The potential of bioengineered exosomes in regenerative medicine: a next generation therapy

The limitations of conventional drug delivery systems and synthetic nanocarriers have spurred the search for advanced therapeutic platforms in regenerative medicine. Bioengineered exosomes/sEV, natural extracellular vesicles with inherent biocompatibility and targeting capabilities, have emerged as a groundbreaking solution. This review explores the fabrication of these nanovesicles as precision drug delivery vehicles through strategies such as parent-cell modification, direct cargo loading (via sonication, electroporation, and extrusion), and surface functionalization. Critically, the synergy between exosomes and biomaterial scaffolds-including natural and synthetic polymers, hydrogels, and metallic implants-is highlighted as a transformative approach to overcome challenges of rapid clearance and off-target delivery, enabling localized, sustained release at injury sites. We detail their profound regenerative efficacy in healing chronic wounds by modulating inflammation and promoting angiogenesis, in repairing bone defects via osteogenic signaling activation, and in treating complex neurological and cardiovascular diseases by crossing biological barriers like the blood-brain barrier. Despite the promising preclinical outcomes summarized herein, significant hurdles in scalable production, standardization, and clinical translation remain. Addressing these challenges is essential to fully harness the potential of this cell-free therapy. Ultimately, bioengineered exosomes represent a versatile and powerful frontier in regenerative medicine, offering a targeted, efficient, and potentially transformative approach for tissue repair and the treatment of degenerative diseases.