Mesenchymal stem cells (MSCs) since their initial discovery have been a subject of intense investigations. Paracrine activity is the predominent mechanism of MSCs in tissue repair via the release of extracellular vesicles (EVs). Mesenchymal stem cells derived extracellular vesicles (MSCs-EVS) are small spherical membrane bounded fragments in the conditioned medium of MSCs. EVs differ in their origin, size and contents,yet they have the ability to induce changes in the recipient cells. Several studies were carried out investigating the therapeutic potentials of MSCs-EVs in many fields including cardiovascular, respiratory, renal diseases and cancer. They were also reported to have immunomodulatory effects. EVs have many advantages over the use of MSCs including the ability to home to target tissue with no organ accumulation, no toxicity and no long term maldifferentiation of engrafted cells. In addition, EVs are able to deliver biological materials safer than current methods including viral vehicles. MSCs-EVs are promising biomedical tools in stem cell based therapies.