Gene therapy represents a transformative approach for treating genetic and acquired diseases by introducing, replacing, or silencing specific genes to restore normal cellular function. Over the past two decades, advances in vector engineering and delivery strategies have significantly expanded the therapeutic landscape of gene therapy. Among the various vector systems developed, adeno-associated virus (AAV) has emerged as one of the most successful and widely adopted platforms due to its favorable safety profile, efficient transduction, and long-term gene expression in both dividing and non-dividing cells1,2. To date, multiple AAV-based therapeutics have received regulatory approval for clinical use, including treatments for spinal muscular atrophy, retinal dystrophies, and hemophilia, marking important milestones in translational medicine3. The broad tropism and low immunogenicity of AAV vectors have also enabled their application across a variety of tissues, including the liver, muscle, central nervous system, and eye4. As a result, AAV has become a leading platform for in vivo gene delivery, supporting ongoing preclinical and clinical studies targeting metabolic, neurological, and cardiovascular disorders.
Despite its remarkable clinical success, AAV-based gene therapy faces several intrinsic challenges that continue to limit its broader application. One major constraint lies in the limited genome packaging capacity of the AAV capsid (~4.7 kb), which restricts its use for delivering large or multiple therapeutic genes5,6. In addition, the biodistribution and cellular tropism of AAV vectors are largely determined by their serotypes, each exhibiting distinct affinities for specific tissues. Although extensive capsid engineering and peptide display strategies have been employed to enhance tissue targeting and transduction efficiency, achieving precise and predictable tropism across diverse biological contexts remains a significant hurdle7. Another critical limitation is the prevalence of pre-existing neutralizing antibodies (NAbs) against natural AAV serotypes in the human population. Even low titers of NAbs can substantially reduce vector transduction efficiency, limiting patient eligibility and complicating repeated dosing8,9. Various strategies, such as rational capsid redesign, immunosuppressive regimens, and transient plasma exchange, have been explored to mitigate antibody-mediated neutralization10,11, yet these approaches offer only partial or transient relief. Collectively, these limitations reduce the overall therapeutic efficacy and reproducibility of AAV-mediated gene delivery in clinical settings.
In recent years, extracellular vesicle-enveloped AAV (EV-AAV) has been explored as an alternative vector with the potential to overcome several key limitations of conventional AAVs12,13,14,15. During vector packaging, a portion of AAV particles can be secreted through vesicular trafficking pathways and become enclosed within extracellular vesicles. This process is believed to involve AAV-encoded membrane-associated accessory protein (MAAP), which facilitates viral egress and promotes membrane association16,17. The resulting EV-AAV particles exhibit improved transduction efficiency and enhanced resistance to neutralizing antibodies compared with conventional AAV, primarily due to the vesicular membrane that promotes cellular uptake and provides partial shielding from antibody recognition18. However, despite these advantages, EV-AAV production remains inefficient. Typically, only a small fraction of vector genomes (approximately 0.5%-12%) are secreted into the culture medium as EV-associated AAVs, while the majority remain intracellular or exist as free AAVs12,13. Consequently, large-scale production is required to obtain sufficient vector yield. Furthermore, EV-AAV generation has been primarily demonstrated using HEK293T producer cells, whose EVs may exhibit rapid hepatic clearance, short circulation half-life, and potential biosafety concerns. These limitations highlight the need for a more efficient and customizable membrane-envelopment strategy, motivating the development of the cell membrane-enveloped AAV (CME-AAV) platform presented in this study.
Mesenchymal stem cells (MSCs) and their EVs have been extensively studied for their regenerative potential and immune-evasive properties. Beyond therapies based on cells or naturally secreted EVs, recent studies have demonstrated an alternative approach for enhanced drug delivery using nanoparticles cloaked with MSC membranes19,20,21. The MSC membrane coating confers active targeting capability, reduces immune clearance, and prolongs circulation time, of which effects are likely attributed to the intrinsic molecular composition of MSC-derived membranes22,23. Building on this concept, we utilized MSC-derived membrane material to construct a cell membrane-enveloped AAV (CME-AAV) nanovesicle for gene delivery. To achieve this, purified MSC membrane fragments were mixed with recombinant AAV particles and subjected to a controlled extrusion process, a technique originally established for liposome fabrication24,25. Through size-defined extrusion, the membrane components spontaneously assemble into nanoscale vesicles encapsulating AAV particles. The resulting CME-AAVs were further purified from free, unencapsulated AAVs using density gradient-based centrifugation. This strategy enables efficient and reproducible preparation of membrane-enveloped AAV vectors, which exhibit markedly enhanced transduction efficiency compared with conventional AAVs and maintain comparable resistance to neutralizing antibodies as EV-AAVs. By substituting different transgenes, the CME-AAV platform holds broad potential for the treatment of various genetic and acquired diseases.