[Research progress on the mechanisms and optimization strategies of mesenchymal stem cell-derived exosomes in the treatment of liver diseases].

As an emergent acellular therapeutic tool, mesenchymal stem cell-derived exosomes (MSC-Exos) have demonstrated good application prospects in the prevention and treatment of liver diseases. MSC-Exos exhibit a lower immunogenicity and tumorigenic risk in comparison to traditional stem cell therapy and can also exert multiple therapeutic effects in liver diseases by carrying various active factors, including miRNAs and proteins, which play anti-inflammatory, anti-cell death, anti-fibrosis roles among others. In recent years, MSC-Exos have demonstrated effective therapeutic outcomes in different liver disease models, particularly receiving widespread attention in the field of acute and chronic liver injury and liver fibrosis. This article systematically reviews the mechanistic research of MSC-Exos and key variables influencing their efficacy in liver disease treatment, including exosome preparation techniques, tissue sources, drug administration plans, and delivery routes. Additionally, it focuses on discussing its functional optimization strategies, such as pretreatment, engineering modifications, and intelligent delivery systems, and explores the synergistic advantages of combined intervention with MSC-Exos and traditional Chinese and Western medicine. MSC-Exos is still considered a hot direction for achieving precise treatment of liver disease, although current research still faces challenges such as inconsistent standards and insufficient clinical evidence. In the future, it will be necessary to strengthen standardized production and clinical translation research to promote its clinical application in individualized interventions.