• MSC-derived exosomes precisely regulate pyroptosis, offering a novel acellular therapeutic strategy for various diseases.
• Pyroptosis is a key pathological mechanism in inflammatory, ischemic, and degenerative diseases, and its modulation is critical for therapy.
• Exosomes from different MSC sources exhibit distinct functions, enabling tailored treatments for specific conditions.
• This review highlights the clinical translational potential of MSC-derived exosomes in pyroptosis-related disease management.