Smart Nanodelivery Systems for Immunometabolic Modulation in Osteoarthritis

Osteoarthritis (OA) is a chronic degenerative joint disease characterised primarily by immunometabolic disorders within the synovium-cartilage axis. Conventional therapies are limited by poor drug accumulation and nonspecific distribution at lesion sites, resulting in suboptimal and short-lived efficacy. In recent years, smart responsive nanodelivery systems (SRNSs) have demonstrated considerable potential for OA treatment. This review systematically summarises the major responsive mechanisms of SRNSs-such as pH, reactive oxygen species, enzymes and temperature-and their corresponding targeting strategies, including hyaluronic acid (HA)-cluster of differentiation 44, arginine-glycine-aspartic acid-collagen II and immune ligand recognition. The dual modulatory roles of SRNSs in the synovium-cartilage axis are highlighted. By analysing validation evidence from representative material systems-such as zeolitic imidazolate framework-8, poly(lactic-co-glycolic acid) and liposomes-in animal models, we delineate the synergistic mechanisms of SRNSs in inflammation suppression, metabolic remodelling and tissue regeneration. In the discussion section, we further explore key challenges for SRNSs, including biosafety concerns, lesion heterogeneity, manufacturing processes and regulatory standards. Potential strategies-such as biomimetic membrane camouflage, multi-omics-based stratification, artificial intelligence (AI) simulation and virtual clinical trials-are also proposed. Additionally, by comparing SRNSs with gene therapy, cell-penetrating peptides and exosome-based delivery, this review suggests that future OA therapies may evolve toward hybrid platforms integrating materials, biological systems and gene-based interventions. Looking ahead, smart systems endowed with self-feedback, self-evolution and visualisation capabilities are expected to move OA treatment toward a new era of personalised, adaptive and multidimensional precision interventions.