Chinese herbal medicine-derived exosome-like nanovesicles for orthopaedic diseases: evidence, methods, and translation.

Chinese herbal medicine/medicinal plant-derived exosome-like nanovesicles (CHM/medicinal plant-derived ELNVs) are emerging as promising nanoplatforms for orthopaedic diseases because of their favorable biocompatibility, complex bioactive cargos, and potential multi-target regulatory activity. This mini-review summarizes current evidence with emphasis on a minimum reporting framework, disease-module interpretation, mechanistic integration, and translational barriers. Methodologically, future studies should clearly report source authentication, isolation strategy, vesicle characterization, purity or cargo fingerprints, route-specific safety indicators, and disease-relevant potency readouts. In terms of disease evidence, osteoporosis currently represents the most mature application module, whereas osteoarthritis and bone repair are emerging local-delivery fields, and intervertebral disc disorders, tendon/ligament injury, and rheumatoid arthritis-related musculoskeletal inflammation remain early or indirect indications. Mechanistically, CHM/medicinal plant-derived ELNVs may regulate bone remodeling, bone-vascular coupling, inflammation, oxidative stress, and extracellular matrix homeostasis through coordinated cargo- and delivery-dependent effects. However, meaningful translation is still limited by insufficient CMC-oriented batch control, inadequate cargo-causality validation, insufficient pharmacokinetic and biodistribution evidence, and limited long-term safety data. Overall, CHM/medicinal plant-derived ELNVs remain promising but require reproducible, route-specific, and clinically interpretable evidence chains.