Immunomodulatory extracellular vesicles: an alternative to cell therapy for COVID-19

ABSTRACT

Introduction: SARS-CoV-2 induces a cytokine storm and can cause inflammation, fibrosis and apoptosis in the lungs, leading to acute respiratory distress syndrome (ARDS). ARDS is the leading cause of mortality and morbidity the associated to COVID-19, and the cytokine storm is a prominent etiological factor. Mesenchymal stem cell-derived extracellular vesicles are an alternative therapy for the management of inflammatory and autoimmune conditions due to their immunosuppressive properties. The immunomodulatory and tissue regeneration capabilities of extracellular vesicles may support their application as a prospective therapy for COVID-19.

Areas Covered: We explored the clinical evidence on extracellular vesicles as antiviral agents and in mitigating ARDS, and their therapeutic potential in COVID-19.

Expert Opinion: Clinical trials using extracellular vesicles are registered against COVID-19 associated complications, with some evidence of safety and efficacy. Extracellular vesicles present an alternative potential for cell therapy for COVID-19 management, but further preclinical and clinical investigations are needed.

KEYWORDS:

• Exosomes
• extracellular vesicles
• antiviral
• COVID-19
• cytokine storm
• acute respiratory distress syndrome
• ARDS
• SARS-CoV-2

Article highlights

• SARS-CoV-2 induces a cytokine storm that leads to ARDS, increased mortality, and major strain on health care resources.

• The immunomodulatory, tissue regeneration, and antiviral capabilities of MSCs are a possible therapeutic alternative for COVID-19-associated ARDS. Yet, the use of MSCs has limitations.

• Extracellular vesicles are a cell-free alternative to MSC: they can produce equivalent therapeutic effects without MSC associated limitations.

• Although additional studies are necessary to ascertain the full therapeutic potential of extracellular vesicles in COVID-19, preliminary preclinical and clinical evidence are promising.

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Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

No funding has been received.