Gene

microRNA

Cell biology

Stroke recovery

Engineering

Neuroscience

Biology

Microvesicles

Stem cell

Psychiatry

Biochemistry

Neurovascular bundle

Traumatic brain injury

Mechanical engineering

Rehabilitation

Bioinformatics

Psychology

Stroke (engine)

Physical therapy

Exosome

Medicine

Chemistry

Pathology

Nature Reviews Neurology

Stroke is a leading cause of disability worldwide, and brain injuries devastate patients and their families, but currently no drugs on the market promote neurological recovery. Limited spontaneous recovery of function as a result of brain remodelling after stroke or injury does occur, and cell-based therapies have been used to promote these endogenous processes. Increasing evidence is demonstrating that the positive effects of such cell-based therapy are mediated by exosomes released from the administered cells and that the microRNA cargo in these exosomes is largely responsible for the therapeutic effects. This evidence raises the possibility that isolated exosomes could be used alone as a neurorestorative therapy and that these exosomes could be tailored to maximize clinical benefit. The potential of exosomes as a therapy for brain disorders is therefore being actively investigated. In this Review, we discuss the current knowledge of exosomes and advances in our knowledge of their effects on endogenous neurovascular remodelling events. We also consider the opportunities for exosome-based approaches to therapeutic amplification of brain repair and improvement of recovery after stroke, traumatic brain injury and other diseases in which neurorestoration could be a viable treatment strategy. In this Review, the authors discuss the evidence that exosomes could be used as a neurorestorative therapy after stroke or traumatic brain injury and how engineering of their microRNA cargo could optimize this approach.

Exosomes — beyond stem cells for restorative therapy in stroke and neurological injury