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Extracellular vesicles (EVs) are nano-sized vehicles secreted by all live cells to establish communication with adjacent cells. In recent years, mammalian EVs (MEVs) have been widely investigated for their therapeutic implications in human disease conditions. As the understanding of MEV composition and nature is advancing, scientists are constantly exploring alternatives for EV production with similar therapeutic potential. Plant-derived exosome-like nanovesicles (PDEVs) may be a better substitute for MEVs because of their widespread sources, cost-effectiveness, and ease of access. Cissus quadrangularis (CQ), known as "bone setter or Hadjod", is a perennial plant utilized for its osteogenic potential. Its crude powder extract formulations are widely used as tablets and syrups. The present work elucidates the isolation of exosome-like nanovesicles (henceforth exosomes) from the culture supernatants of an in vitro cultured callus tissue derived from CQ. The physical and biological properties of the exosomes were successfully investigated using different characterization techniques. The therapeutic potential of the CQ exosomes was found to ameliorate the wound scratch injury and oxidative stress conditions in human-derived mesenchymal stem cells (hMSCs) and the pre-osteoblast (MC3T3) cell line. These exosomes also induced the proliferation and differentiation of hMSCs, as observed by alkaline phosphatase activity. These findings may serve as a proof of concept for further investigating the CQ exosomes as a nanocarrier for drug molecules in various therapeutic bone applications. [ABSTRACT FROM AUTHOR]

Extracellular vesicles (EVs) are nano-sized vehicles secreted by all live cells to establish communication with adjacent cells. In recent years, mammalian EVs (MEVs) have been widely investigated for their therapeutic implications in human disease conditions. As the understanding of MEV composition and nature is advancing, scientists are constantly exploring alternatives for EV production with similar therapeutic potential. Plant-derived exosome-like nanovesicles (PDEVs) may be a better substitute for MEVs because of their widespread sources, cost-effectiveness, and ease of access. Cissus quadrangularis (CQ), known as “bone setter or Hadjod”, is a perennial plant utilized for its osteogenic potential. Its crude powder extract formulations are widely used as tablets and syrups. The present work elucidates the isolation of exosome-like nanovesicles (henceforth exosomes) from the culture supernatants of an in vitro cultured callus tissue derived from CQ. The physical and biological properties of the exosomes were successfully investigated using different characterization techniques. The therapeutic potential of the CQ exosomes was found to ameliorate the wound scratch injury and oxidative stress conditions in human-derived mesenchymal stem cells (hMSCs) and the pre-osteoblast (MC3T3) cell line. These exosomes also induced the proliferation and differentiation of hMSCs, as observed by alkaline phosphatase activity. These findings may serve as a proof of concept for further investigating the CQ exosomes as a nanocarrier for drug molecules in various therapeutic bone applications.

Traditional bone setter's gangrene is a devastating complication arising from the practice of TBS with a prevalence of 4.29%, and most cases require amputation, which led to permanent disability. This case demonstrates a catastrophic presentation of the lower limb gangrene secondary to traditional bone setter's treatment. A 39-year-old man with history of treatment by traditional bone setter presented with generalized pain with loss of the skin throughout the entire right lower leg, leaving soft and hard tissue exposed to the environment. His vital signs showed tachycardia and fever. Pulses were absent on the entire lower leg except for the femoral artery. The radiograph revealed gas density around the soft tissue suggestive of gas gangrene. After stabilization, an above-knee amputation was performed by the orthopedic surgeon. Traditional bone setter's gangrene is a significant contributor to amputations in many developing countries. The practice of scarification, massage with herbal concoctions and creams, and a tight splint may lead to infection, vascular compromise, compartment syndrome that may terminate in gangrene or death of the limb. This progressive limb-threatening infection emphasizing the importance of early recognition of compartment syndrome, adequate resuscitation or stabilization, and prompt and aggressive treatment. This case highlights the menace of TBS activities and the dangers inherent in their practice. People who are misguided by false beliefs should be educated by public enlightenment. Appropriate legislation should be supplemented by the government to integrate traditional bone settings with the new orthopedic care services. • Traditional bone setter's practice has been associated with unacceptable outcomes such as gangrene • This practice lacks the fundamental scientific principles of fracture management and infection prevention and control • Limb gangrene eventually can lead to sepsis. Proper medical and surgical intervention are necessary • This case presents a potential benefit of amputation in a patient with limb gangrene and progressive deterioration [ABSTRACT FROM AUTHOR]