Beyond the magic bullet: Programming delivery systems to overcome the antibody specificity paradox

The era of antibody therapeutics, while transformative, has reached a therapeutic plateau. We posit this stagnation stems from a central, unresolved conflict: the Paradox of Specificity, where the exquisite molecular-level targeting of antibodies is systematically nullified by the indiscriminate nature of their systemic administration. This review argues for a fundamental paradigm shift from the prevailing antibody-centric model to the rational design of Antibody-Carrier Integrated Systems (ACIS). Within this framework, the delivery system is no longer a passive carrier but is reconceptualized as a contextual intelligence layer-an engineered interface capable of sensing biological cues to strictly govern when and where the drug is active. We systematically analyze key strategies to achieve this vision, from fortifying the antibody's core stability and programming its spatiotemporal release kinetics, to redefining the localized therapeutic environment via localized delivery. By critically evaluating translational hurdles and envisioning a future of computational co-design, this review provides a strategic roadmap to finally resolve the paradox, thereby unlocking the full, unrealized potential of antibody-based precision medicine.