Exercise influences musculoskeletal repair through extracellular vesicles

Exercise places stress on muscles, tendons, and bones. In many cases this stress leads to beneficial adaptations that strengthen tissues. However, intense or repetitive exercise can also cause injury. Understanding how the body repairs these tissues is an important area of research in sports medicine and rehabilitation.

Scientists have recently become interested in the role of extracellular vesicles, especially exosomes, in coordinating how the body responds to physical stress. These tiny particles are released by cells and carry molecules such as RNA and proteins that allow cells to communicate with one another. Because of this ability, they can influence inflammation, tissue repair, and regeneration.

Researchers at China Three Gorges University examine how exercise affects RNA activity and exosome signaling in musculoskeletal tissues. The authors summarize research showing that exercise changes the types of RNA molecules produced in muscle and connective tissues. Some of these RNAs are packaged into exosomes and transported to other cells.

Illustration depicting how different exercise modalities impose biomechanical stress on muscle satellite cells, osteoblasts, and fibroblasts, leading to exosome biogenesis and targeted exosome delivery to damaged muscle fibers, bone cells, and tendon cells, with downstream signaling promoting tissue repair and regeneration.

Exercise-induced exosomal RNA–RBP network mediates musculoskeletal tissue repair and regeneration. The schematic depicts exosome biogenesis under exercise stress, selective RNA–RBP cargo sorting, targeted delivery to recipient cells, and downstream activation of repair-related signaling pathways.

Several types of RNA appear to be particularly important in this process. These include circular RNAs (circRNAs) and long non-coding RNAs (lncRNAs), which do not produce proteins but help regulate how genes are expressed. When these RNAs interact with RNA-binding proteins (RBPs), they form networks that influence how cells respond to injury.

Exosomes act as delivery vehicles for these RNA–RBP networks. When tissues experience mechanical stress from exercise, cells release exosomes that carry regulatory RNA molecules to neighboring cells. These signals can activate repair pathways, regulate inflammation, and guide tissue remodeling.

The authors also highlight how different types and intensities of exercise can influence this signaling system. Moderate exercise may promote regenerative signaling that strengthens musculoskeletal tissues, while excessive strain can activate pathways associated with inflammation or injury.

Understanding how exosomes regulate these responses could have important medical applications. Researchers believe these extracellular vesicles may serve as biomarkers, helping clinicians detect tissue stress or injury before symptoms become severe. In the future, engineered exosomes might even be used as therapies that deliver regenerative molecules directly to injured tissues.

The review emphasizes that integrating multiple types of biological data, including genomics, transcriptomics, and proteomics, will be important for fully understanding these repair mechanisms. As research progresses, insights into exosome-mediated signaling could improve diagnosis, rehabilitation strategies, and personalized treatments for musculoskeletal injuries.

Liu J, Chen H, Yang Y, Jia Z, Li Y, Zhong X, Jiang H, Mao Z, Zheng M. (2026) Exercise stress and tissue remodeling: advances in exosome-mediated RNA–RBP networks in musculoskeletal injury repair and functional recovery. Frontiers in Genetics 17:1775005. [article]

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