Exosomes and Renal Fibrosis: Diagnostic Value, Therapeutic Potential and Challenges.

Evidence from laboratory and animal studies provides groundwork for understanding mechanisms and potential before human studies continue.

• Level A · Stronger Clinical Evidence
• Level B · Emerging clinical evidence with positive signals
• Level C · Early human research exploring benefits
• Level D · Scientific groundwork from lab and animal studies
• Emerging · Emerging topic under active research

Abstract (original English)

Renal fibrosis is a key pathological process in the progression of chronic kidney disease (CKD) to end-stage renal disease (ESRD), characterised by irreversible damage to the renal parenchyma. Currently, effective curative treatments are lacking. Exosomes, double-layer phospholipid vesicles containing bioactive components such as proteins, lipids, and nucleic acids, play a pivotal role in intercellular communication. Under physiological conditions, exosomes contribute to kidney development (eg regulating of ureteric bud branching and nephron formation) and maintenance of cellular homeostasis (eg protection of the glomerular filtration barrier and regulation of electrolyte balance). In pathological conditions, damaged renal tubular epithelial cells (RTECs) and other renal cell types release exosomes carrying pro-fibrotic factors (eg miR-21, TGF-β), which activate fibroblasts and facilitate excessive extracellular matrix (ECM) deposition, thereby accelerating the fibrotic process. Exosomes possess significant diagnostic value, as their protein components (eg Cp and CD2AP in urinary exosomes) and RNA cargo (eg lncRNA, miRNA, circRNA) may serve as biomarkers for renal function impairment. Therapeutically, exosomes derived from bone marrow, adipose tissue, umbilical cord, and urine can delay fibrosis through multiple mechanisms, including anti-inflammatory effects, antioxidant activ

Evidence level

Evidence from laboratory and animal studies provides groundwork for understanding mechanisms and potential before human studies continue.

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