Precision nanomedicine against pulmonary tuberculosis: the role of lipid-based drug delivery systems

Tuberculosis (TB) is one of the world's leading causes of death and continues to pose a major global public health challenge. Caused by <i>Mycobacterium tuberculosis</i>, TB most commonly presents as pulmonary disease and is primarily treated with prolonged multidrug anti-bacterial regimens, though drug resistance poses a threat. Recent advancements in nanomedicine have created new opportunities to utilize lipid-based nanocarriers to improve treatment outcomes and overcome the physical limitations of first and second-line antibacterial drugs. The Embase, MEDLINE, PubMed, Scopus, and Google Scholar databases yielded 105 peer-reviewed articles published in the last decade that have demonstrated significant advances in the development of lipid-based nanocarriers for delivering anti-bacterial drugs to the lungs. In contrast to polymeric and metallic nanoparticles, lipid nanocarrier platforms, such as solid lipid nanoparticles, nanostructured lipid carriers, liposomes, and lipid-polymer hybrid nanoparticles, can be readily taken up by alveolar macrophages, exploit endogenous lipid-processing pathways, and achieve sustained intracellular drug release without eliciting excessive cytotoxicity. These features are particularly relevant for TB, where treatment efficacy is limited not only by microbial resistance but also by granulomatous barriers that restrict drug exposure. Therefore, lipid-based nanocarriers are a promising solution to improve payload delivery, particularly for drug-resistant pulmonary TB.