Mesenchymal Stem Cell-Derived Exosomes for Keratoconus: A Novel Therapeutic Approach.

Keratoconus (KC) is a progressive corneal ectatic disorder with limited treatment options addressing its underlying pathophysiology. Current therapies, including corneal cross-linking and transplantation, focus on halting progression rather than reversing damage. Mesenchymal stem cell-derived exosomes (MSC-Exo) have emerged as promising cell-free therapeutic agents with regenerative, anti-inflammatory, and immunomodulatory properties. This short communication synthesizes current evidence on MSC-Exo for KC treatment. Preclinical studies demonstrate that MSC-Exo enhances keratocyte proliferation, reduces fibrosis and inflammation, modulates extracellular matrix proteins, and promotes epithelial wound healing. Exosomes from various MSC sources show therapeutic efficacy across in vitro and animal models. While clinical evidence remains limited, early studies support safety and feasibility for ocular applications. MSC-Exo represents a promising therapeutic approach capable of modulating key KC pathological mechanisms, warranting further clinical investigation.