Emerging insights into mesenchymal stem cells and exosome-based therapies for liver injury.

Hepatic ischemia-reperfusion injury, fatty liver, liver fibrosis, liver peroxidative injury, and drug-induced liver injury are among the most common liver diseases. Mesenchymal stem cells (MSCs) possess multi-lineage differentiation potential and immunomodulatory functions. In the treatment of liver injury, MSCs can promote repair through homing effects, direct differentiation into hepatocyte-like cells (HLCs), immunomodulation, and anti-fibrotic mechanisms. Clinically, MSCs contribute to liver injury repair either directly or indirectly via the secretion of exosomes. Beyond their reparative role, MSC-derived exosomes can also serve as molecular biomarkers for the diagnosis and prognosis of liver diseases. Establishing higher-quality standards, robust auditing and evaluation systems, and conducting deeper mechanistic studies are essential prerequisites for the future clinical application of MSCs in the treatment of liver diseases.