“…Native EVs offer unique advantages for cellular regulation and the efficient delivery of therapeutic payloads. However, several studies have highlighted the intrinsic limitations of native EVs including long-term maintenance of parental cell culture with minimal metabolic/phenotypic variation ( Lambshead et al, 2018 ; Cherian et al, 2020 ; Escude Martinez de Castilla et al, 2021 ), bio-distribution (i.e., organ targeting) ( Escude Martinez de Castilla et al, 2021 ; Lazaro-Ibanez et al, 2021 ; Ullah et al, 2021 ; Witwer and Wolfram, 2021 ), clearance rates [complement and immune systems (RES-MPS system)] ( Wiklander et al, 2015 ; Ha et al, 2016 ; Kwon, 2020 ; Lara et al, 2020 ; Buschmann et al, 2021 ; Escude Martinez de Castilla et al, 2021 ; Lazaro-Ibanez et al, 2021 ), and crucially, difficulties associated with large scale generation (i.e., processing times, variable potency between batches, good manufacturing practice; GMP) ( Whitford and Guterstam, 2019 ; Cherian et al, 2020 ; Buschmann et al, 2021 ; Escude Martinez de Castilla et al, 2021 ; Ullah et al, 2021 ; Witwer and Wolfram, 2021 ). Moreover, the regulatory machinery of EVs and their distinct subtypes associated with production and cellular uptake remains largely unknown.…”