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Mesenchymal stem cell\u2010derived exosomes (MSC\u2010Exos) offer promising anti\u2010inflammatory therapeutic potential through immune modulation, tissue repair, and their inherently low immunogenicity. This review elucidates MSC\u2010Exos\u2019 molecular regulation of DED inflammation, demonstrating their suppression of the TLR4\/NF\u2010\u03baB signaling axis, the IRAK1\/TRAF6\/NF\u2010\u03baB cascade reaction, the STAT3 transcriptional regulatory network, and the NLRP3 inflammasome activation pathway, while revealing a synergistic mechanism through which MSC\u2010Exos ameliorate the ocular surface inflammatory microenvironment by modulating the Th17\/Treg immune balance via the gut\u2013eye axis and facilitating FBXW7\u2010mediated ubiquitination degradation pathways. Despite this therapeutic potential, clinical translation is hampered by exosomal heterogeneity, difficulties in standardization, and suboptimal delivery efficiency and long\u2010term efficacy. Future progress will require the integration of nanotechnology and gene editing to enhance therapeutic functionality, ultimately positioning MSC\u2010Exos as precision biologics for DED.<\/jats:p>","DOI":"10.1155\/sci\/2026673","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T07:52:42Z","timestamp":1788940362000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Mechanisms of Mesenchymal Stem Cell\u2010Derived Exosomes in Dry Eye Disease: From Inflammation Pathways to Therapeutic Prospects"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-6875-3452","authenticated-orcid":false,"given":"Jiahuan","family":"Yi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9214-3046","authenticated-orcid":false,"given":"Fangfang","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1215-6155","authenticated-orcid":false,"given":"Yale","family":"Tian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-3454-1357","authenticated-orcid":false,"given":"Zihe","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2728-042X","authenticated-orcid":false,"given":"Xujie","family":"Deng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9202-4250","authenticated-orcid":false,"given":"Zhi","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3172-8671","authenticated-orcid":false,"given":"Shigang","family":"Xia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7190-3993","authenticated-orcid":false,"given":"Jia","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0263-2138","authenticated-orcid":false,"given":"Qiguo","family":"Xiao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,9]]},"reference":[{"key":"e_1_2_14_1_2","doi-asserted-by":"crossref","first-page":"107","DOI":"10.31348\/2020\/29","article-title":"Dry Eyes Disease. 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