Therapeutic potential of extracellular vesicles in systemic lupus erythematosus: a systematic review

Current therapies for Systemic lupus erythematosus (SLE), such as immunosuppressants and glucocorticoids, are associated with significant side effects, necessitating alternative treatment approaches. Extracellular vesicles (EVs) have emerged as a potential therapeutic option due to their immunomodulatory properties and ability to regulate innate and adaptive immune responses. Thus, the objective of the present study was to systematically analyze the therapeutic potential of EVs for treating SLE. A systematic review was conducted according to PRISMA guidelines. An electronic search was performed in the PubMed/ MEDLINE, Scopus, Cochrane Library and Open Gray databases covering the period up to September 2024 to respond to the PICO answer "Would EVs have therapeutic potential in SLE?" Control of Systemic lupus erythematosus progression and the cellular and molecular mechanisms present were considered the primary and secondary outcome, respectively. The bias risk of studies was evaluated by SYRCLE's RoB. A total of 7 studies met the inclusion criteria, and the data exhibited that EVs reduced disease severity, improved survival rates and ameliorated organ-specific damage in SLE models. It was seen that EVs reduction of autoantibody, Th17 and Tfh cells, type-1 macrophage, neutrophils and pro-inflammatory cytokines, alongside an increase in Tregs, immunosuppressive cytokines and type-2 macrophage. The studies showed high scientific evidence. EV therapy exhibits potential in mitigating SLE progression by modulating immune responses and reducing inflammation. Further research is required to confirm these datas in humans, facilitating advancement for future clinical applications.