Emerging Frontiers in acute kidney injury: The role of extracellular vesicles

Acute kidney injury (AKI) remains a prevalent and critical clinical condition. Although considerable advancements have been achieved in clinical and fundamental research in recent decades, the enhancements in AKI diagnosis and therapeutic approaches, such as the development of emerging biomarkers including neutrophil gelatinase-associated lipocalin (NGAL) and liver fatty acid-binding protein (FABP1) for early detection of AKI and the exploration of "goal-directed" hemodynamic treatment methods and renal replacement therapies, have yet to fulfill the demands of modern medicine. Extracellular vesicles (EVs) serve as pivotal messengers in cell-to-cell communication, exerting a vital impact on both physiological and pathological processes. They exhibit immense potential as disease regulators, innovative biomarkers, therapeutic agents, and drug delivery vehicles. In recent times, the diagnostic and therapeutic potential of EVs in AKI has garnered widespread recognition and exploration, making them a focal point in clinical research. Consequently, a comprehensive overview of EVs' role in AKI is of great importance. This review delves into the multifaceted roles of EVs from diverse cellular sources, including tubular epithelial cells (TECs), mesenchymal stem cells (MSCs), progenitor cells, platelets and macrophages, within the context of AKI. It scrutinizes their contributions to disease progression and mitigation, their diagnostic marker potential, and encompasses a variety of conventional and novel EVs extraction techniques suitable for AKI clinical applications. Moreover, it underscores four innovative strategies for engineering EVs to boost production efficiency, targeting precision, circulatory stability and therapeutic potency. These advancements pave the way for novel approaches in the diagnosis and treatment of AKI. We are optimistic that as research into EVs progresses, the future will bring about earlier detection, more tailored treatments, and a more holistic management of AKI.