Exosomes, small vesicles containing proteins, nucleic acids, and lipids, are emerging as promising drug delivery vehicles due to their ability to target specific tissues and enhance therapeutic effects while reducing side effects. Mesenchymal stem cells (MSCs) are widely used in tissue engineering, regenerative medicine, and immunotherapy, and exosomes derived from MSCs exhibit unique immunomodulatory functions, low immunogenicity, and the ability to penetrate tumor tissues, making them ideal for drug delivery systems. This review discusses the characteristics, preparation methods, applications, and potential risks of MSC-derived exosomes as drug delivery systems. MSC-derived exosomes are rich in various biomolecules and can be extracted using methods such as ultracentrifugation, ultrafiltration, and size exclusion chromatography. They have been shown to effectively deliver therapeutic agents to target tissues, particularly in inflammatory diseases, cancer, immune diseases, ischemic diseases, and fibrotic diseases. However, the production and application of exosomes face challenges, including the need for standardized culture conditions and the potential for exosomes to promote tumor growth or metastasis under certain conditions. Further research is needed to optimize exosome preparation and improve their therapeutic potential.Exosomes, small vesicles containing proteins, nucleic acids, and lipids, are emerging as promising drug delivery vehicles due to their ability to target specific tissues and enhance therapeutic effects while reducing side effects. Mesenchymal stem cells (MSCs) are widely used in tissue engineering, regenerative medicine, and immunotherapy, and exosomes derived from MSCs exhibit unique immunomodulatory functions, low immunogenicity, and the ability to penetrate tumor tissues, making them ideal for drug delivery systems. This review discusses the characteristics, preparation methods, applications, and potential risks of MSC-derived exosomes as drug delivery systems. MSC-derived exosomes are rich in various biomolecules and can be extracted using methods such as ultracentrifugation, ultrafiltration, and size exclusion chromatography. They have been shown to effectively deliver therapeutic agents to target tissues, particularly in inflammatory diseases, cancer, immune diseases, ischemic diseases, and fibrotic diseases. However, the production and application of exosomes face challenges, including the need for standardized culture conditions and the potential for exosomes to promote tumor growth or metastasis under certain conditions. Further research is needed to optimize exosome preparation and improve their therapeutic potential.