EMSC-Exos relieved osteoarthritis by reducing inflammation, inhibiting pain, and restoring matrix homeostasis. (A) The mechanism of EMSC-Exos promoting joint repair. (B) Time-dependent injury response after treatment indicated the effect of Exos treatment on pain. (C) Exos treatment suppressed inflammation. Expression of IL-1β+ cells in cartilage at 2, 4, and 8 weeks. (D) Exos treatment reduced apoptosis. Expression of CCP3+ cells in cartilage at 2, 4, and 8 weeks. (E) Exos reversed TMJ degeneration in OA patients. Schematic model of joint condyle head (left), condyle height in different areas (upper right), percentage of cartilage thickness in different areas (lower right). * Compared to OA + PBS group, # compared to Sham group, n = 6–8/group. Reproduced with permission [161]. Copyright 2019, Elsevier.