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The surface modification of blood exosomes with transferrin-conjugated superparamagnetic nanoparticles via interaction with the transferrin receptor, with L17E endosomolytic peptides (IWLTALKFLGKHAAKHEAKQQLSKL) via electrostatic interactions, and with cholesterol-conjugated miR-21 inhibitor by anchoring to the lipid membrane increased tumor accumulation and drug delivery and enabled efficient endosomal escape 40

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Their evidence base comes from trial programs such as STEP (semaglutide for weight management, published in The New England Journal of Medicine , 2021), SURMOUNT (tirzepatide for weight management, NEJM 2022), and SURMOUNT-OSA (tirzepatide for obstructive sleep apnea, NEJM 2024)