Leveraging extracellular vesicle biology for novel tests and therapeutics for kidney fibrosis

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)

Kidney fibrosis is mechanistically characterised by tissue injury followed by development of a fibrogenic niche. The fibrogenic niche involves chronic inflammation, vascular rarefaction, glomerulosclerosis, tubular atrophy, interstitial accumulation of extracellular matrix which replaces functional kidney parenchyma-culminating in reduced kidney function. Extracellular vesicles are bilipid membrane-encased nanoparticles that play critical roles as cell-to-cell messengers and waste management mechanisms. Extracellular vesciels communication has been demonstrated within the glomerulus, within the tubular compartment and, between tubular and glomerular compartments. Diverse extracellular vesicle cargoes interact with key pathways regulating cell facte and inflammation to mediate kidney fibrosis. Extracellular vesicles cargos can be leveraged as biomarkers to develop minimally invasive tests for kidney fibrosis and pinpoint active pathobiological processes to guide personalised mechanism-driven care. Mesechymal cell-derived extracellular vesicles, extracellular vesicles from bioengineered cells, post-modified extracellular vesicles and suppression of extracellular vesicle uptake have demonstrated promise in preclinical studies for preventing kidney fibrosis. Roadblocks to clinical implementation of extracellular vesicles as biomarkers include lack of standardised collection, measur

Evidence level

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

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