmology, 2025. DOI: 10.1186/s12886-025-04078-9. PMID: 40394561.
• Wang 2025c. Injection of human umbilical cord mesenchymal stem cells exosomes for the treatment of knee osteoarthritis: from preclinical to clinical research. Journal of Translational Medicine, 2025. DOI: 10.1186/s12967-025-06623-y. PMID: 40500748.
• Hyun 2025. Safety and Anti‐Inflammatory Effects of Engineered Extracellular Vesicles (ILB‐202) for NF‐κB Inhibition: A Double‐Blind, Randomized, Placebo‐Controlled Phase 1 Trial. Journal of Extracellular Vesicles, 2025. DOI: 10.1002/jev2.70141. PMID: 41002119.
• Estupinan 2025. Adipose Mesenchymal Stem Cell‐Derived Exosomes Versus Platelet‐Rich Plasma Treatment for Photoaged Facial Skin: An Investigator‐Blinded, Split‐Face, Non‐Inferiority Trial. Journal of Cosmetic Dermatology, 2025. DOI: 10.1111/jocd.70208. PMID: 40414798.
• Pan 2025. Mesenchymal stem cell–derived small extracellular vesicles (sEVs) as a therapy for sepsis-related liver injury: evidence from a systematic review and meta-analysis. Frontiers in Pharmacology, 2025. DOI: 10.3389/fphar.2025.1707784. PMID: 41394125.
• Doi 2025. Small RNA Profiles of Serum-Derived Extracellular Vesicles in the Comorbid Condition of Frailty and Obstructive Pulmonary Disease: An Observational, Cross-Sectional Study. Biomolecules, 2025. DOI: 10.3390/biom15121663. PMID: 41463319.
• Niu 2026. Altered circRNAs: a novel potential mechanism for the functions of extracellular vesicles derived from platelet-rich plasma. Frontiers in Bioinformatics, 2026. DOI: 10.3389/fbinf.2025.1690932. PMID: 41584514.
• Civelek 2024. Effects of exosomes from mesenchymal stem cells on functional recovery of a patient with total radial nerve injury: A pilot study. World Journal of Stem Cells, 2024. DOI: 10.4252/wjsc.v16.i1.19. PMID: 38292440.
• Zhu 2022. Nebulized exosomes derived from allogenic adipose tissue mesenchymal stromal cells in patients with severe COVID-19: a pilot study. Stem Cell Research & Therapy, 2022. DOI: 10.1186/s13287-022-02900-5. PMID: 35619189.
• Li 2025. Clinical investigation on nebulized human umbilical cord MSC-derived extracellular vesicles for pulmonary fibrosis treatment. Signal Transduction and Targeted Therapy, 2025. DOI: 10.1038/s41392-025-02262-3. PMID: 40461474.
• Su 2024. Natural and bio-engineered stem cell-derived extracellular vesicles for spinal cord injury repair: A meta-analysis with trial sequential analysis. Neuroscience, 2024. DOI: 10.1016/j.neuroscience.2024.10.018. PMID: 39490519.
• Svolacchia 2024. Exosomes and Signaling Nanovesicles from the Nanofiltration of Preconditioned Adipose Tissue with Skin-B ® in Tissue Regeneration and Antiaging: A Clinical Study and Case Report. Medicina, 2024. DOI: 10.3390/medicina60040670. PMID: 38674316.
• Zeng 2025. MiRNA-loaded MSC exosomes restore autophagy flux for acute pancreatitis therapy. Frontiers in Immunology, 2025. DOI: 10.3389/fimmu.2025.1613716. PMID: 40842993.
• Ghanem 2025. Large extracellular vesicles (microvesicles) in diabetic nephropathy: a systematic review of preclinical studies. Frontiers in Pharmacology, 2025. DOI: 10.3389/fphar.2025.1622280. PMID: 41142249.
• Zhong 2023. Neural stem cell-derived exosomes and regeneration: cell-free therapeutic strategies for traumatic brain injury. Stem Cell Research & Therapy, 2023. DOI: 10.1186/s13287-023-03409-1. PMID: 37553595.
• Mitra 2026. Effect of Glucoraphanin on the Abundance of Nrf2 Regulated Genes Within Circulating Small Extracellular Vesicles: A Pilot Dietary Intervention. Molecular Nutrition & Food Research, 2026. DOI: 10.1002/mnfr.70397. PMID: 41603376.
• Vreones 2022. Oral nicotinamide riboside raises NAD+ and lowers biomarkers of neurodegenerative pathology in plasma extracellular vesicles enriched for neuronal origin. Aging Cell, 2022. DOI: 10.1111/acel.13754. PMID: 36515353.
• Antoniewicz 2024. Vascular Stress Markers Following Inhalation of Heated Tobacco Products: A Study on Extracellular Vesicles. Cardiovascular Toxicology, 2024. DOI: 10.1007/s12012-024-09934-6. PMID: 39472409.
• Su 2025. The role of synovial mesenchymal stem cell-derived exosomes in cartilage repair: a systematic review. Frontiers in Pharmacology, 2025. DOI: 10.3389/fphar.2025.1617874. PMID: 40635749.
• Dai 2026. Stem cell-derived exosomes in tissue regeneration of oral and maxillofacial region: A systematic review. Medicine, 2026. DOI: 10.1097/MD.0000000000046948. PMID: 41496030.