This review demonstrates the anti-inflammatory effects of exosomes on osteoarthritis, highlighting preclinical studies and clinical trials for potential treatment benefits.
Aims This review examines the therapeutic potential of adipose tissue-derived stem cell (ADSC) exosomes for osteoarthritis (OA), focusing on their anti-inflammatory and cartilage regeneration properties. Methods A PubMed search (2012 to 2024) was conducted using keywords related to ADSCs, exosomes, and OA. Inclusion criteria focused on studies investigating ADSCs and ADSC-exosomes characteristics, animal OA models, and human OA patients. Exclusion criteria included case reports, case series, and conference abstracts. Results ADSCs are an abundant stem cell source with low immunogenicity. ADSC-exosomes exhibit anti-inflammatory effects and promote cartilage regeneration via miRNA transport. Preclinical studies demonstrate inhibition of synovial thickening, cartilage destruction, and macrophage activity. Clinical trials suggest that intra-articular ADSCs are safe and effective, with higher doses improving pain relief and cartilage regeneration. Conclusion ADSC-exosomes are a promising cell-free therapy for OA, with reduced immune rejection and tumorigenicity compared to ADSC transplantation. Standardizing exosome isolation and production remains a challenge. Further research is needed to confirm long-term safety and efficacy in humans. Cite this article: Bone Joint Res 2025;14(12):1092–1108.
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