Mesenchymal Stem Cell-derived Exosomes in the Treatment of End-stage Liver Disease

End-stage liver disease (ESLD) poses a significant threat to human health due to its high mortality rate. Although liver transplantation represents the most effective treatment modality, its application is limited by donor scarcity and prohibitive costs, thereby necessitating the development of innovative and efficacious therapeutic strategies. Within the realm of regenerative medicine, stem cell therapy has emerged as a promising alternative for ESLD treatment, with mesenchymal stem cells (MSCs) being at the forefront due to their exceptional multifunctional differentiation and self-renewal capabilities. Nonetheless, safety concerns, including the potential risk of tumorigenesis associated with MSCs, remain inadequately addressed. Recent evidence indicates that the therapeutic effects of MSCs are primarily mediated through paracrine mechanisms, with MSC-derived exosomes (MSC-Exos) serving as the principal effector mediators. The utilization of exosomes alone for therapeutic purposes not only preserves the beneficial effects of MSCs but also mitigates risks such as tumorigenic potential. Over the past few years, MSC-Exos have demonstrated significant ad-vancements across various medical disciplines, including cardiology, neurology, and gastroenterology. This review outlines the key mechanisms and recent progress in utilizing MSC-Exos in treating end-stage liver disease, seeking to highlight their unique therapeu- tic role.