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Hidden Proteotoxic Cargo May Undermine Stem Cell Therapy Success

Stem cell and cell-free extracellular vesicle (EV) therapies are entering clinical practice faster than their quality-control systems can adapt. This review argues that proteostatic fitness--the ability of donor cells to maintain protein homeostasis under stress--is an overlooked determinant of therapeutic success. Senescence during ex vivo expansion can impair protein quality control and enrich EV cargo with proteotoxic species, including oxidized superoxide dismutase 1 (SOD1). The authors propose that senescence burden and EV proteomic integrity should become critical quality attributes, with targeted clearance of misfolded SOD1 as a possible pre-transplant strategy. Such measures could better align manufacturing release tests with the oxidative and inflammatory stress that cells face after transplantation.

October 21, 2026


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