Extracellular Vesicles: An Emerging Clinical Opportunity in Musculoskeletal Disease

Extracellular vesicles (EVs) are important mediators of cell-to-cell communication in the extracellular space. These membranous nanoparticles carry various molecules, often referred to as "cargo," which are delivered to nearby target cells. In the past decade, developments in nanotechnology have allowed for various new laboratory techniques for the increased utilization of EVs in cellular and animal studies. Such techniques have evolved for the isolation, characterization, and delivery of EVs to biological tissues. This emerging technology has immense clinical potential for both diagnostic and therapeutic applications. Various EV cargo molecules, including DNA, RNA, and proteins, can act as pathological biomarkers. Furthermore, EVs derived from certain cell sources have shown therapeutic benefit in certain pathologies. In addition to their native therapeutic benefit, EVs can be engineered to carry and selectively deliver therapeutic agents. While EVs have gained increasing interest in various pathologies, few studies have compiled their clinical potential in musculoskeletal pathologies. To bridge this gap, we present an overview of EVs, introduce current laboratory preparation techniques, and outline the most recent literature regarding the potential therapeutic applications of EVs in musculoskeletal pathologies. Over the past decade, research on extracellular vesicles (EVs) has increased exponentially, creating opportunities to translate these findings. More recently, an increasing number of studies have highlighted the various roles EVs play in the pathogenesis of musculoskeletal disorders. This knowledge has led to greater opportunities for clinical utilization of EVs as biomarkers and therapeutics. In this review, we compile and present a detailed overview of findings demonstrating clinical promise. An increased understanding of the clinical potential of EVs along with their limitations is essential before their translation into clinical practice.