2023, Vol. 27 ›› Issue (24): 3926-3936

Extracellular vesicles for acute kidney injury in preclinical research: a meta-analysis

Li Qingru1, Wang Yifan1, Chen Guanting1, Shi Ruoyu1, Zhang Linqi2     

Abstract: OBJECTIVE: Acute renal injury is one of the common clinical critical diseases, and the long-term prognosis of surviving patients is not optimistic. This study systemically assessed the effectivity of extracellular vesicles on animal models of acute kidney injury, hoping to inspire for clinical trials.
METHODS: Articles related to the treatment of extracellular vesicles for acute kidney injury in preclinical animal models were retrieved from PubMed, Embase, Web of Science, Cochrane Library, WanFang, VIP, CNKI, and Chinese Biomedical Literature Database. The retrieval time was from the establishment of the database to August 1, 2022. Data were independently extracted by two researchers. SYRCLE Animal Experiment Bias Risk Assessment table was used to evaluate the literature quality. RevMan 5.4 software and Stata 14.0 software were used to perform meta-analysis on serum creatinine, urea nitrogen, tumor necrosis factor-α, tubular necrosis and tubular type outcome indicators.  
RESULTS:   (1) A total of 19 randomized controlled animal experimental studies were included, with 399 rodents. There were 169 rodents in the extracellular vesicle treatment group, 168 rodents in the control group and 62 rodents in the stem cell treatment group. (2) The meta-analysis results demonstrated that serum creatinine level (SMD=-5.41, 95%CI:-6.95 to -3.88, P < 0.001) and urea nitrogen level (SMD=-4.57, 95%CI:-5.94 to -3.20, P < 0.001), and tumor necrosis factor-α level (SMD=-2.15, 95%CI:-2.63 to -1.68, P < 0.001) were significantly lower in the extracellular vesicle groups compared with the animal model control groups. Tubular necrosis (SMD=-6.15, 95%CI:-9.66 to -2.64, P=0.001) and casts (SMD=-3.33, 95%CI:-4.17 to -2.49, P=0.001) were significantly reduced. There was no significant difference in the improvement of serum creatinine between the extracellular vesicle group and the mesenchymal stem cell group (SMD=-1.23, 95%CI:-2.80-0.35, P=0.127) and in the improvement of urea nitrogen (SMD=-0.34, 95%CI:-2.19-1.50, P=0.715).
CONCLUSION: Extracellular vesicles could improve the levels of serum creatinine and urea nitrogen in animal models with acute kidney injury, which could significantly reduce the level of tumor necrosis factor-α, tubular necrosis and casts. Extracellular vesicles for acute kidney injury provide an important reference for further clinical trials.

Key words: extracellular vesicle, preclinical research, acute kidney injury, serum creatinine, urea nitrogen, tumor necrosis factor-α, meta-analysis