MSC exosomes have also been investigated in preclinical studies as an acellular alternative to cell-based therapy for ARDS. MSC exosomes have been shown to reduce the levels of pro-inflammatory signaling molecules, which contribute to the pathogenesis of ARDS. They also increase the levels of anti-inflammatory signaling mediators that may help to reduce the severity of the lung injury, which causes increased permeability of the alveolar epithelium. The resulting accumulation of proteinaceous fluid in the smallest air sacs of the lungs impairs the normal oxygen exchange between the lungs and the circulation. Other contents of MSC exosomes, such as keratinocyte growth factor, may help to restore the normal barrier of the alveolar epithelium and contribute to the clearance of the fluid in the alveoli. MSC exosomes have also demonstrated the ability to transfer mitochondria to cells, potentially contributing to their ability to maintain cellular energy metabolism and increasing cellular survival. These and other effects of MSC exosomes demonstrated in preclinical studies of ARDS suggest the potential of exosomes as a therapeutic agent.
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