Overcoming biological barriers: Precision engineered extracellular vesicles for personalized neuromedicine

As the demand for precision medicines continues to grow, the traditional “one-size-fits-all” approach in neuromedicine research is shifting toward next-generation drug delivery techniques due to high costs and failure rates. Extracellular vesicles (EVs) promise a transformation in precision medicine, but the complexity of individual patients as well as biological and physiological barriers often require the integration of multiple functions in EVs to deliver personalized therapies. The next generation of drug delivery systems has the potential to create a paradigm shift in patient acceptance, but their success depends on overcoming previous challenges in overcoming biological and physiological barriers. A promising area of research is the use of EVs, which are important regulators of intercellular signaling and have the ability to bypass the blood-brain and blood-cerebrospinal fluid barriers to deliver drugs to the Central Nervous System (CNS). Engineered EVs have been developed for various clinical applications, including those for the treatment of colorectal cancer and irritable bowel disease. Cell-based therapies have been reported to have EV-mediated therapeutic effects, and the microRNAs carried by EVs are responsible for these effects. However, the mechanisms and surface biofabrication strategies by which EVs overcome physiological barriers are not yet fully understood. This review discusses the design and biofabrication of EVs for delivery to the CNS and their potential use as neurorestorative therapies tailored for maximum clinical benefit. • The lack of treatment options for neurodegenerative diseases. • EVs combined with precision medicine may offer tailored treatments. • Gene therapies encounter challenges such as biological barriers. • Engineered EV-based delivery is essential for overcoming drug delivery challenges.