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Exosomes show promise as next-generation therapy for osteoarthritis (OA) due to their ability to modulate inflammation and cartilage synthesis. Recent advances in the engineering of exosomes have enhanced their targeted therapeutic potential for OA. 

Cationic-motif-modified exosomes provide a platform for gene delivery by overcoming ocular barriers faced during topical delivery as they exhibit full-depth penetration in porcine retinal explants significantly higher than native exosomes. 

Surface modification of milk exosomes with hydrophilic and zwitterionic peptides improves stability in the gastrointestinal tract, permeability through intestinal mucus, and uptake into epithelial cells, thereby markedly increasing the efficiency of oral administration for gene delivery. 

Abstract Gene therapy has the potential to facilitate targeted expression of therapeutic proteins to promote cartilage regeneration in osteoarthritis (OA). The dense, avascular, aggrecan‐glycosaminoglycan (GAG) rich negatively charged cartilage, however, hinders their transport to reach chondrocytes in effective doses. While viral vector mediated gene delivery has shown promise, concerns over immunogenicity and tumorigenic side‐effects persist. To address these issues, this study develops surface‐modified cartilage‐targeting exosomes as non‐viral carriers for gene therapy. Charge‐reversed cationic exosomes are engineered for mRNA delivery by anchoring cartilage targeting optimally charged arginine‐rich cationic motifs into the anionic exosome bilayer by using buffer pH as a charge‐reversal switch. Cationic exosomes penetrated through the full‐thickness of early‐stage arthritic human cartilage owing to weak‐reversible ionic binding with GAGs and efficiently delivered the encapsulated eGFP mRNA to chondrocytes residing in tissue deep layers, while unmodified anionic exosomes do not. When intra‐articularly injected into destabilized medial meniscus mice knees with early‐stage OA, mRNA loaded charge‐reversed exosomes overcame joint clearance and rapidly penetrated into cartilage, creating an intra‐tissue depot and efficiently expressing eGFP; native exosomes remained unsuccessful. Cationic exosomes thus hold strong translational potential as a platform technology for cartilage‐targeted non‐viral delivery of any relevant mRNA targets for OA treatment.