Use of mesenchymal stromal cells and their exosomes in the correction of ischemic intestinal injuries

The purpose of the study: to conduct a comprehensive analysis of current scientific data on the use of mesenchymal stromal cells (MSCs) and their exosomes for the correction of ischemic intestinal damage, assess the prospects for clinical application, and identify existing limitations.

Materials and methods. The study is based on a systematic analysis of publications from 2000 to 2024 in PubMed, Scopus, Web of Science, eLibrary, and the Cochrane Library. The key-words used were “intestinal ischemia”, “mesenchymal stromal cells”, “exosomes”, “regenerative medicine’, and “intestinal ischemia-reperfusion”. The search identified 235 publications; after excluding duplicates and screening abstracts, 127 were selected. The full texts of 89 articles were analyzed for relevance to the study objective. The final analysis included 25 references.

Results. MSCs and the exosomes they produce have been shown to exhibit a significant therapeutic effect in ischemic intestinal injury. The main mechanisms include paracrine regulation through the secretion of growth factors (VEGF, FGF, HGF), immunomodulation (a 60-70% reduction in TNF-α and IL-6), stimulation of angiogenesis (an increase in capillary density by 45%), and suppression of apoptosis (a 50–60% reduction). Autologous adipose- and bone marrow-derived MSCs demonstrate the greatest efficacy, while allogeneic cells require further safety studies. Exosomes, as a cell-free alternative, demonstrate efficacy comparable to MSCs with a lower risk of complications. The analyzed studies did not reveal convincing evidence of the superiority of MSCs over exosomes or vice versa; most authors indicate comparable therapeutic effects.

Conclusion. MSC- and exosome-based therapy represents a promising approach to treating ischemic intestinal injury, aligned with the principles of regenerative and personalized medicine. However, for widespread clinical implementation, further research is needed to standardize protocols, evaluate long-term outcomes, and develop uniform requirements for materials, including indications, contraindications, dosages, and types of cellular product used.

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