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Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Stem Cells. Dec 26, 2025; 17(12): 114076
Published online Dec 26, 2025. doi: 10.4252/wjsc.v17.i12.114076
Optimizing mesenchymal stem cell therapy for tendon-bone healing: Multifaceted approaches and future directions
Han Li, Zhi-Peng Li, Meng-Ting Zhu, Chen-Hao Lan, Yu-Xin Wang, Ping Liao, Zheng Chen, Peng Wang, Jin-Ke Sun, Zhen Shi, Peng-Yu Lu, Chao Lou, Guo-Hong Xu
Han Li, Chen-Hao Lan, Yu-Xin Wang, Ping Liao, Zheng Chen, Chao Lou, Guo-Hong Xu, Department of Orthopedics, Affiliated Dongyang Hospital of Wenzhou Medical University, Jinhua 322100, Zhejiang Province, China
Zhi-Peng Li, Peng Wang, Zhen Shi, Second Department of Orthopedics, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
Zhi-Peng Li, Tianjian Advanced Biomedical Laboratory, Zhengzhou University, Zhengzhou 450001, Henan Province, China
Meng-Ting Zhu, Department of Neurology, Union Medical College Hospital of Fujian Medical University, Fuzhou 350001, Fujian Province, China
Jin-Ke Sun, Third Department of Orthopedics, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
Peng-Yu Lu, First Department of Orthopedics, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
Co-first authors: Han Li and Zhi-Peng Li.
Co-corresponding authors: Chao Lou and Guo-Hong Xu.
Author contributions: Li H and Li ZP contributed equally to the development and writing of this review and are therefore recognized as co-first authors; Li H and Li ZP conceptualized and designed the study; Zhu MT, Lan CH, Wang YX, and Liao P conducted the literature review, extracted and analyzed key references, and drafted the initial manuscript; Chen Z, Wang P, Sun JK, and Shi Z prepared the figures and graphical illustrations; Lu PY critically revised the manuscript for intellectual content and contributed to methodological refinement; Lou C and Xu GH jointly supervised the entire project, critically reviewed and finalized the manuscript, and secured research funding; hence, they are recognized as co-corresponding authors. The collaboration between Lou C and Xu GH was essential to the successful completion and publication of this work.
Supported by Jinhua Public Welfare Technology Application Research Project, No. 2025-4-229; and Zhejiang Province Medical and Health Science and Technology Plan, No. 2022KY1343.
Conflict-of-interest statement: All authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Guo-Hong Xu, Chief Physician, Professor, Department of Orthopedics, Affiliated Dongyang Hospital of Wenzhou Medical University, No. 60 Wuning West Road, Jinhua 322100, Zhejiang Province, China. xgh316@163.com
Received: September 11, 2025
Revised: October 12, 2025
Accepted: November 11, 2025
Published online: December 26, 2025
Processing time: 105 Days and 13.5 Hours
Abstract

Tendon-bone healing remains a significant clinical challenge due to the high risk of re-rupture following injury. While mesenchymal stem cells (MSCs) show great potential in enhancing tendon-bone healing, their clinical application is limited by issues such as low delivery efficiency, restricted differentiation potential, and potential immunogenicity. Recently, various strategies combining MSCs with other approaches, such as preconditioning, biomaterial integration, gene modification, and exosome application, have been developed, resulting in improved therapeutic outcomes. This review explored the current methods used to optimize MSC therapy for tendon-bone healing, examining the advantages, disadvantages, and underlying mechanisms of each approach, providing a foundation for future research and clinical applications.

Keywords: Tendon-bone healing; Mesenchymal stem cells; Exosomes; Biomaterials; Preconditioning; Gene modification

Core Tip: This review synthesized advances optimizing mesenchymal stem cell-based therapy for tendon-bone healing, spanning metabolic or mechanical preconditioning, instructive biomaterials (aligned fibers, gradient mineralization, controlled release), gene/cargo engineering, and exosome-centered paracrine modulation. These strategies target persistent hurdles (poor homing/engraftment, lineage commitment at the fibrocartilaginous interface, hostile inflammatory milieu, and immunogenicity) while improving zonal enthesis regeneration and mechanical integration. We also highlighted scalable manufacturing and safety/readout standardization as key enablers to translate robust efficacy from preclinical models to rigorous clinical trials.