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已发表论文
外泌体与肾纤维化：诊断价值、治疗潜力及挑战
Authors Li Y, Waheed YA, Sun D
Received 19 March 2025
Accepted for publication 23 August 2025
Published 13 September 2025 Volume 2025:20 Pages 11267—11294
DOI https://doi.org/10.2147/IJN.S529311
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Dr Sachin Mali
Yumeng Li,1 Yousuf Abdulkarim Waheed,1 Dong Sun1– 3
1Department of Nephrology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of China; 2Department of Internal Medicine and Diagnostics, Xuzhou Medical University, Xuzhou, People’s Republic of China; 3Clinical Research Center for Kidney Disease, Xuzhou Medical University, Xuzhou, People’s Republic of China
Correspondence: Dong Sun, Department of Nephrology, Affiliated Hospital of Xuzhou Medical University, 99 West Huai-Hai Road, Xuzhou, 221002, People’s Republic of China, Email sundongxz@126.com
Abstract: 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 activity, promotion of angiogenesis, and regulation of signalling pathways (eg NOTCH, AKT). Engineered exosomes exhibit enhanced targeting and delivery efficiency through endogenous or exogenous loading methods, thereby further improving therapeutic efficacy. However, current research faces challenges including inconsistent methods of exosome isolation and purification, absence of standardised identification protocols, insufficient stability, and barriers to clinical translation. This review summarises the current progress in exosome research related to renal fibrosis, covering physiological and pathological roles, diagnostic and therapeutic potential, and existing challenges, aiming to facilitate translation from basic research to clinical practice and to provide novel strategies for precise diagnosis and treatment of renal fibrosis.
Keywords: exosomes, renal fibrosis, CKD, ECM, MSCs
1Department of Nephrology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of China; 2Department of Internal Medicine and Diagnostics, Xuzhou Medical University, Xuzhou, People’s Republic of China; 3Clinical Research Center for Kidney Disease, Xuzhou Medical University, Xuzhou, People’s Republic of China
Correspondence: Dong Sun, Department of Nephrology, Affiliated Hospital of Xuzhou Medical University, 99 West Huai-Hai Road, Xuzhou, 221002, People’s Republic of China, Email sundongxz@126.com
Abstract: 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 activity, promotion of angiogenesis, and regulation of signalling pathways (eg NOTCH, AKT). Engineered exosomes exhibit enhanced targeting and delivery efficiency through endogenous or exogenous loading methods, thereby further improving therapeutic efficacy. However, current research faces challenges including inconsistent methods of exosome isolation and purification, absence of standardised identification protocols, insufficient stability, and barriers to clinical translation. This review summarises the current progress in exosome research related to renal fibrosis, covering physiological and pathological roles, diagnostic and therapeutic potential, and existing challenges, aiming to facilitate translation from basic research to clinical practice and to provide novel strategies for precise diagnosis and treatment of renal fibrosis.
Keywords: exosomes, renal fibrosis, CKD, ECM, MSCs