Engineered exosome based immunomodulation therapies: Advancements and clinical applications

Exosome applications in biomedicine have gained momentum in the last two decades, mainly due to their remarkable versatility. Exosomes are extracellular vesicles that carry diverse nucleic acids, proteins, lipids, enzymes, and growth factors, making them ideal for intercellular communication. Their surface can be engineered to express specific molecules and loaded with exogenous cargo such as drugs, nucleic acids, and therapeutic proteins. Exosomes also bear proteins and cell markers. Their immunocompetence initiation is also well established. Stem and immune cell exosomes have been extensively studied for their immunomodulatory effects in solid tumors, leukemia, cardiovascular diseases, diabetes, and inflammatory and rheumatic diseases, both in their natural and engineered forms.. Exosomes are majorly engineered via surface decoration by desired molecules, either by chemical methods or parent cells’ engineering to express molecules on their surface. For instance, CAR-cells isolated exosomes have been immensely investigated for various diseases therapies. Moreover, immunomodulating molecules loading on exosomes is a known method for exosome engineering aiming at specific disease therapy. In this review, we focus on the role of engineered exosomes in immune modulation therapy for various diseases and conditions, highlighting their intriguing potential in this field.