Exosomes Regulate Liver Diseases Through the TGF-β1/Smads Signaling Pathway and the Intervention of Traditional Chinese Medicine: A Narrative Review

Liver disease is a common chronic illness with increasing incidence and mortality. Exosomes are small membrane vesicles (30-200 nm) containing complex RNAs and proteins that serve as mediators of intercellular communication. The role of exosomes in liver disease is complex and sometimes contradictory. In certain situations, they may suppress liver disease, whereas in others, they promote its progression. This duality raises important questions regarding the overall impact of these drugs on the treatment of liver disease. The Transforming Growth Factor-beta1 (TGF-β1)/Smads signaling pathway plays a significant role in the occurrence and development of liver diseases, and exosomes mediate liver disease by regulating the TGF-β1/Smads signaling pathway. Research has shown that Traditional Chinese Medicine (TCM) can exert liver-protective effects by influencing exosomes to modulate the TGF-β1/Smads signaling pathway. Using keywords such as "exosomes", "TGF-β1/Smads signaling pathway", "liver fibrosis", "hepatocellular carcinoma", "liver diseases", and "traditional Chinese medicine", this article reviews the literature from databases, including CNKI, PubMed, and SCOPUS. It summarizes how exosome-mediated regulation of the TGF-β1/Smads signaling pathway affects the development of liver diseases and compiles relevant studies on the anti-liver disease effects of TCM through exosomal modulation of this pathway.