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Figure 3. Engineering exosomes, from therapeutic goals to design strategies and technical approaches. Following the rationale of “therapeutic purpose/strategic design/technical approach,” the schematic outlines the central engineering paradigms for stem cell-derived exosomes in the treatment of atherosclerosis. The strategies span three interconnected domains: optimization of production platforms (e.g., empagliflozin preconditioning), refinement of delivery modalities (e.g., inhalable preparations, stent-anchored sustained-release systems, and biomimetic nanorobots achieved through membrane fusion), and efficient loading of therapeutic cargos (e.g., mRNA, siRNA, and small-molecule agents). These integrated engineering approaches address the intrinsic shortcomings of native exosomes, including limited targeting accuracy, low production efficiency, and suboptimal cargo encapsulation, thereby establishing a conceptual basis for precision exosome therapeutics in atherosclerosis. Created in BioRender. Yang Z (2025) https://BioRender.com/vt6f36k.