Coupling extracellular vesicles with nanomedicine for precision theranostics

Nanomedicine represents one of the pivotal technologies that further bridges critical gaps in precision theranostics through targeted delivery, integrated diagnostics and therapeutics, and personalized treatment. Among various nanocarriers, extracellular vesicles (EVs) have attracted substantial interest owing to their nanoscale dimensions, favorable biocompatibility relative to synthetic counterparts, and innate capacity to transport bioactive cargoes. The central focus in this field is the inherent heterogeneity of EVs, which provides promising opportunities for biomarker-driven patient stratification while presents significant challenges in quality control and batch reproducibility. Recent progress in surface engineering has significantly optimized the targeting capability and pharmacokinetic profiles of EV-based systems in preclinical models, yet their clinical translation remains restricted by major challenges, including manufacturing scalability and the lack of disease and subgroup-specific standardization. Given that EV functionality and safety are highly context-dependent varying with cell source, loading strategy, and recipient pathophysiology bridging the gap between large-scale production and patient-specific customization emerges as a critical priority for translating EV-based nanomedicines into routine precision oncology treatment and beyond.