Table 2.

Overview of the characteristics of mesenchymal stem cell (MSC)^exo that suggest their potential in gestational diabetes mellitus (GDM) treatment.

Biological Process	Effects	Reference
Angiogenesis/Cell proliferation	Proliferation, migration and tube formation of endothelial cells through the Wnt4/β-Catenin Pathway/ Transferring miR), tube formation into endothelial cells miR-135b and by targeting factor-inhibiting HIF-1/ Promotes the enhancement of the proliferation and migration of fibroblasts by transferring signals to target cells activating several signaling important pathways (Akt, ERK and STAT3) and inducing the expression of a number of growth factors - [hepatocyte growth factor (HGF), insulin-like growth factor-1 (IGF1), nerve growth factor (NGF) and stromal-derived growth factor-1 (SDF1)]/ Inducing neovascularization in preclinical models by the paracrine effect by transferring pro-angiogenic microRNAs / Endothelial cell angiogenesis by transferring miR-125a/	[221,222,223,224,225]
Immunomodulation	Immunomodulatory effect of human stimulated T cells by inhibitory effect in the differentiation and activation of T cells as well as a reduced T cell proliferation and IFN-γ release/ Modulation of the local and systemic maternal immune system by exosomes secreted from trophoblast cells that carry HLA-G and B7 family immunomodulators/ MSC-derived exosome possesses the immunomodulatory properties mediated by paracrine factors suppressing the secretion of pro-inflammatory factor TNF-a and IL-1b, increasing TGF-β, inducing the conversion of T helper type 1 into T helper type 2 also reducing the potential of T cells to differentiate into IL 17/ Exosomes are the trigger the release of cytokines/chemokines from immune cells and stimulation of anti-tumor immune reactions or in a systemic immunosuppression by inducing the secretion of pro-inflammatory cytokines such as IL-1β, tumor necrosis factor (TNF)-α, IL-23a, CCL5 (RANTES) and IL-6/ Exosomes from MSCs ameliorate experimental bronchopulmonary dysplasia and restore lung function through MΦ immunomodulation by suppressing the pro-inflammatory “M1” state and augmenting an anti-inflammatory “M2-like via Cytokines, such as Ccl2, Ccl7 and IL6/ MSC exosomes enhanced the survival of allogenic skin graft in mice by induced polymyxin-resistant by activating APCs via MyD88-dependent.	[198,226,227,228,229,230]
Tissue regeneration	Fibroblast activation to initiate tissue regenerative responses by delivering TGF-b1 mRNA among others yet to be identified moieties/ Osteochondral regeneration by the action of regulatory components including miRs, mRNAs and proteins/ Accelerate skeletal muscle regeneration by enhancing myogenesis and angiogenesis, which is at least in part mediated by miRs such as miR-494/ Enhance cartilage tissue regeneration and prevent osteoarthritis of the knee in a rat model by the overexpression miR-140-5p/ As biomimetic tools for stem cell differentiation inducing stem cell differentiation and tissue regeneration by signaling mechanisms triggered (P38 mitogen activating protein kinase pathway) from exosomes.	[231,232,233,234,235]