Red blood cells (RBCs) and RBC membrane-derived nanoparticles
have
been historically developed as bioinspired drug delivery systems to
combat the issues of premature clearance, toxicity, and immunogenicity
of synthetic nanocarriers. RBC-based delivery systems possess characteristics
including biocompatibility, biodegradability, and long circulation
time, which make them suited for systemic administration. Therefore,
they have been employed in designing optimal drug formulations in
various preclinical models and clinical trials to treat a wide range
of diseases. In this review, we provide an overview of the biology,
synthesis, and characterization of drug delivery systems based on
RBCs and their membrane including whole RBCs, RBC membrane-camouflaged
nanoparticles, RBC-derived extracellular vesicles, and RBC hitchhiking.
We also highlight conventional and latest engineering strategies,
along with various therapeutic modalities, for enhanced precision
and effectiveness of drug delivery. Additionally, we focus on the
current state of RBC-based therapeutic applications and their clinical
translation as drug carriers, as well as discussing opportunities
and challenges associated with these systems.