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Extracellular vesicles in renal disease

This article has been updated

Key Points

  • Extracellular vesicles are involved in cell–to–cell communication and they transfer nucleic acids, proteins and lipids that can alter the phenotype of the recipient cell

  • Extracellular vesicles can be used as biomarkers of renal diseases

  • Circulating microvesicles and exosomes may contribute to the development of renal diseases by immunomodulation, thrombogenesis and matrix modulation

  • Extracellular vesicles may have a therapeutic role in tissue regeneration after acute kidney injury

  • Extracellular vesicles have the potential to transfer endogenous and exogenous therapeutic substances to recipient cells

Abstract

Extracellular vesicles, such as exosomes and microvesicles, are host cell-derived packages of information that allow cell–cell communication and enable cells to rid themselves of unwanted substances. The release and uptake of extracellular vesicles has important physiological functions and may also contribute to the development and propagation of inflammatory, vascular, malignant, infectious and neurodegenerative diseases. This Review describes the different types of extracellular vesicles, how they are detected and the mechanisms by which they communicate with cells and transfer information. We also describe their physiological functions in cellular interactions, such as in thrombosis, immune modulation, cell proliferation, tissue regeneration and matrix modulation, with an emphasis on renal processes. We discuss how the detection of extracellular vesicles could be utilized as biomarkers of renal disease and how they might contribute to disease processes in the kidney, such as in acute kidney injury, chronic kidney disease, renal transplantation, thrombotic microangiopathies, vasculitides, IgA nephropathy, nephrotic syndrome, urinary tract infection, cystic kidney disease and tubulopathies. Finally, we consider how the release or uptake of extracellular vesicles can be blocked, as well as the associated benefits and risks, and how extracellular vesicles might be used to treat renal diseases by delivering therapeutics to specific cells.

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Figure 1: Release and uptake mechanisms of extracellular vesicles.
Figure 2: Physiological processes influenced by extracellular vesicles.
Figure 3: Involvement of microvesicles in vasculitis and thrombotic microangiopathies.
Figure 4: Drugs that block extracellular vesicle release and uptake.

Change history

  • 28 July 2017

    This article has been updated to remove some characters that were accidently inserted at the end of a word. The error did not impact on the scientific meaning.

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Acknowledgements

The authors gratefully acknowledge R. Tati (Department of Pediatrics, Lund University, Sweden) for help with figures 1 and 2. They are also grateful for funding from The Swedish Research Council (K2013-64X-14008-13-5 and K2015- 99X-22877-01-6), The Knut and Alice Wallenberg Foundation (Wallenberg Clinical Scholar 2015.0320), The Torsten Söderberg Foundation, Skåne Centre of Excellence in Health, Crown Princess Lovisa's Society for Child Care, Region Skåne and The Konung Gustaf V:s 80-årsfond.

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Karpman, D., Ståhl, Al. & Arvidsson, I. Extracellular vesicles in renal disease. Nat Rev Nephrol 13, 545–562 (2017). https://doi.org/10.1038/nrneph.2017.98

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