2023-Exosomes and microvesicles in kidney transplantation_the long road from trash to gol

Kidney transplantation significantly enhances the survival
rate and quality of life of patients with end-stage kidney
disease. The ability to predict post-transplantation rejection
events in their early phases can reduce subsequent
allograft loss. Therefore, it is critical to identify biomarkers
of rejection processes that can be acquired on routine
analysis of samples collected by non-invasive or minimally
invasive procedures. It is also important to develop new
therapeutic strategies that facilitate optimisation of the
dose of immunotherapeutic drugs and the induction of
allograft immunotolerance. This review explores the challenges
and opportunities offered by extracellular vesicles
(EVs) present in biofluids in the discovery of biomarkers of
rejection processes, as drug carriers and in the induction
of immunotolerance. Since EVs are highly complex structures
and their composition is affected by the parent cell’s
metabolic status, the importance of defining standardised
methods for isolating and characterising EVs is also
discussed. Understanding the major bottlenecks associated
with all these areas will promote the further investigation
of EVs and their translation into a clinical setting.