Immunomodulatory Extracellular Vesicles: An alternative to cell therapy for COVID-19.

Gupta, Ashim; Kashte, Shivaji; Kadam, Sachin; Gupta, Manu; Rodriguez, Hugo C; Potty, Anish G; El-Amin Iii, Saadiq F; Maffulli, Nicola

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 reason for the 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 management of inflammatory and autoimmune conditions because of 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 to cell therapy for COVID-19 management, but further pre-clinical and clinical investigations are needed.