Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.
World J Stem Cells. May 26, 2026; 18(5): 117689
Published online May 26, 2026. doi: 10.4252/wjsc.v18.i5.117689
Published online May 26, 2026. doi: 10.4252/wjsc.v18.i5.117689
Bone marrow mesenchymal stromal cell-derived exosomes in knee osteoarthritis: Bridging mechanistic understanding to clinical applications
Ashwini Raja, Aadithya Siddarth Sridhar, Department of Orthopaedics, Faculty of Medicine - Sri Lalithambigai Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai 600095, Tamil Nadu, India
Naveen Jeyaraman, Madhan Jeyaraman, Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai 600077, Tamil Nadu, India
Naveen Jeyaraman, Swaminathan Ramasubramanian, Arulkumar Nallakumarasamy, Sathish Muthu, Madhan Jeyaraman, Department of Regenerative Medicine, Agathisha Institute of Stemcell and Regenerative Medicine, Chennai 600030, Tamil Nadu, India
Naveen Jeyaraman, Sathish Muthu, Madhan Jeyaraman, Department of Orthopaedics, Ortho
Ashika Mudilikulam Sukumaran, Department of Biochemistry, Faculty of Medicine - Sri Lalithambigai Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai 600095, Tamil Nadu, India
Arulkumar Nallakumarasamy, Department of Orthopaedics, Jawaharlal Institute of Postgraduate Medical Education and Research, Karaikal 609602, Puducherry, India
Sathish Muthu, Central Research Laboratory, Meenakshi Medical College Hospital and Research Institute, Meenakshi Academy of Higher Education and Research, Kanchipuram 631552, Tamil Nadu, India
Co-first authors: Ashwini Raja and Naveen Jeyaraman.
Author contributions: Raja A and Jeyaraman N contributed equally and are co-first authors. Jeyaraman N designed the research; Raja A, Jeyaraman N, Sukumaran AM, Sridhar AS, Ramasubramanian S, and Nallakumarasamy A analyzed the articles for performing review and wrote the manuscript; Muthu S and Jeyaraman M finalized the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Madhan Jeyaraman, MD, PhD, Researcher, Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Velap
Received: December 15, 2025
Revised: January 27, 2026
Accepted: March 3, 2026
Published online: May 26, 2026
Processing time: 163 Days and 14.4 Hours
Revised: January 27, 2026
Accepted: March 3, 2026
Published online: May 26, 2026
Processing time: 163 Days and 14.4 Hours
Core Tip
Core Tip: Bone marrow mesenchymal stromal cell exosomes show promise as cell-free therapeutics for knee osteoarthritis by delivering microRNAs and long noncoding RNAs that modulate nuclear factor kappa B, Wnt/β-catenin, phosphatidylinositol 3-kinase/protein kinase B/mechanistic target of rapamycin and mitogen-activated protein kinases pathways. They suppress chondrocyte apoptosis, enhance matrix synthesis, polarise macrophages, and reduce pain behaviours. Delivery innovations like hydrogels improve retention, but rigorous Minimal Information for Studies of Extracellular Vesicles 2023-compliant characterisation and adequately powered randomised trials remain essential before clinical translation as disease-modifying therapy.