Exosome is a kind of vesicle secreted by a variety of cells with lipid bilayer membrane structure, which has good biocompatibility, high targeting and high stability, and is a natural nanoscale drug carrier with great development potential in drug delivery system. In this paper, exosomes and their properties, exosome drug delivery pathways and methods, the design strategy of engineered exosome drug delivery systems for targeted disease therapy, and the application of exosome drug delivery systems in the treatment of a variety of diseases were reviewed. Exosome drug delivery pathways could be divided into two categories: exogenous and endogenous. Common exosome drug delivery methods included electroporation, co-incubation, and ultrasound. Engineered exosome drug delivery system can further improve drug loading and enhance drug targeting. The main way of engineering is to modify exosome surface through genetic engineering technology, physical modification, chemical modification, etc. Exosome drug delivery system provides a new idea for targeted therapy of arthritis, tumor, brain and other diseases.
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