Jian-Guo Feng, PhD, Associate Professor, Principal Investigator, Department of Anesthesiology, The Affiliated Hospital, Southwest Medical University, No. 25 Taiping Street, Luzhou 646000, Sichuan Province, China. fengjianguo@swmu.edu.cn
Research Domain of This Article
Dermatology
Article-Type of This Article
editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Chun-Yi Wu, Xie-Hua Xiao, Jian-Guo Feng, Department of Anesthesiology, The Affiliated Hospital, Southwest Medical University, Luzhou 646000, Sichuan Province, China
Co-first authors: Chun-Yi Wu and Xie-Hua Xiao.
Author contributions: Wu CY and Xiao XH contributed to writing-original draft, have made crucial and indispensable contributions towards the completion of the project and thus qualified as the co-first authors of the paper; Wu CY contributed to visualization and software; Feng JG contributed to conception and design of the study, manuscript review and editing; all authors contributed to the manuscript and approved the submitted version.
Supported by Sichuan Science and Technology Program, No. 2025ZNSFSC0744; Health Commission of Sichuan Province Medical Science and Technology Program, No. 24QNMP040; and Luzhou Science and Technology Program, No. 2025RCX002.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Corresponding author: Jian-Guo Feng, PhD, Associate Professor, Principal Investigator, Department of Anesthesiology, The Affiliated Hospital, Southwest Medical University, No. 25 Taiping Street, Luzhou 646000, Sichuan Province, China. fengjianguo@swmu.edu.cn
Received: December 2, 2025 Revised: January 14, 2026 Accepted: February 4, 2026 Published online: September 15, 2026 Processing time: 272 Days and 21.8 Hours
Abstract
Chronic diabetic wounds represent a significant burden on global healthcare, characterized by their refractory nature and high risk of lower-limb amputation, which is mainly attributed to impaired angiogenesis and persistent endothelial dysfunction in a hostile hyperglycemic microenvironment. Mesenchymal stem cell-derived exosomes (MSC-Exos) have emerged as promising cell-free therapeutic options; however, their baseline bioactivity is often insufficient to achieve consistent clinical efficacy. Chen et al recently published a study in World Journal of Diabetes showing that fractional carbon dioxide (CO2) laser-based photothermal preconditioning of adipose-derived MSCs enhances the pro-angiogenic activity of Exos by enriching sphingosine-1-phosphate (S1P) cargo and activating endothelial S1P receptor 1/protein kinase B/hypoxia-inducible factor-1α signaling. In this editorial, we position these findings within the broader context of Exo engineering and preconditioning strategies for diabetic wound repair. We also highlight the conceptual distinction among physical, pharmacological and genetic preconditioning approaches, and discuss the specific advantages of fractional CO2 laser as a drug-free, dose-tunable and clinically familiar platform to enhance the functional potency and cargo composition of Exos rather than simply increase total Exos yield. We further outline key translational issues that remain to be addressed, including donor heterogeneity, parameter and dose standardization, and the integration of laser preconditioning into scalable good manufacturing practice compliant Exo production workflows. Overall, clinically available fractional CO2 laser systems offer a uniquely controllable preconditioning modality that can bridge the gap between promising preclinical data and real-world applications of MSC-Exos in diabetic wound healing, provided that their safety, reproducibility and long-term vascular effects are rigorously evaluated.
Core Tip: This editorial highlight that fractional carbon dioxide (CO2) laser pre-conditioning offers a novel, drug-free strategy to enhance the therapeutic quality of adipose-derived mesenchymal stem cell exosomes (Exos) for diabetic wound repair. We emphasize recent findings that this physical pre-conditioning strategy, utilizing clinically established and dose-tunable photothermal stimulation, enriches sphingosine-1-phosphate (S1P) cargo and activates endothelial S1P receptor 1/protein kinase B/hypoxia-inducible factor-1α signaling, thereby promoting improved angiogenesis and cytoprotection. This concept reframes fractional CO2 lasers as a scalable, good manufacturing practice-compatible platform to “upgrade” Exos bioactivity for chronic diabetic wounds.
