Oral milk exosome-PLGA nanoparticles enhance anti-tuberculosis efficacy of PBTZ169 and bedaquiline

The oral delivery of next-generation anti-tuberculosis drugs, such as PBTZ169 and bedaquiline (BDQ), is hindered by their poor solubility and low bioavailability. We, here, developed a bioinspired delivery platform that combines milk exosomes with poly(lactic-co-glycolic acid) (PLGA) nanoparticles to deliver the two drugs separately. This nanodelivery system leverages the gastrointestinal stability and mucosal penetration of exosomes, along with the high encapsulation efficiency of PLGA, significantly enhancing drug hydrophilicity and stability. In murine models, the exosome-coated nanoparticles increased plasma bioavailability by 2.5- to 4.9-fold compared with free drugs and achieved superior accumulation in target organs, while mitigating the cardiotoxicity risk associated with BDQ. This synergistic strategy, integrating synthetic and natural carriers, overcomes key pharmacological barriers, offering a promising approach to developing effective and patient-compliant oral therapies for tuberculosis and other potentially infectious diseases.