Abstract
Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH) arise from coupled disturbances in lipid handling, insulin sensitivity, mitochondrial function, immune signaling, gut-liver communication, and fibrogenesis. Plant extracts and isolated compounds can act across several of these processes, but variable composition, uncertain active constituents, and limited oral exposure constrain their development. Purpose: This review compares source-plant extracts, defined bioactive compounds, and plant-derived exosome-like nanoparticles (PELNs) as related but distinct forms of plant pharmacology for MASLD/MASH. Study design: A narrative review integrating PELNs, source-plant extracts, isolated compounds, and clinical studies.Methods: A structured two-stage search of PubMed, Web of Science, Scopus, and Embase was conducted to identify evidence relevant to MASLD/MASH. Results: Evidence from the corresponding plants supports effects on lipogenesis, fatty-acid oxidation, oxidative stress, inflammasome signaling, intestinal barrier function, gut microbiota, hepatocyte injury, and hepatic stellate-cell activation. Direct PELN evidence is much narrower: 12 preclinical studies cover 11 plant sources, and most by a single report. Selected PELNs have shown intestinal, metabolic, inflammatory, or antifibrotic activity, but vesicle identity, functional cargo, oral fate, and tissue exposure are often incompletely defined. Engineered vesicle hybrids may improve cargo loading or distribution, although their pharmacology cannot be attributed to native PELNs alone. Clinical studies have examined several source-plant preparations, but no purified PELN formulation has entered clinical evaluation for MASLD/MASH. Conclusion：Progress will require standardized preparation, separation of vesicle-mediated effects from co-isolated constituents, causal cargo validation, quantitative biodistribution, direct comparison with source extracts and free compounds, and repeated-dose safety testing. At present, PELNs remain a preclinical research platform rather than an established therapeutic class.