Engineered red blood cells and RBC-inspired platforms for drug delivery, transfusion, and therapeutic translation

Red blood cells (RBCs) are promising natural carriers for drug delivery owing to their inherent biocompatibility, prolonged circulation time, high loading capacity, and sustained release capability. Engineered RBCs have demonstrated considerable potential across a wide range of therapeutic applications. This review provides a comprehensive overview of advances in RBC engineering, encompassing physical, chemical, and genetic engineering strategies to improve drug loading efficiency, targeting capability, and biosafety. In addition to native RBC-based systems, emerging RBC-inspired platforms, such as synthetic biomimetic RBCs and RBC membrane–camouflaged nanoparticles, are discussed for their roles in drug delivery, toxin clearance, antiviral therapy, and oxygen transport. Key challenges, including scalable manufacturing, long-term safety, precise targeting, and controlled stimuli-responsive release, are also systematically reviewed. Future perspectives emphasize the integration of multimodal engineering strategies, the development of personalized RBC-based systems, and the accelerated translation toward clinical applications. Collectively, these insights underscore the transformative potential of engineered RBCs and RBC-inspired platforms in advancing drug delivery and transfusion medicine.