INS and type 1 diabetes mellitus: A study showed that co-culture of human bone marrow stromal cells and peripheral blood mononuclear cells (PBMC) derived EXOs may inhibit the immunological response by enhancing Treg activation.531,532 Pancreatic cell regeneration is a potential T1DM therapeutic approach.533 MSC-derived EVs have been found to stimulate islet cell regeneration and insulin production by upregulating pancreatic and duodenal homeobox1 (pdx1), TGF-β, and smad1/2.534,535 TGF-β is essential for cell proliferation and differentiation.536 Pdx1 is involved in β-cell differentiation, survival, and functional maintenance.