Engineered exosomes: advanced nanocarriers for targeted therapy and drug delivery in hematological malignancies
Mahsa Rahgoshay, Amir Atashi, Mohammad Vaezi, Mehdi Ajorloo, Sedigheh Amini‐Kafiabad, Mohammad Ahmadvand
Abstract
Hematological malignancies present significant therapeutic challenges, often complicated by drug resistance, poor bioavailability, and systemic toxicity of conventional treatments. Engineered exosomes have emerged as promising therapeutic carriers, offering unique advantages over synthetic nanoparticles through their natural biocompatibility, enhanced barrier penetration, and intrinsic cell-targeting capabilities. This review examines recent advances in exosome engineering strategies for hematological malignancy treatment, encompassing both parental cell-based modifications and direct engineering approaches. We discuss innovative applications across different malignancies, including targeted delivery of tyrosine kinase inhibitors in chronic myeloid leukemia, small interfering RNA delivery in lymphoma, and proteasome inhibitor transport in multiple myeloma. Notably, engineered exosomes demonstrate remarkable efficacy in overcoming drug resistance mechanisms and enhancing therapeutic outcomes while minimizing adverse effects. Surface modification techniques, including antibody decoration and peptide conjugation, have significantly improved targeting specificity and cellular uptake. Despite promising results, challenges persist in scalable production, standardization, and regulatory compliance. We analyze current limitations and propose future directions, emphasizing the development of standardized protocols, quality metrics, and regulatory frameworks. As this field advances, engineered exosomes show the potential to revolutionize hematological cancer treatment through precise, personalized therapeutic delivery systems with enhanced efficacy and reduced toxicity.