Adipose-derived stem cell exosomes: from functional mechanisms to clinical translation in diabetic foot ulcer management

Diabetes is a major global public health challenge. Diabetic foot ulcer (DFU), one of its most severe complications, imposes a substantial economic burden and severely impairs patients' quality of life. Current treatment strategies often yield suboptimal outcomes, underscoring the urgent need for novel therapeutic approaches. Adipose-derived stem cell exosomes (ADSC-Exos) have emerged as a promising cell-free therapy with significant clinical potential. This review integrates the mechanisms through which ADSC-Exos facilitate diabetic wound healing with the phases of wound healing. It elucidates that ADSC-Exos function by alleviating oxidative stress, modulating inflammation, promoting angiogenesis, stimulating cell proliferation and migration, and suppressing excessive fibrosis. Additionally, this study organizes insights into how delivery strategies based on smart materials (e.g., hydrogels and bioscaffolds) and the latest physical modalities can overcome bottlenecks in clinical translation. This review aims to provide an integrated perspective for developing next-generation DFU therapies.