Abstract
Extracellular vesicles (EVs) are membrane-enclosed nanoparticles released by most cells in body fluids and extracellular matrix. They function as signal transducers in intercellular communication, contributing to the maintenance of cell and tissue integrity. EVs biogenesis is deregulated in various pathologies, in structural and functional connection to the pathophysiology of donor cells. Consequently, EVs are considered diagnostic and monitoring factors in many diseases. Despite consensus as to their activity in promoting coagulation and inflammation, there is evidence suggesting protective roles for EVs in stress states. Chronic kidney disease (CKD) patients are at high risk of developing cardiovascular defects. The pathophysiology, comorbidities, and treatment of CKD may individually and in synergy affect extracellular vesiculation in the kidney, endothelium, and blood cells. Oxidative and mechanical stresses, chronic inflammation, and deregulation of calcium and phosphate homeostasis are established stressors of EV release. EVs may affect the clinical severity of CKD by transferring biological response modifiers between renal, vascular, blood, and inflammatory cells. In this Review, we focus on EVs circulating in the plasma of CKD patients. We highlight some recent advances in the understanding of their biogenesis, the effects of dialysis, and pharmacological treatments on them and their potential impact on thrombosis and vascular defects. The strong interest of the scientific community to this exciting field of research may reveal hidden pieces in the pathophysiology of CKD and thus, innovative ways to treat it. Overcoming gaps in EV biology and technical difficulties related to their size and heterogeneity will define the success of the project.
Highlights
Extracellular vesicles (EVs) biogenesis is deregulated in various pathologies, in structural and functional connection to the pathophysiology of donor cells
Chronic kidney disease (CKD) patients are at high risk of developing cardiovascular defects
In this Review, we focus on EVs circulating in the plasma of CKD patients
Summary
EVs represent phenotypic markers of cellular stress and activation in CKD. Apart from the EV-delivered miR223, exosomes and MVs of ESRD patients with low levels of the Gla-rich protein (an anti-inflammatory factor and inhibitor of calcification in the cardiovascular system) can induce calcification in target vascular smooth muscle cells, by promoting osteogenic differentiation and inflammation (Viegas et al, 2018). Several other miRNAs that are potentially encapsulated in plasma EVs, such as the miR-23b (Zhao et al, 2016), have been shown to alleviate fibrosis and albuminuria in diabetic nephropathy, and their levels are pathologically low in the serum and kidney of the patients It is worth studying the degree of encapsulation of those cytoprotective miRNAs into the plasma EVs. Recent reports in animal models of kidney disease showed that miRNA expression is lower in plasma-derived exosomes compared to the plasma and that the miRNA levels may widely vary in each disease context (Xie et al, 2017). Plasma EVs may counteract proinflammatory and procoagulant signals instead of transmitting and amplifying them (Figure 1), and part of them may protect the vascular and kidney functions in CKD
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