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. 2018 Dec 7;6:36. doi: 10.1038/s41413-018-0039-2

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© The Author(s) 2018

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

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Fig. 6 — Roles of exosomes in fracture healing at different stages. a Mesenchymal stem cell (MSC)-derived exosomes have anti-inflammation property by upregulating anti-inflammation factor TGF-β and suppressing pro-inflammation factors: TNF-α and IL-1β. Thus, exosomes can be used to prevent over reaction of inflammation-induced delay of fracture healing. b In the stage of callus formation, exosomes act as promoters by enhancing proliferation and differentiation of endothelial cells as well as the formation of fibroblasts. As a result, enhanced angiogenesis and callus formation induced by exosomes can be detected at this stage. c Osteoblast (OB) and MSC-derived exosomes are promoters of bone remodelling. MSC-derived exosomes are suggested to boost the proliferation and liability of OBs. Besides, MSC and OB-derived exosomes are shown to enhance osteoclast (OC) differentiation. OB-derived exosomes are also enhancers of osteocyte (OY) formation by regulating AT-hook 2 (HMGA2) and AXIN2