摘要

Objectives: To systematically evaluate the efficacy of eleven exosome-based therapies in enhancing wound healing in diabetic wounds. To identify the most effective exosome sources in accelerating wound closure compared to placebo. To provide evidence-based insights that may guide future translational and clinical applications of exosome-based wound therapies. Introduction: Diabetic wounds pose a significant healthcare challenge due to delayed healing processes and increased risk of complications. Exosome-based therapies derived from various cellular sources have emerged as promising interventions. This study aims to evaluate the comparative efficacy of eleven exosome-based therapies in enhancing wound healing, with wound closure rate as the primary outcome. Materials / method: A network meta-analysis was conducted to compare eleven exosome-based therapies for diabetic wound healing: placebo, MT-hBMMSC-Exos, hMenSC-Exos, miR-126-MSC-Exos, Nrf2-ADSC-Exos, Fibro-Exos, SMSCs-126-Exos, ADMSC-Exos, hAEC-Exos, PRP-Exos, and HUVEC-Exos. Wound closure rate was the primary outcome. Mean differences with 95% confidence intervals (CIs) were calculated to assess relative effectiveness across interventions. Results: Human umbilical vein endothelial cell-exosome (HUVEC-Exo) showed significant wound closure rates compared to Placebo with a mean difference of -43.25 (95% CI: -45.50, -41.00). Other therapies, such as Human umbilical cord blood-derived mesenchymal stem cell-exosomes (hUCB-MSC-Exos, -26.73; CI: -37.30, -16.16) and Platelet-rich plasma-exosomes (PRP-Exos, -19.95; CI: -23.77, -16.13), demonstrated notable improvements. Adipose-derived mesenchymal stem cell-exosomes (ADMSC-Exos, -9.89; CI: -13.24, -6.54) and Melatonin-stimulated human bone marrow mesenchymal stem cells-exosomes (MT-hBMMSC-Exos, -1 Conclusion: Exosome-based therapies, particularly HUVEC-Exo, hUCB-MSC-Exos, and PRP-Exos, significantly enhance wound healing in diabetic wounds. These findings highlight their potential as innovative interventions for managing chronic wounds. Further clinical studies are warranted to validate these results and facilitate clinical translation.