Extracellular vesicles as precision therapeutic Vectors: Charting the future of cell-targeted Therapies

Extracellular vesicles (EVs) have emerged as promising vectors for precision therapeutic applications owing to their unique inherent ability to target specific cells and tissues. This review explores the multifaceted role of EVs in disease therapy, focusing on their natural targeting abilities and potential for enhancing therapeutic agent delivery. This review focuses on the inherent targeting mechanisms of EVs and their application in antitumor strategies, anti-inflammatory therapies, tissue repair, and immune modulation. Moreover, it surveys the innovative bioengineering strategies that can improve the efficiency with which cargo is loaded into EVs, techniques for engineering EVs to achieve precision delivery of their cargo, and strategies for scalable EV production. Finally, challenges, such as scalability, standardization, and biosafety, still need to be addressed. This review provides a forward-looking perspective on the role of EVs in clinical settings, emphasizing their importance in the development of precise and potent treatment strategies. • EVs exhibit cell-specific targeting mechanisms, including surface protein interactions, glycan-mediated recognition, and membrane fusion pathways, enabling precision delivery of chemotherapeutic agents, RNA therapeutics, and immunomodulators to tumor cells, immune cells, and damaged tissues. • Bioengineering innovations enhance EV functionality, such as ligand-receptor binding, magnetic nanoparticle-guided delivery, and RNA/drug encapsulation, exemplified by FAK siRNA-loaded EVs reversing cetuximab resistance in colon cancer and reshaping immunosuppressive tumor microenvironments. • Key challenges in clinical translation—scalability, biosafety, and standardization—require interdisciplinary collaboration, advanced production technologies (e.g., bioreactors, microfluidics), and harmonized regulatory frameworks to unlock EVs' full potential in precision medicine.