Polysaccharides have been used in various biomedical applications due to availability and biocompatibility. In particular, polysaccharides have gained increasing interest in the development of functional nanomedicines as a component to provide a stealth function, improve interactions with target tissues or enable environment-responsive drug release. This review discusses recent advances in nanomedicine engineering based on polysaccharides with a specific emphasis on the rationale, applications and the remaining challenges.