[Research progress on the role of exosomal miRNA in spinal cord injury and intervention by traditional Chinese medicine].

Spinal cord injury (SCI) remains a significant challenge in modern medicine due to its complex pathophysiological mechanisms, the irreversibility of damage, and limited treatment options. Recent studies have shown that microRNAs (miRNAs) transported by exosomes play a crucial role in the occurrence, progression, and outcomes of SCI. This article systematically reviews the functional mechanisms of exosomal miRNAs in SCI, with a particular focus on elucidating the unique advantages and molecular mechanisms by which Traditional Chinese Medicine (TCM) intervenes in SCI through an integrated "multi-component, multi-target, multi-pathway" approach that modulates miRNA networks. The content encompasses the biogenesis of exosomal miRNAs and their regulatory roles in various pathological processes post-SCI, including the inflammatory microenvironment, axonal regeneration, cell apoptosis, and vascular injury. It provides a detailed summary of how active TCM components and compound formulas target specific miRNAs to regulate corresponding signaling pathways, thereby exerting synergistic and integrated effects across multiple aspects such as inhibiting inflammatory responses, reducing apoptosis, and promoting axonal regeneration and revascularization. Despite some progress in SCI research, numerous challenges persist, including the complexity of regulatory mechanisms, difficulties in clinical translation, and shortcomings in delivery technologies. Building on this, the article points out future directions for the integrated treatment of SCI combining traditional Chinese and Western medicine, explores the application prospects of nano-drug delivery systems in enhancing the delivery efficiency and therapeutic specificity of TCM, and provides a theoretical basis and conceptual reference for in-depth exploration of miRNA-targeted therapy and the modernization of TCM research. In conclusion, with the continuous advancement of integrated Chinese and Western medicine research, more effective treatment options for SCI patients are anticipated, ultimately improving their quality of life and prognosis.