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Moreover, compared to viable cell therapy, MSCs-Exo exhibit superior adaptability and greater potential in clinical translation, primarily due to their ultra-small size that enables penetration of the vascular endothelial barrier and interstitial spaces, thereby avoiding the issues of entrapment in pulmonary capillaries (first-pass effect) and mechanical obstruction commonly associated with intravenous infusion of MSCs (Teng et al., 2022