Abstract
Stroke is the leading cause of physical disability among adults. Stem cells such as mesenchymal stem cells (MSCs) secrete a variety of bioactive substances, including trophic factors and extracellular vesicles (EVs), into the injured brain, which may be associated with enhanced neurogenesis, angiogenesis, and neuroprotection. EVs are circular membrane fragments (30 nm−1 μm) that are shed from the cell surface and harbor proteins, microRNAs, etc. Since 2013 when it was first reported that intravenous application of MSC-derived EVs in a stroke rat model improved neurological outcomes and increased angiogenesis and neurogenesis, many preclinical studies have shown that stem cell-derived EVs can be used in stroke therapy, as an alternative approach to stem cell infusion. Although scientific research regarding MSC-derived EV therapeutics is still at an early stage, research is rapidly increasing and is demonstrating a promising approach for patients with severe stroke. MSC therapies have already been tested in preclinical studies and clinical trials, and EV-mediated therapy has unique advantages over cell therapies in stroke patients, in terms of biodistribution (overcoming the first pass effect and crossing the blood-brain-barrier), cell-free paradigm (avoidance of cell-related problems such as tumor formation and infarcts caused by vascular occlusion), whilst offering an off-the-shelf approach for acute ischemic stroke. Recently, advances have been made in the understanding of the function and biogenesis of EVs and EVs therapeutics for various diseases. This review presents the most recent advances in MSC-derived EV therapy for stroke, focusing on the application of this strategy for stroke patients.
Highlights
Stroke is the leading cause of physical disability among adults
This review presents the most recent advances in MSCderived extracellular vesicles (EVs) therapy for stroke, focusing on the clinical application of this strategy for stroke patients
Moon et al showed that cultivation of mesenchymal stem cells (MSCs) with either serum obtained from stroke patients, or treatment of ischemic brain extracts on culture media, could activate restorative properties of MSCs and the release of EVs, suggesting that signals from an ischemic brain can affect the efficacy of MSCs and MSC-derived EVs and activate the secretion of EVs from MSCs [20, 94]
Summary
Stroke is the leading cause of physical disability among adults. One-fourth to a half of stroke survivors are left with significant disabilities. Stem cell-derived EVs contain many molecules that may have therapeutic effects in stroke [70], such as microRNAs, proteins, and mitochondria (Table 1).
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