Abstract
This chapter reviews in vitro and preclinical evidence supporting MSC–EV-based therapies across multiple organ systems. It summarizes mechanistic findings from cellular models and evaluates efficacy in animal studies, including large-animal modelsLarge–animal models. The chapter highlights key therapeutic effects such as immunomodulation, tissue repair, and metabolic regulation. Limitations related to methodological variability, dosing inconsistencies, and translational gaps are critically discussed.