Table 4.

Current exosomes engineering techniques for Af treatments.

Exosomes engineering technologies	Pros	Cons
Encapsulate cargoes by sucrose gradient ultracentrifugation	Protect drugs from degradation, enhance drugs stability, bioavailability and effect	This protocol can only be used for hydrophobic drugs
Encapsulation cargoes through incubation, freeze-thaw cycles, sonication, and extrusion	Allows loading of both hydrophilic and hydrophobic drugs	Causes exosomal bilayer disruption
EV-imitating structure (liposomes)	Targeting, stable structure and contents	Physiochemical instability Can form unwanted degradants
Fusing cardiomyocyte-specific binding peptide to the exosomes (Cardiac homing peptide)	Enhance exosomes targeting	Displays only protein loading
Manipulation of the loading mechanism to selectively load cargoes into the exosomes (protein loading in exosomes based on integration of light sensitive reversible proteins interaction module)	Enhance exosomes targeting Controllable mechanism of loading	Displays only protein loading
Transfection of a gene encoding exosome-targeting proteins into parent cells.	Enhance production efficiency, specific packaging, and delivery to target cells	Displays only protein loading
Heart patches and hydrogels	Making exosomes release more sustained with higher bioavailability; enhance exosomes effects with better target	The delivery approaches with enhanced retention is unsatisfactory