Advances in the Treatment of Diabetic Foot with MSC-derived Exosomes

Abstract

Diabetes is a chronic metabolic disease with a worldwide epidemic and its prevalence is increasing every year. Meanwhile, diabetes imposes serious economic burdens on the world. Commonly and seriously as a complication of type 2 diabetes, the diabetic foot is a multi-factorial chronic non-healing wound that not only poses serious threats to the patient's physical health but also comes along with huge financial and psychological burdens. In the long run, the risk of amputation is much higher inpatients who suffer from diabetic foot than in healthy people. [1] The prognosis for the diabetic foot is not encouraging in today's treatment paradigm, with the majority of patients having an unsatisfactory prognosis after conventional treatment, eventually leading to tissue necrosis, gangrene, and amputation. Numerous studies have suggested that mesenchymal stem cell exosomes (MSCs-Exos) have potential therapeutic value for patients with DFU and are increasingly being available in clinical practice. MSCs-Exos can accelerate DFU wound healing by promoting coagulation, inhibiting inflammatory responses, boosting cell proliferation and angiogenesis, and increasing collagen deposition. In addition, this article reviews the clinical application of MSC-derived exosomes in the treatment of diabetic foot and the advantages and limitations of MSC-derived exosomes as carriers, exploring the extraction process of exosomes. In the future, a unified and standardized guideline specification for purification and isolation techniques should also be established and enhanced, and a license for clinical application should be obtained. To verify the security and efficacy of exosomes in DFU treatment, large sample, and multi-centre clinical research should be designed.