Exploring the Regenerative Role of Exosomes as a Potential Therapy for Peripheral Nerve Injury: A Systematic Review.

Exosomes are nano-sized extracellular vesicles loaded with bioactive cargo that mediate intercellular communication. Their emerging role in tissue regeneration has garnered increasing attention, especially in the context of peripheral nerve injury (PNI), which poses a significant therapeutic challenge. Although many studies have explored exosome-based therapies for PNI, the findings are often fragmented and lack a comprehensive synthesis. This systematic review aims to synthesize the current evidence and elucidate the molecular mechanisms through which exosomes contribute to neural regeneration. This systematic review, conducted in accordance with PRISMA 2020 guidelines, included 33 eligible studies identified through Scopus, ScienceDirect, PubMed, and Google Scholar. Exosomes derived from diverse cellular sources were assessed for their capacity to enhance repair outcomes. Reported cargo, including miRNAs and neurotrophic factors, has been shown to activate key signaling pathways that promote neurite outgrowth, modulate Schwann cell and immune responses, stimulate angiogenesis, and activate perineurial cells. By orchestrating these processes, exosomes emerge as a promising therapeutic strategy to enhance nerve regeneration and functional recovery.