Xueli Man, Ting Lin, Zhixuan Xie, Juan Jin, Qiang He
{"title":"细胞源性外泌体对糖尿病肾病的有益作用：临床前证据的系统回顾和荟萃分析。","authors":"Xueli Man, Ting Lin, Zhixuan Xie, Juan Jin, Qiang He","doi":"10.1007/s00592-025-02473-8","DOIUrl":null,"url":null,"abstract":"<div><h3>Aims</h3><p>Recent studies indicate that cell-derived exosomes are effective in treating diabetic renal injury, though their precise mechanisms remain unclear. This meta-analysis evaluates the therapeutic efficacy of exosomes in diabetic nephropathy.</p><h3>Methods</h3><p>In addition to reviewing references and consulting experts, we systematically searched PubMed, Cochrane Library, EMBASE, and Web of Science for studies on exosome therapy for diabetic nephropathy. Seven outcome measures were selected to evaluate efficacy: blood glucose [(fasting blood glucose (FBG) and random blood glucose (RBG)], renal function parameters [serum creatinine (SCR), blood urea nitrogen (BUN), 24-hour urinary protein (24 h UP) and albumin-to-creatinine ratio (UACR)], and inflammatory factors. Study quality was assessed using the SYRCLE risk of bias tool, and data were analyzed using RevMan (version 5.3) software.</p><h3>Results</h3><p>We included 17 studies involving 288 animals, with follow-up durations ranging from 2 to 14 weeks. Pooled analysis demonstrated that exosome treatment significantly improved GLU (FBG: SMD − 1.39, 95% CI -2.70 to -0.08, <i>P</i> = 0.04; RBG: SMD − 1.29, 95% CI -2.25 to -0.34, <i>P</i> < 0.008), SCR (SMD − 1.45, 95% CI -2.14 to -0.76, <i>P</i> < 0.0001), BUN (SMD − 2.06, 95% CI -3.01 to -1.11, <i>P</i> < 0.0001), 24 UP (SMD − 2.88, 95% CI -3.97 to -1.78, <i>P</i> < 0.00001), and UACR (SMD − 2.00, 95% CI -3.15 to -0.85, <i>P</i> = 0.0007) compared to the diabetic model group. Qualitative analysis revealed that exosomes increased anti-inflammatory factors while reducing pro-inflammatory factors (<i>P</i> < 0.05). No adverse effects of exosomes were reported in any of the included studies.</p><h3>Conclusions</h3><p>Current evidence indicates that exosomes attenuate diabetic nephropathy progression through anti-inflammatory, anti-fibrotic, anti-apoptotic, and autophagy-inducing mechanisms. To demonstrate the most efficient exosomes and therapeutic parameters for the treatment of diabetic nephropathy, future studies should conduct sizable, randomized, double-blind trials with high-quality, long-term follow-ups.</p></div>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":"62 5","pages":"607 - 620"},"PeriodicalIF":3.1000,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Beneficial effects of cell-derived exosomes on diabetic nephropathy: a systematic review and meta-analysis of preclinical evidence\",\"authors\":\"Xueli Man, Ting Lin, Zhixuan Xie, Juan Jin, Qiang He\",\"doi\":\"10.1007/s00592-025-02473-8\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Aims</h3><p>Recent studies indicate that cell-derived exosomes are effective in treating diabetic renal injury, though their precise mechanisms remain unclear. This meta-analysis evaluates the therapeutic efficacy of exosomes in diabetic nephropathy.</p><h3>Methods</h3><p>In addition to reviewing references and consulting experts, we systematically searched PubMed, Cochrane Library, EMBASE, and Web of Science for studies on exosome therapy for diabetic nephropathy. Seven outcome measures were selected to evaluate efficacy: blood glucose [(fasting blood glucose (FBG) and random blood glucose (RBG)], renal function parameters [serum creatinine (SCR), blood urea nitrogen (BUN), 24-hour urinary protein (24 h UP) and albumin-to-creatinine ratio (UACR)], and inflammatory factors. Study quality was assessed using the SYRCLE risk of bias tool, and data were analyzed using RevMan (version 5.3) software.</p><h3>Results</h3><p>We included 17 studies involving 288 animals, with follow-up durations ranging from 2 to 14 weeks. Pooled analysis demonstrated that exosome treatment significantly improved GLU (FBG: SMD − 1.39, 95% CI -2.70 to -0.08, <i>P</i> = 0.04; RBG: SMD − 1.29, 95% CI -2.25 to -0.34, <i>P</i> < 0.008), SCR (SMD − 1.45, 95% CI -2.14 to -0.76, <i>P</i> < 0.0001), BUN (SMD − 2.06, 95% CI -3.01 to -1.11, <i>P</i> < 0.0001), 24 UP (SMD − 2.88, 95% CI -3.97 to -1.78, <i>P</i> < 0.00001), and UACR (SMD − 2.00, 95% CI -3.15 to -0.85, <i>P</i> = 0.0007) compared to the diabetic model group. Qualitative analysis revealed that exosomes increased anti-inflammatory factors while reducing pro-inflammatory factors (<i>P</i> < 0.05). No adverse effects of exosomes were reported in any of the included studies.</p><h3>Conclusions</h3><p>Current evidence indicates that exosomes attenuate diabetic nephropathy progression through anti-inflammatory, anti-fibrotic, anti-apoptotic, and autophagy-inducing mechanisms. 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引用次数: 0
摘要
目的：最近的研究表明，细胞来源的外泌体在治疗糖尿病肾损伤中是有效的，尽管其确切机制尚不清楚。这项荟萃分析评估了外泌体治疗糖尿病肾病的疗效。方法：在查阅文献和咨询专家的基础上，系统检索PubMed、Cochrane Library、EMBASE和Web of Science，获取外泌体治疗糖尿病肾病的相关研究。选择7个结局指标来评价疗效：血糖[(空腹血糖（FBG）和随机血糖（RBG）]、肾功能参数[血清肌酐（SCR）、血尿素氮（BUN）、24小时尿蛋白（24 h UP）和白蛋白/肌酐比（UACR）]和炎症因子。采用sycle偏倚风险工具评估研究质量，使用RevMan （version 5.3）软件分析数据。结果：我们纳入了17项研究，涉及288只动物，随访时间为2至14周。汇总分析显示，外泌体处理显著改善GLU (FBG: SMD - 1.39, 95% CI -2.70 ~ -0.08, P = 0.04；RBG: SMD - 1.29, 95% CI -2.25 -0.34， P结论：目前的证据表明外泌体通过抗炎、抗纤维化、抗凋亡和自噬诱导机制减缓糖尿病肾病的进展。为了证明治疗糖尿病肾病最有效的外泌体和治疗参数，未来的研究应该进行大规模的、随机的、双盲的、高质量的长期随访试验。
Beneficial effects of cell-derived exosomes on diabetic nephropathy: a systematic review and meta-analysis of preclinical evidence
Aims
Recent studies indicate that cell-derived exosomes are effective in treating diabetic renal injury, though their precise mechanisms remain unclear. This meta-analysis evaluates the therapeutic efficacy of exosomes in diabetic nephropathy.
Methods
In addition to reviewing references and consulting experts, we systematically searched PubMed, Cochrane Library, EMBASE, and Web of Science for studies on exosome therapy for diabetic nephropathy. Seven outcome measures were selected to evaluate efficacy: blood glucose [(fasting blood glucose (FBG) and random blood glucose (RBG)], renal function parameters [serum creatinine (SCR), blood urea nitrogen (BUN), 24-hour urinary protein (24 h UP) and albumin-to-creatinine ratio (UACR)], and inflammatory factors. Study quality was assessed using the SYRCLE risk of bias tool, and data were analyzed using RevMan (version 5.3) software.
Results
We included 17 studies involving 288 animals, with follow-up durations ranging from 2 to 14 weeks. Pooled analysis demonstrated that exosome treatment significantly improved GLU (FBG: SMD − 1.39, 95% CI -2.70 to -0.08, P = 0.04; RBG: SMD − 1.29, 95% CI -2.25 to -0.34, P < 0.008), SCR (SMD − 1.45, 95% CI -2.14 to -0.76, P < 0.0001), BUN (SMD − 2.06, 95% CI -3.01 to -1.11, P < 0.0001), 24 UP (SMD − 2.88, 95% CI -3.97 to -1.78, P < 0.00001), and UACR (SMD − 2.00, 95% CI -3.15 to -0.85, P = 0.0007) compared to the diabetic model group. Qualitative analysis revealed that exosomes increased anti-inflammatory factors while reducing pro-inflammatory factors (P < 0.05). No adverse effects of exosomes were reported in any of the included studies.
Conclusions
Current evidence indicates that exosomes attenuate diabetic nephropathy progression through anti-inflammatory, anti-fibrotic, anti-apoptotic, and autophagy-inducing mechanisms. To demonstrate the most efficient exosomes and therapeutic parameters for the treatment of diabetic nephropathy, future studies should conduct sizable, randomized, double-blind trials with high-quality, long-term follow-ups.
期刊介绍：
Acta Diabetologica is a journal that publishes reports of experimental and clinical research on diabetes mellitus and related metabolic diseases. Original contributions on biochemical, physiological, pathophysiological and clinical aspects of research on diabetes and metabolic diseases are welcome. Reports are published in the form of original articles, short communications and letters to the editor. Invited reviews and editorials are also published. A Methodology forum, which publishes contributions on methodological aspects of diabetes in vivo and in vitro, is also available. The Editor-in-chief will be pleased to consider articles describing new techniques (e.g., new transplantation methods, metabolic models), of innovative importance in the field of diabetes/metabolism. Finally, workshop reports are also welcome in Acta Diabetologica.
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