Therapeutic potential of mesenchymal stromal cell-derived extracellular vesicles in obstetrics and gynecology

In recent years, mesenchymal stromal cell (MSC) therapy has been widely studied as a major trend in medicine. However, it faces several clinical limitations, including immune reactions, tumor risks, and low homing efficiency. Consequently, cell-free strategies using MSC-derived extracellular vesicles (MSC-EV), particularly exosomes, are being studied as an increasingly recognized safer alternative. This mini-review aims to summarize current preclinical and early clinical evidence on the therapeutic potential of MSC-EV in female reproductive disorders, with a particular focus on premature ovarian insufficiency and thin endometrium, and to outline the key translational challenges to their clinical application. Preclinical and clinical data indicate that MSC-EV modify target tissue functions by transferring microRNA, proteins, and lipids. In chemotherapy-induced premature ovarian insufficiency models, MSC-EV restore folliculogenesis, increase anti-Müllerian hormone levels, and reduce granulosa cell apoptosis. In thin endometrium models, vesicles improve tissue regeneration and stimulate angiogenesis via the wingless-related integration site / β-catenin and mitogenactivated protein kinase / extracellular signal-regulated kinase (MAPK/ERK) pathway. Overall, MSC-EV serve as a viable cell-free option in reproductive medicine, though standardized protocols and robust clinical trials are still required.

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