Kidney-heart crosstalk: the extracellular vesicles connection

Area of Science:

• Nephrology
• Cardiology
• Biomedical Engineering

Background:

• Chronic Kidney Disease (CKD) significantly increases cardiovascular disease (CVD) risk, with mortality largely driven by CVD.
• Beyond traditional factors like hypertension and diabetes, CKD involves inflammation, oxidative stress, mineral imbalances, and uremic toxins, heightening cardiovascular vulnerability.
• Altered extracellular vesicles (EVs) in CKD reflect metabolic and inflammatory states, contributing to cardiovascular pathology.

Purpose of the Study:

• To review how EVs mediate the link between kidney dysfunction and cardiovascular pathology.
• To discuss the role of EVs as biomarkers for early CVD detection and risk stratification in CKD patients.
• To explore the therapeutic potential of EVs in managing CKD-associated CVD.

Main Methods:

• Literature review synthesizing current knowledge on EV mechanisms in CKD-associated CVD.
• Analysis of evidence on EV function in endothelial dysfunction, vascular calcification, inflammation, thrombosis, and cardiac remodeling.
• Examination of preclinical data on stem cell-derived and engineered EVs for cardiac repair.

Main Results:

• EVs transfer bioactive molecules (proteins, microRNAs), promoting endothelial dysfunction, vascular calcification, inflammation, thrombosis, and cardiac remodeling.
• EVs show promise as biomarkers for early CVD detection and risk stratification in CKD.
• Preclinical studies indicate therapeutic potential for stem cell-derived and engineered EVs in cardiac repair.

Conclusions:

• EVs are key mediators connecting renal dysfunction to cardiovascular complications in CKD.
• EVs hold significant potential as diagnostic biomarkers and therapeutic targets for CKD-associated CVD.
• Further research, including standardization and human trials, is crucial for clinical translation of EV-based therapies.