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神奇的小泡泡如何對心臟醫學有幫助？成人心臟細胞幾乎無法再生，一旦發生心臟的傷害，受傷壞死的細胞無法恢復，就只能仰賴殘餘存活的細胞苦苦支撐心臟功能，如何在藥物之外，使患者的心臟組織有自癒能力，是我們努力的目標。

外泌體 (Exosome) 提供我們一個治療的新機會。利用細胞分泌的囊泡，其中充滿了調控因子、基因物質以及營養成分，許多最新研究顯示外泌體有治療的效果。這對於我們心臟科醫師的啟示是，除了藥物，促進患者本身的細胞活化，產生自我療癒效應，將是未來一個很重要的治療方向。

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科學家發現細胞會不斷分泌一些小泡泡，過往以為這些是排除廢棄物的機制，在持續研究後，被誤以為是垃圾袋的「外泌體」，於近年被重新發現具有幫助組織修復的能力，才重新受到矚目。

這些大約30-150 奈米大小的泡泡外泌體，當接收到「細胞異常」的訊息時，外泌體會攜帶著蛋白質，與富含DNA、RNA、miRNA等活性基因訊息，將這些「指令」傳遞到要修復的細胞，調控著其他細胞的生理與再生行為，達到癒合作用。

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被研究人員發現具有幫助組織修復的能力後，外泌體小囊泡在2013年獲得諾貝爾生醫獎，對於難以修復的神經退化、心臟組織受損等不可逆的衰退有所幫助，重要性受到研究學者和醫師們的高度重視。

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紐約西奈山醫院/The Mount Sinai Hospital ，使用間質干細胞(MSC) 為12名COVID-19引起的急性呼吸窘迫症候群(ARDS)進行治療，10天後就可免除呼吸器，存活率可達83%。

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英格蘭牛津生技公司 Evox Therapeutics 開發外泌體專利，目前已有7項專利在在歐洲或美國獲得核准，外泌體醫學蓬勃發展。

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全世界的學術、醫療機構，分別在腫瘤、神經疾病、罕見疾病、其他再生醫療等領域投入治療研究。

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外泌體可降低氧化反應產生自由基，改善細胞功能以及存活率。

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外泌體活化纖維母細胞，可幫助修復受損組織。外泌體也可幫助再生皮膚中的膠原蛋白及刺激關節軟骨的生成。

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外泌體透過I/III型膠原蛋白促使受損皮膚的組織重塑。在癒合期間減少纖維化改善疤痕形成。

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外泌體可藉由降低發炎因子，如：TNF-α、IL-1β 等數值減低身體發炎狀況。

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外泌體可調節免疫細胞的活性，以改善自身免疫性疾病並緩解不必要的發炎反應。

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