The foundations of this transformation are already established in the clinic. Liposomal doxorubicin and albumin-bound paclitaxel became FDA-approved cancer therapeutics decades ago, improving tolerability and therapeutic index for patients. The decisive proof of concept, however, came with the lipid nanoparticle platforms that enabled the rapid development and global deployment of mRNA vaccines against SARS-CoV-2. According to the authors, these milestones demonstrate not only that nanomedicine works, but that nanoscale engineering can accelerate the translation of advanced therapeutics, reshape response profiles, reduce toxicity and make molecular modalities previously infeasible in vivo a practical reality.

One of the most striking frontiers described in the perspective is the use of living cells as delivery vehicles. Rather than fighting the body’s biological barriers with synthetic materials alone, researchers are now exploiting them. Nanoparticles can hitchhike on red blood cells, dramatically reducing clearance by the liver and spleen while extending circulation time, and in some designs depositing their cargo preferentially in the lungs through contact-mediated dislodging from the cell surface. Discoidal polymer particles known as cellular backpacks ride on macrophages, monocytes, T cells, neutrophils and B cells, modulating immune cell behavior in applications ranging from cancer to multiple sclerosis and traumatic brain injury. These hybrid systems combine the precision of engineered materials with the navigation skills of the body’s own cells.

Immunology is emerging as a central arena for this new generation of nanotechnologies. Cell membrane–coated nanoparticles, or CNPs, wrap synthetic cores in natural cellular membranes, presenting native antigen repertoires that conventional vaccines struggle to replicate. Cancer cell membrane–coated particles elicit potent antitumor immunity, while bacterial outer membrane vesicle platforms preserve pathogen-associated molecular patterns to generate broad-spectrum protection, including against antimicrobial-resistant strains. Nanotoxoids take this further, detaining bacterial toxins on nanoparticle surfaces so the immune system can safely learn their shapes. Advances in membrane genetic engineering and modular linker chemistry are now turning these platforms into rapidly customizable, scalable vaccine systems.

Perhaps the most futuristic concept described is the living pharmacy: implanted, encapsulated cells that continuously manufacture biologics inside the body. The recent FDA approval of Neurotech’s ENCELTO, an encapsulated allogeneic cell therapy implanted in the eye, anchors the feasibility of the approach. Modern platforms combine synthetic biology programs that control what cells produce, biomaterials that tame the foreign body response while allowing oxygen and nutrient exchange, and device interfaces offering retrievability and external control, including electro- and optogenetic actuation. Key challenges ahead include improving volumetric efficiency, ensuring predictable dosing behavior and demonstrating durable performance in large-animal models.

On the cancer front, the perspective highlights how macrophages, long viewed as obstacles that clear nanoparticles from circulation, are being reprogrammed into therapeutic partners. Ultrasound-guided platforms deliver STING agonists directly to antigen-presenting cells, while constructs that disrupt the CD47 ‘don’t eat me’ signal enable macrophage-mediated tumor cell phagocytosis. Blocking the MARCO receptor reduces hepatic sequestration of nanoparticles, boosting tumor accumulation. In hypovascularized breast cancer liver metastases, redirecting albumin-bound paclitaxel transport toward macrophages significantly improves therapeutic outcomes in a setting where conventional intravenous delivery largely fails. Implantable nanofluidic drug-eluting seeds add another layer of control, sustaining localized intratumoral immunotherapy for more than four weeks and converting immunologically cold tumors into hot ones at a fraction of the systemic dose.

Polymer chemistry is advancing carrier performance in parallel. Poly(2-oxazoline) and poly(2-oxazine) micelles achieve drug loads ten to one hundred times higher than traditional micelles, enabling intravenous formulations with minimal excipient content. The first POx-based medical product, a hemostatic sealing patch, received European approval in 2023, and the absence of preexisting anti-POx antibodies makes these polymers attractive alternatives to polyethylene glycol, which is increasingly associated with immunogenicity. Vascular-confined discoidal nanoconstructs carrying tissue plasminogen activator, meanwhile, recanalize roughly ninety percent of occluded venules in mouse models compared with about forty percent for free tPA, while preserving neurological outcomes and improving survival in stroke models.

Gene and RNA nanotherapies represent another pillar of the expanded field. In vivo CRISPR delivery via lipid nanoparticles aims to democratize access to genetic cures, bypassing the roughly 2.2 million dollar per patient cost of autologous ex vivo editing. Mesoscale nanoparticles of 300 to 500 nanometers selectively target the renal proximal tubule, delivering siRNAs and mRNAs for kidney diseases that have historically been inaccessible to systemic RNA therapeutics. In the liver, a strategy termed Repair Drive uses transient siRNA inhibition of an essential gene to eliminate unedited hepatocytes, expanding precisely corrected cells from less than one percent to approximately twenty-five percent of the liver. Transient telomerase mRNA delivered by lipid nanoparticles is showing promise for protecting skin from radiation-induced DNA damage, operating through genome and mitochondrial maintenance rather than telomere extension.

The perspective also documents a radical extension of the concept: therapeutics built from organelles and biological vesicles themselves. Extracellular vesicles from brain endothelial cells carry functional mitochondria and, when administered intravenously after stroke in mice, significantly reduce brain infarct volume and improve neurological function. Exogenous mitochondrial transfer into plaque macrophages reduces atherosclerotic burden and improves markers of fatty liver disease, positioning mitochondrial transplantation as an emerging metabolic nanotherapy. Hybrid vesicles that merge extracellular vesicle targeting with synthetic liposome stability offer enhanced tumor accumulation with improved scalability over native EV preparations.

The authors close with a vision of a modular nanomedicine ecosystem in which nanoparticles behave like cells, cells function as therapeutic devices, devices operate as immunomodulators, and imaging technologies evolve into pharmacologic tools. Realizing that vision, they emphasize, will require manufacturing and quality-by-design frameworks that embed reproducibility, safety and scalability from the outset, translating laboratory ingenuity into clinical-grade platforms capable of sensing, computing and responding to disease in real time.

Subject of Research: The expansion of nanomedicine beyond drug carriers into implantable devices, cell-based systems and living therapeutics

Article Title: Nanomedicine beyond carriers — devices, cells & living therapeutics

Article References: Grattoni, A., Paci, M. M., Arnold, N., Aryal, S., Artzi, N., Bao, G., Barcena, A. J. R., Bentov-Arava, E., Blanco, E., Chua, C. Y. X., Corradetti, B., Cryer, A. M., Decuzzi, P., De Giorgi, M., Fell, C., Gao, W., Govindaswamy, B., Jiang, W., Kara, G., … Godin, B. (2026). Nanomedicine beyond carriers — devices, cells & living therapeutics. Biomedical Microdevices, 28(3), Article 65. https://doi.org/10.1007/s10544-026-00836-8

Image Credits: AI Generated

DOI: 10.1007/s10544-026-00836-8

Keywords: nanomedicine, drug delivery, lipid nanoparticles, mRNA vaccines, cell membrane-coated nanoparticles, immunotherapy, living pharmacies, CRISPR, extracellular vesicles, mitochondrial transfer, nanofluidic implants, poly(2-oxazoline)

For decades, mRNA technology was relegated to the outskirts of mainstream medicine. Although recognized in principle for its potential to deliver coded instructions for proteins into a patient’s cells, it needed years of trial and error to mature. Then came the extraordinary acceleration offered by COVID-19 vaccine development, where mRNA-based vaccines from firms like Moderna and BioNTech/Pfizer demonstrated that these treatments could indeed be developed and deployed in record time. But what Larry Ellison is suggesting goes far beyond the principle that mRNA can be used to mount immune responses. He envisions a future in which we create an mRNA therapy specifically for each patient’s cancer profile—meaning that no two people’s vaccines need be exactly alike. You wouldn’t just have a “generic” immunization against, say, a subtype of breast cancer or lung cancer. Instead, medical labs, assisted by AI software, would map the precise mutations or surface markers in a patient’s tumor cells, then create a unique mRNA blueprint that instructs that individual’s immune system to identify and target the malignant cells. If you imagine multiple patients, each with a different set of tumor mutations and immunological nuances, the idea is that thousands or even millions of unique mRNA sequences could be generated and tested or, at the very least, validated in silico within days. The AI part is crucial because the scale of computations needed to design such tailored vaccines is mind-boggling.

What sets Ellison’s statement apart is not merely the mention of AI in medicine, for that is no longer revolutionary. Instead, it’s the bold claim that the entire pipeline—from diagnosing a patient’s tumor signature, to figuring out the relevant immunological targets, to coding an mRNA therapy, to physically manufacturing it—could be done in under two days. Whether that is 48 hours from the moment a patient’s blood or tumor sample is taken, or from the time the physician presses “go” on a software platform, is unclear. Yet even the very idea of compressing the vaccine design cycle to two days marks a quantum leap from the norm. Typically, it can take weeks or months just to finalize the design of a novel therapeutic, let alone test it for safety or efficacy. So the notion here is that specialized AI software, presumably fed by colossal data sets, will automatically generate a new mRNA sequence that instructs the patient’s cells on what cancer-related proteins to target. The advanced robots or “lights-out” manufacturing lines, as some call them, then deposit the materials into a microfluidic system that produces small, personalized batches of vaccine. The entire process is so frictionless, so automated, that it can happen in hours, not weeks.

We know that mRNA vaccines are agile in principle—once you have a certain packaging technology, like lipid nanoparticles, the only change you need is the specific code in the RNA. But we also know that bridging from a conceptual framework to a standard medical procedure involves an enormous array of challenges. Biopharmaceutical regulation, for instance, typically requires any new therapy to go through a rigorous clinical trial process, ensuring it is both safe and effective. So, does Ellison’s scenario foresee a streamlined or even partially automated regulatory structure that can handle a mass of new, personalized therapies? Are we about to see advanced computational models and in vitro microfluidic tests that can all but guarantee the safety of such a vaccine before it is administered to the patient? We might imagine advanced AI systems simulating immunological responses in silicon with such fidelity that real-world trials become less arduous. But as of now, we do not have that level of official acceptance for preclinical computational evidence. If we are heading this direction, it would mean the entire regulatory system, from the FDA to the EMA and all other jurisdictions, would have to evolve to accommodate near-real-time generation of immunotherapies. Some might see that as pure fantasy; others see it as the inevitable future.

Yet there’s more to “people not understanding what this means” than just the timeline for design or regulatory complexities. The statement implies that if you can design a custom mRNA vaccine in two days, you’re basically bringing Moore’s Law–style iteration to the fight against cancer. You might vaccinate a patient with a certain design, evaluate the immune response in real-time, gather data about which mutated peptides or antigens elicited the best T-cell infiltration. Then you tweak the design, re-run it, and generate the next batch. This iterative cycle of “design-test-redesign” might occur at breakneck speed. The synergy between AI’s algorithmic power and the swift manufacturing pipeline merges to create a personalized, dynamic therapy that evolves with the tumor. Suppose the tumor acquires new mutations or reverts to a new strategy to evade the immune system; in principle, you could spool up a fresh vaccine code to block the new malignant variant. This near-term future, if realized, transforms cancer management from a static “Here’s your chemotherapy or targeted therapy regimen, hope it works” approach to an adaptive “We’ll chase the cancer and keep updating your therapy as if we’re rolling out software patches.” That’s radical—like turning the entire fight against cancer into a constant arms race at the molecular level.

One might also wonder about the role of Oracle here. Ellison’s company is known primarily for database systems, enterprise software, and cloud services, but in the last few years, it has pivoted somewhat to focus on health data and analytics. Conceivably, Oracle might be the data platform that integrates all the genomic and clinical records. The combination of patient data, advanced analytics, and AI could indeed allow for that dynamic synergy. That Ellison himself is heralding this future might be read as a sign that Oracle sees a big opportunity in health-care data management for personalized medicine—one in which the cost of storing and processing large-scale genomic data is trivial compared to the potential advantages in patient care.

Of course, the public reaction to the idea of AI designing personalized mRNA therapies may be complicated by concerns about data privacy, algorithmic biases, or errors that slip through an automated pipeline. We need not only to trust AI to design a therapy but also to trust that the code it generates is robust enough not to harm the patient. The fiasco scenario would be an AI that incorrectly identifies a normal protein as a target, leading the vaccine to trigger an autoimmunity crisis. This is where advanced AI verification and interpretability become crucial. Additionally, the system must ensure that data used to train these models covers the huge genetic diversity of human populations, because a solution that works for one set of genotypes may not work for another. If the AI is solely trained on the data from large medical centers in North America or Western Europe, we risk ignoring the particular genetic variants in, for instance, sub-Saharan Africa or East Asia, leading to suboptimal or unsafe designs in those populations. Hence, to fully realize Ellison’s vision, we must push for global data-sharing, or at least a set of robust, widely representative training sets that can handle the entire diversity of the human genome.

The mention of “making them robotically in 48 hours” also underscores the larger trend that manufacturing is becoming more agile, smaller-scale, and automated. If you have fully robotic labs that can do everything from mixing reagents to packaging the final product, you might indeed pump out custom vaccine vials for a single patient. But that also implies an infrastructural shift. Are these production lines likely to exist in major medical centers, or could they be deployed in smaller labs across the world? The logistics behind shipping raw reagents, guaranteeing sterility, controlling for quality assurance, delivering final products, and training staff to operate such advanced robotics could be daunting. For countries that have underdeveloped health-care systems, the gap might become even more glaring. Possibly, though, the availability of advanced robotics might eventually reduce costs so that remote areas can “print” these therapeutics locally. Or, these specialized manufacturing sites remain in large advanced hubs, and the final products get shipped or flown to the patient. One can see the complexities branching out in every direction.

However, none of these complexities seem to deter Ellison’s optimism. His statement, if it truly captures the direction that Oracle and other tech titans are heading, illuminates the scale of ambition. We are at the point that the synergy among big data, machine learning, genomic science, and advanced biotechnology can yield leaps forward that might have felt unattainable a decade ago. People who dismiss these claims might say, “It’s hype; 48 hours is a marketing slogan.” But there is also a strong possibility that we are seeing the early signals of a disruptive approach. We might see a pilot program in the next few years where a small subset of cancer patients with a specific tumor type receive AI-designed mRNA vaccines. Early results might be uncertain, but the iterative process of improvement will refine both the AI’s accuracy and the manufacturing pipeline. If, after a few cycles, the outcomes show improved survival or fewer side effects than conventional chemo or immunotherapy, the impetus to expand the pilot becomes immense.

At a conceptual level, it’s reminiscent of how, in the late 1990s, only a handful of visionaries could fathom how the Internet might transform commerce and communication globally. Now, with personalized mRNA vaccines designed by AI, we might witness a transformation in health care so profound that it shifts from diagnosing diseases to systematically customizing a cure for each person. The possible benefits for cancer treatment alone are staggering, but we can extrapolate to other maladies—infectious diseases, autoimmune disorders, or even certain forms of degenerative conditions. In principle, once you master the puzzle of coding instructions into cells, you can do it for nearly any protein-based therapy. Moreover, the dynamic, iterative approach might open pathways to “always current” therapies that adapt to a pathogen’s or tumor’s mutations in near real-time, effectively curtailing the race that disease processes typically run uncontested.

There will be ethical ramifications, too. Not only who pays for such technology, but who gets it. Does this become something available solely to the wealthy who can afford custom immunization? If the process truly scales and is driven by mostly robotic labor, maybe the cost can drop dramatically. The dream scenario is that once the pipeline is standardized, the marginal cost of generating each new vaccine is minimal, so you can produce it cheaply for millions of people. But this dream depends on large-scale adoption, supportive regulation, robust oversight, and indeed a shift in how we conceive of health care, from broad-spectrum mass-market therapies to individually tailored ones.

All in all, Ellison’s remarks carry the power to astonish because they cut to the heart of what might be the greatest aspiration of modern medicine: the capacity to defeat, or at least substantially tame, cancer. Many experts already foresee a day when we treat cancer as a manageable chronic condition, thanks to advanced immunotherapies. The arrival of AI-driven, mRNA-based solutions speeds that timeline in ways that can be jarring to those used to the plodding pace of medical research. At the same time, one must temper the euphoria with caution, bearing in mind the regulatory labyrinth, the reliability of AI’s predictive capabilities, and the sheer engineering complexity of mass customization in biotech. Realizing these aims will require visionary leadership, huge investments, and perhaps a decade or more to refine the pipeline to the point that it is widely deployed. Nonetheless, Ellison’s statement signals that major players in the technology sphere intend to push vigorously in that direction.

Whatever shape it ultimately takes, the possibility that AI will design an mRNA vaccine for each patient’s unique cancer signature, then have it robotically produced in under two days, is a scenario that redefines the boundaries of what we believed was possible in health care. It also reframes the role of large data management corporations like Oracle, showing that the interplay of data, AI, cloud computing, robotics, and pharmaceutical science is rapidly converging. It may be that we look back in a few years and marvel at how quickly personalized medicine advanced once these technologies converged. Or we might find that the hype outstripped reality, that regulatory constraints and real-world complexities led to a more modest revolution. The only certainty is that the conversation has changed. The pronouncements of Larry Ellison have become a rallying cry for an era in which custom vaccines—once an almost utopian idea—are to be viewed not as a remote possibility but as an impending milestone. And it underscores the sense of astonishment and perhaps the sense of hope: if this truly works, we might say farewell to the notion that cancer is unstoppable, and greet an era in which therapy is swiftly shaped to each patient’s genome, delivered by precise robots, and iterated at near-lightning speed. That is indeed enough to leave one speechless.