Exosomes, a type of extracellular vesicle, are promising nanocarriers for drug delivery due to their natural biocompatibility and ability to carry therapeutic and imaging molecules. This review summarizes methods for engineering exosomes for drug delivery, including passive and active loading techniques, and discusses the advantages and challenges of using exosomes from different cell sources. Exosomes can be modified to enhance their stability, efficacy, and targeting capabilities. Various strategies, such as sonication, extrusion, freeze-thaw cycles, electroporation, and click chemistry, are used to load drugs and imaging agents into exosomes. Exosomes derived from different sources, including tumor cells, plant cells, and immune cells, have been explored for their potential in therapeutic applications. However, challenges remain in ensuring the safety and efficacy of exosome-based therapies. The review highlights the importance of selecting appropriate donor cells and modifying exosomes to optimize their therapeutic potential. Exosomes offer a promising alternative to traditional nanocarriers due to their natural biocompatibility and ability to deliver drugs and imaging agents efficiently. Further research is needed to overcome challenges in large-scale production and clinical translation of exosome-based therapies.Exosomes, a type of extracellular vesicle, are promising nanocarriers for drug delivery due to their natural biocompatibility and ability to carry therapeutic and imaging molecules. This review summarizes methods for engineering exosomes for drug delivery, including passive and active loading techniques, and discusses the advantages and challenges of using exosomes from different cell sources. Exosomes can be modified to enhance their stability, efficacy, and targeting capabilities. Various strategies, such as sonication, extrusion, freeze-thaw cycles, electroporation, and click chemistry, are used to load drugs and imaging agents into exosomes. Exosomes derived from different sources, including tumor cells, plant cells, and immune cells, have been explored for their potential in therapeutic applications. However, challenges remain in ensuring the safety and efficacy of exosome-based therapies. The review highlights the importance of selecting appropriate donor cells and modifying exosomes to optimize their therapeutic potential. Exosomes offer a promising alternative to traditional nanocarriers due to their natural biocompatibility and ability to deliver drugs and imaging agents efficiently. Further research is needed to overcome challenges in large-scale production and clinical translation of exosome-based therapies.