Mesenchymal stem cell-derived exosomes (MSC-EVs) are emerging as a promising therapeutic option for various chronic liver diseases. MSC-EVs, a type of extracellular vesicle, have shown potential in maintaining tissue homeostasis and supporting tissue regeneration. They play a crucial role in immunomodulation, anti-inflammatory effects, and tissue repair. MSC-EVs can be obtained from various tissues and have been studied for their ability to reduce liver inflammation, promote liver regeneration, and inhibit fibrosis. MSC-EVs have been investigated in the treatment of liver diseases such as acute liver injury, metabolism-associated fatty liver disease (MAFLD), autoimmune hepatitis (AIH), and liver fibrosis. They have demonstrated anti-inflammatory, anti-fibrotic, and regenerative properties, which are essential for liver repair and regeneration. MSC-EVs can suppress the activation of inflammatory cells, reduce the production of inflammatory cytokines, and inhibit the progression of liver fibrosis. MSC-EVs have also been shown to improve liver function and reduce liver damage in various animal models. They can be used to deliver therapeutic molecules such as miRNAs and drugs to specific liver cells, enhancing their therapeutic potential. However, challenges remain in the standardization of MSC-EV production, purification, and clinical application. Further research is needed to optimize the use of MSC-EVs in the treatment of chronic liver diseases and to develop effective clinical strategies. Overall, MSC-EVs hold great promise as a novel therapeutic approach for the treatment of chronic liver diseases.Mesenchymal stem cell-derived exosomes (MSC-EVs) are emerging as a promising therapeutic option for various chronic liver diseases. MSC-EVs, a type of extracellular vesicle, have shown potential in maintaining tissue homeostasis and supporting tissue regeneration. They play a crucial role in immunomodulation, anti-inflammatory effects, and tissue repair. MSC-EVs can be obtained from various tissues and have been studied for their ability to reduce liver inflammation, promote liver regeneration, and inhibit fibrosis. MSC-EVs have been investigated in the treatment of liver diseases such as acute liver injury, metabolism-associated fatty liver disease (MAFLD), autoimmune hepatitis (AIH), and liver fibrosis. They have demonstrated anti-inflammatory, anti-fibrotic, and regenerative properties, which are essential for liver repair and regeneration. MSC-EVs can suppress the activation of inflammatory cells, reduce the production of inflammatory cytokines, and inhibit the progression of liver fibrosis. MSC-EVs have also been shown to improve liver function and reduce liver damage in various animal models. They can be used to deliver therapeutic molecules such as miRNAs and drugs to specific liver cells, enhancing their therapeutic potential. However, challenges remain in the standardization of MSC-EV production, purification, and clinical application. Further research is needed to optimize the use of MSC-EVs in the treatment of chronic liver diseases and to develop effective clinical strategies. Overall, MSC-EVs hold great promise as a novel therapeutic approach for the treatment of chronic liver diseases.