Autoimmune hepatitis (AIH) is an immune-mediated liver disease that currently faces limited treatment options. In its advanced stages, AIH can progress to liver fibrosis and cirrhosis. Recent research has increasingly focused on cell-free therapies, particularly the use of mesenchymal stem cell (MSC)-derived exosomes (Exos), which have shown promise in treating autoimmune diseases, including AIH. MSC-Exos, as microvesicles with low immunogenicity, high safety, and permeability, can deliver RNA, DNA, proteins, lipids, and various drugs for disease treatment, showing promising clinical application prospects. This review provides a comprehensive summary of the current research on MSC-Exos in the treatment of autoimmune hepatitis (AIH) and explores the underlying molecular mechanisms involved. It highlights the significant regulatory effects of MSC-Exos on immune cells and their ability to modify the microenvironment, demonstrating anti-inflammatory and anti-fibrotic properties while promoting liver regeneration. Additionally, this review also discusses potential challenges and future strategies for advancing Exo-based therapies in the treatment of AIH.

Mesenchymal stem cells (MSCs) are capable of differentiating into various cell types and play a crucial role in repairing aging tissues and diseased organs. Aging manifests as a gradual loss of cellular, tissue, and organ function, leading to the progression of pathologies. Exosomes (Exos) are extracellular vesicles secreted by cells, which maintain cellular homeostasis, clear cellular debris, and facilitate communication between cells and organs. This review provides a comprehensive summary of the mechanisms for the synthesis and sorting of MSC–Exo miRNAs and summarizes the current research status of MSCs–Exos in mitigating aging and age-related diseases. It delves into the underlying molecular mechanisms, which encompass antioxidative stress, anti-inflammatory response, and the promotion of angiogenesis. Additionally, this review also discusses potential challenges in and future strategies for advancing MSC–Exo miRNA-based therapies in the treatment of aging and age-related diseases.

Liver fibrosis is a chronic pathological process driven by the activation of hepatic stellate cell (HSC) and characterized by the excessive deposition of extracellular matrix (ECM) components in response to persistent liver injury. This condition can lead to progressive hepatic dysfunction, cirrhosis, and ultimately liver failure. Growth differentiation factor 15 (GDF15) has emerged as a pivotal regulator in the initiation and progression of liver fibrosis, exhibiting context-dependent profibrotic and antifibrotic effects. GDF15 modulates multiple cellular processes, including HSC activation and macrophage polarization, as well as the functions of T cells, natural killer cells, B cells and mesenchymal stem cells. This review provides a comprehensive overview of the role of GDF15 in regulating HSC activation and immune cell responses and elaborates on its immunomodulatory functions in attenuating liver fibrosis. Furthermore, we discuss the therapeutic potential of targeting GDF15 for the treatment of liver fibrosis. Ultimately, this review aims to provide a theoretical foundation and propose novel intervention strategies for the early diagnosis and targeted therapy of liver fibrosis.