Mesenchymal stem cell (MSC)-derived exosomes are small vesicles containing proteins, nucleic acids, and lipids that facilitate intercellular communication. They have shown promise as efficient drug delivery vehicles due to their immunomodulatory properties, low immunogenicity, ability to penetrate tumor tissues, and high yield. MSCs are widely used in tissue engineering, regenerative medicine, and immunotherapy, and their exosomes have been studied for their potential in disease therapy. MSC-derived exosomes can deliver therapeutic substances to target tissues, enhancing treatment efficacy and reducing side effects. They have been used in various applications, including inflammatory diseases, cancer, immune diseases, ischemic diseases, and fibrotic diseases. For example, MSC-derived exosomes have been shown to reduce cerebral infarction in stroke models, regulate inflammation, and promote tissue regeneration. They can also target cancer cells, inhibit tumor growth, and enhance angiogenesis. However, the use of MSC-derived exosomes as drug delivery vehicles presents challenges, including immune compatibility, instability of their contents, and potential for exosome spread to other tissues. Additionally, the cargo of MSC-derived exosomes, such as miRNAs, can influence tumor progression depending on their species. While MSC-derived exosomes offer significant therapeutic potential, their clinical application remains challenging due to these risks and the need for further research to optimize their preparation, drug-loading methods, and therapeutic applications.Mesenchymal stem cell (MSC)-derived exosomes are small vesicles containing proteins, nucleic acids, and lipids that facilitate intercellular communication. They have shown promise as efficient drug delivery vehicles due to their immunomodulatory properties, low immunogenicity, ability to penetrate tumor tissues, and high yield. MSCs are widely used in tissue engineering, regenerative medicine, and immunotherapy, and their exosomes have been studied for their potential in disease therapy. MSC-derived exosomes can deliver therapeutic substances to target tissues, enhancing treatment efficacy and reducing side effects. They have been used in various applications, including inflammatory diseases, cancer, immune diseases, ischemic diseases, and fibrotic diseases. For example, MSC-derived exosomes have been shown to reduce cerebral infarction in stroke models, regulate inflammation, and promote tissue regeneration. They can also target cancer cells, inhibit tumor growth, and enhance angiogenesis. However, the use of MSC-derived exosomes as drug delivery vehicles presents challenges, including immune compatibility, instability of their contents, and potential for exosome spread to other tissues. Additionally, the cargo of MSC-derived exosomes, such as miRNAs, can influence tumor progression depending on their species. While MSC-derived exosomes offer significant therapeutic potential, their clinical application remains challenging due to these risks and the need for further research to optimize their preparation, drug-loading methods, and therapeutic applications.