各种程度的创伤性脑损伤（TBI）是一种重要的公共卫生负担，导致一系列影响，可能导致死亡或生活质量下降。脂质体和间充质干细胞源外泌体是两种药物运输剂，具有在TBI治疗中提高药物疗效以及具有附加治疗效果的潜力。它们具有许多物理相似之处，但关键差异影响了它们作为纳米载体的性能。脂质体可以大规模商业生产，并且其封装效率更高。与脂质体相比，外泌体具有其所缺乏的固有荷载物和靶向配基，使得外泌体更能促进神经再生，并且不会引发脂质体可能引起的输注反应。然而，关于外泌体和脂质体与肿瘤的相互作用存在一些问题。外泌体和脂质体可以使用相同的给药途径，导致其在体内的分布有所不同。虽然纳米载体类型对于在脑中的积累效应尚不明确，但靶向给药可以增加外泌体和脂质体在脑中的积累，同时外泌体和脂质体均可用于按需释放药物。虽然二者尚未用于人类TBI，但临床前试验显示了它们的巨大潜力，与其他脑损伤和疾病相关的临床试验也证实了它们的潜力。尽管还有一些问题有待解决，但迄今为止的研究显示，由于各种差异，外泌体是治疗TBI的更好纳米载体选择。© 2023。作者，美国药物科学家协会独家许可。

Traumatic brain injury (TBI) of all severities is a significant public health burden, causing a range of effects that can lead to death or a diminished quality of life. Liposomes and mesenchymal stem cell-derived exosomes are two drug delivery agents with potential to be leveraged in the treatment of TBI by increasing the efficacy of drug therapies as well as having additional therapeutic effects. They exhibit several physical similarities, but key differences affect their performances as nanocarriers. Liposomes can be produced commercially at scale, and liposomes achieve higher encapsulation efficiency. Meanwhile, the intrinsic cargo and targeting moieties of exosomes, which liposomes lack, give exosomes a greater ability to facilitate neural regeneration, and exosomes do not trigger the infusion reactions that liposomes can. However, there are concerns about both exosomes and liposomes regarding interactions with tumors. The same routes of administration can be used for both exosomes and liposomes, resulting in somewhat different distribution throughout the body. While the effect of the nanocarrier type on accumulation in the brain is not concrete, targeting leads to increased accumulation of both exosomes and liposomes in the brain, upon which on-demand release can be used for both drug deliverers. Although neither have been applied to TBI in humans, preclinical trials have shown their immense potential, as have clinical trials pertaining to other brain injuries and conditions. While questions remain, research thus far shows that the various differences make exosomes a better choice of nanocarrier for TBI.© 2023. The Author(s), under exclusive licence to American Association of Pharmaceutical Scientists.