Mesenchymal stem cells derived extracellular vesicles for chronic kidney disease: pleiotropic mechanisms of actions of a versatile therapy.

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)

Chronic kidney disease (CKD) has increasingly become a major health concern worldwide, globally affecting 10%-15% of adults, with significant implications for morbidity and mortality. This progressive condition can potentially evolve into end-stage renal disease (ESRD), requiring dialysis or renal transplant. However, the heaviest impact of CKD is due to an associated increased cardiovascular risk, due to frequently coexisting hypertension and diabetes and non-traditional risk factors, including accumulation of atherogenic toxins, alteration of calcium-phosphate balance, oxidative stress and chronic microinflammation. Mesenchymal stem cells (MSCs) have been proposed as a therapy for CKD due to their immunomodulating and tissue repairing properties. It has been proposed that extracellular vesicles (EVs) may mediate the therapeutic effects of the cells of origin and MSC-EVs have shown promise as treatment of different aspects of CKD in experimental settings. Their anti-fibrotic and anti-apoptotic properties may inhibit progression of CKD and promote healing of tubular and glomerular damage. MSC-EVs can prevent epithelial-mesenchymal transition, a key mechanism of evolution of acute kidney injury towards CKD. These actions may inhibit development of interstitial fibrosis and accumulation of the extracellular matrix components (ECM), key lesions which promote the progression of CKD

Evidence level

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

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