Leszczynska Aleksandra, Stoess Christian, Sung Hana, Povero Davide, Eguchi Akiko, Feldstein Ariel
Department of Pediatrics, University of California, San Diego, CA 92037, USA.
Department of Surgery, TUM School of Medicine, Technical University of Munich, 81675 Munich, Germany.
Biomedicines. 2023 Oct 17;11(10):2808. doi: 10.3390/biomedicines11102808.
Chronic liver diseases can lead to fibrotic changes that may progress to the development of cirrhosis, which poses a significant risk for morbidity and increased mortality rates. Metabolic dysfunction-associated steatotic liver disease (MASLD), alcohol-associated liver disease (ALD), and viral hepatitis are prevalent liver diseases that may lead to cirrhosis. The advanced stages of cirrhosis can be further complicated by cancer development or end-stage liver disease and liver failure. Hence, early detection and diagnosis of liver fibrosis is crucial for preventing the progression to cirrhosis and improving patient outcomes. Traditionally, invasive liver biopsy has been considered the gold standard for diagnosing and staging liver fibrosis. In the last decade, research has focused on non-invasive methods, known as liquid biopsies, which involve the identification of disease-specific biomarkers in human fluids, such as blood. Among these alternative approaches, extracellular vesicles (EVs) have emerged as promising diagnostic and therapeutic tools for various diseases, including chronic liver diseases. EVs are released from stressed or damaged cells and can be isolated and quantified. Moreover, EVs facilitate cell-to-cell communication by transporting various cargo, and they have shown the potential to reduce the expression of profibrogenic markers, making them appealing tools for novel anti-fibrotic treatments. This review focuses on the impact of EVs in chronic liver diseases and exploring their potential applications in innovative therapeutic and diagnostic approaches.
慢性肝病可导致纤维化改变，进而可能发展为肝硬化，这会带来较高的发病风险并增加死亡率。代谢功能障碍相关脂肪性肝病（MASLD）、酒精性肝病（ALD）和病毒性肝炎是常见的可导致肝硬化的肝病。肝硬化的晚期可能会因癌症发生或终末期肝病及肝衰竭而进一步复杂化。因此，肝纤维化的早期检测和诊断对于防止病情进展为肝硬化及改善患者预后至关重要。传统上，肝穿刺活检一直被视为诊断和分期肝纤维化的金标准。在过去十年中，研究集中在非侵入性方法，即所谓的液体活检，其涉及在人体体液（如血液）中识别疾病特异性生物标志物。在这些替代方法中，细胞外囊泡（EVs）已成为包括慢性肝病在内的各种疾病有前景的诊断和治疗工具。EVs由应激或受损细胞释放，可被分离和定量。此外，EVs通过运输各种物质促进细胞间通讯，并且已显示出降低促纤维化标志物表达的潜力，使其成为新型抗纤维化治疗的有吸引力的工具。本综述重点关注EVs对慢性肝病的影响，并探索其在创新治疗和诊断方法中的潜在应用。
