Aug 2026· Nephrology, Dialysis and Transplantation· 0 citations
Medicine
TL;DR
Exosomes have a high translational potential for the diagnosis and treatment of kidney diseases, and this review provides a roadmap for bridging preclinical findings to clinical practice.
Abstract
Background
Kidney disease is a significant global public health and economic burden, with unmet clinical requirements for early diagnostic biomarkers and targeted therapies. Exosomes, nanoscale lipid bilayer vesicles that facilitate intercellular communication through bioactive cargo, have emerged as a promising translational tool for addressing these gaps.
Objective
This review summarizes the classification, biological functions, technical workflows (isolation, characterization, and storage), and physiological/pathological roles of exosomes in kidney disease. It also emphasizes clinically actionable advances in exosome-based diagnosis and therapy and identifies translational barriers.
Methods
This narrative review was conducted through a comprehensive literature search across PubMed, Web of Science, and Scopus databases up to April 2026.
KEY
Findings
Exosomes regulate renal pathological processes, including inflammation, oxidative stress, and fibrosis. Urinary/blood exosomal molecules are potential non-invasive biomarkers for acute/chronic kidney disease. Cell-derived exosomes demonstrate preclinical therapeutic efficacy for renal repairs. However, technical standardization and large-scale clinical validation remain significant challenges.
Conclusion
Exosomes have a high translational potential for the diagnosis and treatment of kidney diseases. Addressing standardization, validation, and regulatory challenges is crucial for clinical adoption, and this review provides a roadmap for bridging preclinical findings to clinical practice.
Exosomes are small membrane-bound extracellular vesicles of endosomal origin that play pivotal roles in intercellular communication by transferring proteins, lipids, metabolites, and nucleic acids. Increasing evidence indicates that these vesicles participate in diverse physiological and pathological processes, including immune regulation, tissue repair, tumor progression, neurodegeneration, and cardiovascular homeostasis. Their distinctive biological properties have consequently generated considerable interest in their development as diagnostic tools, therapeutic agents, and drug-delivery platforms. Recent progress in exosome biology and biogenesis, together with technological advances in vesicle isolation, characterization, engineering, and large-scale production, has accelerated their preclinical development and early clinical translation. Nevertheless, substantial challenges—including donor-cell heterogeneity, low production yields, insufficiently standardized protocols, and regulatory uncertainty—must be addressed before widespread clinical implementation can be achieved. This narrative review integrates current knowledge of exosome biology, diagnostic and therapeutic applications, and engineering strategies. It further examines major translational barriers and outlines future priorities for advancing exosome-based technologies toward precision medicine.
Chin‐Yin Lin, Chih-Yang Lin, W. Shyu et al.· International Journal of Mol...· 0 citations
The rising prevalence of cardiovascular diseases (CVDs) worldwide imposes a substantial economic burden on healthcare systems. Despite major advances in evidence-based therapies and modern healthcare, the demand for novel, time- and cost-effective treatment options continues to grow. Extracellular vesicles (EVs), including apoptotic bodies, microvesicles, and exosomes, are released by numerous cell types and mediate intercellular communication in both physiological and pathological contexts. To date, researchers have amassed compelling evidence for the functional roles of EVs in the development and progression of myocardial disease, supporting their exploration for clinical applications. In this review, we examine the multifunctional roles of EVs from diverse cellular origins in prominent CVD manifestations, highlighting publications of the last eight years and their key findings. They confirm that EVs carry disease-specific molecular cargo, particularly microRNAs, long non-coding RNAs, proteins, and other bioactive molecules, contributing to inflammation, oxidative stress, fibrosis, endothelial dysfunction, and cardiac remodeling, while also serving as promising diagnostic and prognostic biomarkers. Furthermore, emerging preclinical evidence demonstrates the therapeutic potential of engineered or tissue-derived EVs for promoting cardiac repair and limiting adverse cardiac remodeling.
M. Tangos, Luca Schneider, Oliver Jarkas et al.· International Journal of Mol...· 0 citations
This review systematically elucidates the distinct dual role of exosomes, highlighting how they function as either pro-fibrotic drivers or anti-fibrotic protectors depending on their cellular origin and offers a comprehensive framework to accelerate the clinical translation of these nanovesicles into precise diagnostics and targeted therapeutics.
Rui Hu, Jingyu Wang, Ying Yang et al.· Renal Failure· 0 citations
Colorectal cancer (CRC) remains a leading cause of cancer-related morbidity and mortality worldwide despite advances in screening, surgical techniques, and systemic therapies. In recent years, exosomes—nanoscale extracellular vesicles involved in intercellular communication—have emerged as critical regulators of CRC biology. Exosomes mediate tumor progression, metastatic dissemination, immune evasion, and therapeutic resistance through the transfer of bioactive molecules including proteins, lipids, and non-coding RNAs. Moreover, exosomes have gained increasing attention as promising liquid biopsy tools and therapeutic platforms due to their stability, biocompatibility, and ability to reflect tumor molecular dynamics. This review provides a comprehensive overview of exosome biogenesis, molecular composition, and their functional roles in CRC pathogenesis. We further discuss their diagnostic and prognostic value, involvement in therapeutic resistance, and emerging therapeutic applications, with particular emphasis on translational and surgical oncology implications. Finally, we highlight current limitations and future perspectives for clinical integration of exosome-based strategies in CRC management.
Lung cancer remains a global health crisis characterized by high mortality rates and pervasive therapeutic resistance. Recent advances in molecular oncology have identified exosomes, nanoscale extracellular vesicles with diameters of 30–150 nm, as pivotal mediators of the lateral transmission of bioactive molecular signals. This review provides a high-level synthesis of exosomal biogenesis and the nuanced roles these vesicles play in lung cancer. Specifically, we discuss how tumor-derived exosomes orchestrate remodeling of the tumor microenvironment, facilitate premetastatic niche formation, and drive immune evasion via the programmed death-1/programmed death-ligand 1 axis and recruitment of regulatory cells. A significant portion of this review is dedicated to exosomal noncoding RNAs, including microRNAs, long noncoding RNAs, and circular RNAs, emphasizing their stability as liquid biopsy substrates and their involvement in cross-resistance to tyrosine kinase inhibitors and immunotherapies. Furthermore, we evaluate the transition of exosomes from diagnostic candidates to therapeutic tools, including their utility as bio-inspired drug delivery systems and cancer vaccines. Finally, this narrative review critically examines the technical hurdles, ranging from standardized isolation methods to good manufacturing practice scalability that must be overcome to integrate exosome-based precision medicine into routine clinical management of patients with lung cancer.
Liang Wu, Lan Huang, Junchuan Li· Journal of International Med...· 0 citations
Chronic kidney disease (CKD) represents a growing global public health challenge. Current treatments, including pharmacological therapy, immunosuppression, and renal replacement therapy, mainly aim to slow disease progression rather than restore damaged renal tissue, and their efficacy remains limited in many patients. Although stem cell-based therapies have shown regenerative potential, their clinical application is constrained by poor cell survival, limited engraftment, immunogenicity, and potential safety concerns. Stem cell-derived exosomes (SC-exosomes) have therefore attracted increasing attention as a potential cell-free therapeutic strategy. These nanoscale extracellular vesicles can transfer bioactive cargoes, including proteins, lipids, messenger RNAs (mRNAs), and microRNAs (miRNAs), to recipient cells and thereby mediate intercellular communication. Compared with parental stem cell transplantation, SC-exosomes may offer several advantages, including lower immunogenicity, reduced tumorigenic risk, relative stability, and the potential to cross certain biological barriers. This comprehensive review summarizes current research on SC-exosomes in renal diseases, with emphasis on their biological characteristics, therapeutic mechanisms, preclinical evidence, and translational challenges. SC-exosomes may contribute to renal repair by promoting cell survival and regeneration, suppressing inflammation, apoptosis, oxidative stress, and fibrosis, and modulating immune and microvascular responses. We also discuss their potential relevance in multiple renal conditions, including acute kidney injury (AKI), CKD, diabetic nephropathy (DN), and other kidney diseases, as well as the use of exosomal cargoes as candidate diagnostic or prognostic biomarkers. Finally, we outline emerging opportunities and unresolved challenges in this field, including engineered exosomes, targeted delivery, exosome heterogeneity, dose optimization, large-scale production, purification, quality control, and long-term safety. Further standardized preclinical studies and well-designed clinical trials are needed before SC-exosome-based approaches can be translated into routine clinical application.
Qikai Luo, Nan Yang, Yiwei Shang et al.· Stem Cell Research & The...· 0 citations