Mesenchymal stem cell-derived extracellular vesicles for disease therapy by regulating ferroptosis: focus on diabetes mellitus and diabetic complications

• MSC-EVs modulate ferroptosis via three key pathways: iron metabolism, lipid metabolism, and antioxidant defense. • Both natural and engineered MSC-EVs show therapeutic potential in ferroptosis-related diseases, especially diabetes mellitus and its complications. • MSC-EVs offer advantages over MSCs, including lower immunogenicity, higher stability, and cell-free safety, making them promising for clinical translation. • Challenges and opportunities in translating MSC-EV-based ferroptosis modulation into clinical practice are critically evaluated.