Exosome-integrated biomaterials: A paradigm in musculoskeletal regeneration

Musculoskeletal disorders present significant treatment challenges due to their chronic nature and limited intrinsic healing capabilities. Exosomes, which are nanoscale vesicles containing bioactive molecules, have gained attention as potential agents for promoting regeneration and modulating immune responses. Nonetheless, their therapeutic efficacy is hindered by brief circulation times and inadequate retention at sites of injury. The integration of exosomes with biomaterials enhances localized and sustained delivery while simultaneously offering structural and biological guidance. This review explores bioengineering strategies and preclinical applications in the repair of bone, cartilage, tendons, and spinal tissues. Additionally, we address translational challenges, including the standardization of manufacturing processes and regulatory obstacles, and propose solutions to facilitate clinical implementation. Exosome-integrated biomaterials represent an emerging frontier in the field of orthopedic regenerative medicine.