Testicular microcirculation dysfunction-induced Sertoli cell injury—exosome therapy as a novel restorative strategy: a narrative review

Background and Objective: Testicular microcirculation disorders, arising from systemic or local factors, have increasingly been recognized for their detrimental impact on male reproductive health. Sertoli cells are essential for maintaining the spermatogenic microenvironment, constructing the blood-testis barrier, and supporting spermatogenic cell proliferation. Dysfunction of Sertoli cells is a major contributor to testicular dysfunction and male infertility. This review aims to elucidate how testicular microcirculation disorders impair Sertoli cell function and to explore the potential of exosome-based therapies in restoring Sertoli cell function.

Methods: A narrative literature search of PubMed and Web of Science was conducted up to August 25, 2026, to identify relevant publications on testicular microcirculation, Sertoli cell dysfunction, and exosome-based therapeutic strategies. Selected articles were reviewed and synthesized narratively.

Key Content and Findings: Testicular microcirculation disorders impair Sertoli cell function primarily through oxidative stress, disruption of the internal microenvironment, and endocrine/paracrine imbalances. These pathological processes collectively damage male reproductive health. In recent years, exosome-based technologies have shown significant promise in restoring Sertoli cell function. Specifically, exosomes derived from Sertoli cells or mesenchymal stem cells can protect and enhance Sertoli cell function by mediating intercellular communication and delivering bioactive molecules.

Conclusions: This review provides an in-depth analysis of the mechanisms linking testicular microcirculation disorders to Sertoli cell dysfunction and highlights the therapeutic potential of exosome technologies. These findings offer new insights and approaches for the treatment and prevention of male reproductive impairment.