Mechanisms and clinical strategies of mesenchymal stem cell-derived extracellular vesicles intervening in cell regulatory networks to treat pulmonary fibrosis

• MSC-EVs deliver bioactive molecules to multiple lung cell types, modulating signaling pathways and miRNAs to inhibit fibrosis. • Engineered MSC-EVs with targeting peptides or drug loading enhance precision therapy for pulmonary fibrosis. • Inhalation administration of MSC-EVs offers rapid onset and lower doses, avoiding gastrointestinal and hepatic first-pass effects. • Clinical translation faces challenges including standardization, quality control, and in vivo tracking; future research should integrate single-cell and spatial omics.