Therapeutic potential of mesenchymal stem cell exosomes for tumors in the digestive system: From bench to bedside

Exosomes are small, bilayer lipid vesicles with diameters ranging from approximately 40–160 nm. These vesicles carry a diverse array of molecular cargo, including DNA, RNA, lipids, and proteins, which play a critical role in intercellular communication. Among the various cell types, mesenchymal stem cells (MSCs) are recognized as highly efficient producers of exosomes. MSC-derived exosomes (MSC-exo) have been demonstrated to play dual roles in cancer progression, either promoting or inhibiting tumor growth, depending on the specific context. This unique ability positions MSC-exo as a promising tool for cancer therapy. This review examines the multifaceted roles of MSC-exo in various types of digestive system tumors. It highlights the exosomes’ potential to modulate tumor microenvironments, influence immune responses, and deliver therapeutic molecules, thereby offering new avenues for targeted cancer treatment. In addition, the review explores the clinical application value of MSC-exo as anti-tumor agents, emphasizing the exosomes’ potential for drug delivery and personalized medicine. However, despite the exosomes’ therapeutic potential, several challenges must be addressed before MSC-exo can be widely adopted in clinical settings. These include issues related to large-scale production, standardization, safety, and regulatory approval. By addressing these challenges, MSC-exo could emerge as a transformative approach in cancer treatment, offering innovative solutions for precision medicine and improved patient outcomes. This review underscores the importance of continued research to fully realize the potential of MSC-exo in oncology.