Erasmus MC Transplant Institute, Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
Erasmus MC Transplant Institute, Nephrology and Transplantation, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
Transplant Rev (Orlando). 2022 Dec;36(4):100714. doi: 10.1016/j.trre.2022.100714. Epub 2022 Jul 13.
Kidney transplantation is the optimal treatment of end-stage renal disease. Extracellular vesicles (EVs) have tremendous therapeutic potential, but their role in modulating immune responses in kidney transplantation remains unclear.
We performed a systematic review and meta-analysis to investigate the therapeutic efficacy of EVs in preclinical kidney transplant models. Outcomes for meta-analysis were graft survival and renal function. Subgroup analysis was conducted between immune cell derived EVs (immune cell-EVs) and mesenchymal stromal cell derived EVs (MSC-EVs).
Seven studies published from 2013 to 2021 were included. The overall effects showed that EVs had a positive role in prolonging allograft survival (standardized mean difference (SMD) = 2.00; 95% confidence interval (CI), 0.79 to 3.21; P < 0.01; I = 94%), reducing serum creatinine (SCr) (SMD = -2.19; 95%CI, -3.35 to -1.04; P < 0.01; I = 93%) and blood urea nitrogen (BUN) concentrations (SMD = -1.69; 95%CI, -2.98 to -0.40; P = 0.01; I = 94%). Subgroup analyses indicated that only immune cell-EVs significantly prolonged graft survival and improve renal function but not MSC-EVs.
EVs are promising candidates to suppress allograft rejection and improve kidney transplant outcome. Immune cell-EVs showed their superiority over MSC-EVs in prolonging graft survival and improving renal function. For interpretation of the outcomes, additional studies are needed to validate these findings.
肾移植是治疗终末期肾病的最佳方法。细胞外囊泡（EVs）具有巨大的治疗潜力，但它们在调节肾移植中的免疫反应中的作用尚不清楚。
我们进行了系统评价和荟萃分析，以研究 EV 在临床前肾移植模型中的治疗效果。荟萃分析的结果是移植物存活率和肾功能。在免疫细胞衍生的 EV（免疫细胞-EVs）和间充质基质细胞衍生的 EV（MSC-EVs）之间进行了亚组分析。
纳入了 2013 年至 2021 年发表的 7 项研究。总体效应表明，EVs 对延长同种异体移植物存活有积极作用（标准化均数差（SMD）= 2.00；95%置信区间（CI），0.79 至 3.21；P < 0.01；I = 94%），降低血清肌酐（SCr）（SMD = -2.19；95%CI，-3.35 至 -1.04；P < 0.01；I = 93%）和血尿素氮（BUN）浓度（SMD = -1.69；95%CI，-2.98 至 -0.40；P = 0.01；I = 94%）。亚组分析表明，只有免疫细胞-EVs 显著延长移植物存活并改善肾功能，而 MSC-EVs 则不然。
EVs 是抑制同种异体排斥反应和改善肾移植结果的有前途的候选物。免疫细胞-EVs 在延长移植物存活和改善肾功能方面表现出优于 MSC-EVs 的优势。为了解释这些结果，需要进一步的研究来验证这些发现。
