SYSTEMATIC REVIEW article
Front. Pharmacol.
Sec. Renal Pharmacology
Volume 16 - 2025 | doi: 10.3389/fphar.2025.1653907
Protective Role of Exosomes in Renal Ischemia-Reperfusion Injury: A Systematic Review and Meta-Analysis
Provisionally accepted
Weibo Wang1,2Supeng Tai1,2
Xi Cheng1,2Lexing Yang1,2Yifan Chang1,2Junyi Yan1,2
Junyue Tao1,2*
Jun Zhou1,2*- 1Department of Urology, First Affiliated Hospital of Anhui Medical University, Hefei, China
- 2Anhui Medical University, Hefei, China
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Objective Renal ischemia-reperfusion injury (RIRI) is a major cause of acute kidney injury (AKI), commonly triggered by clinical procedures such as nephrectomy, renal transplantation, or shock resuscitation, and may progress to chronic kidney disease (CKD). Although exosomes hold promise as nanotherapeutics with pleiotropic mechanisms for renal protection, robust preclinical validation remains limited. This study aimed to clarify the therapeutic potential of exosome-based interventions for RIRI and to explore factors that modulate their efficacy. Methods This systematic review and meta-analysis synthesized data from 19 controlled preclinical studies involving 245 rodents, retrieved from the PubMed, Web of Science, Embase, and Cochrane Library databases, to evaluate the therapeutic efficacy of exosomes in experimental RIRI models. Results Exosome treatment led to broad therapeutic improvements in renal function, renal damage, inflammation, oxidative stress, apoptosis, pyroptosis, cellular proliferation, and fibrosis. Subgroup analyses identified exosomal source as a critical determinant of efficacy, with mesenchymal stem cell- and endothelial colony-forming cell-derived exosomes outperforming those from fibroblasts. No clear dose-response relationship was observed, and while pre-treatment initially appeared more effective than post-treatment, this difference was not significant after adjusting for confounders. Notably, different administration routes yielded comparable therapeutic outcomes. Conclusion These findings underscore the renoprotective potential of exosome therapy in RIRI and highlight the need for further investigation to optimize therapeutic protocols and accelerate clinical translation.
Keywords: renal ischemia-reperfusion injury, Exosomes, mesenchymal stem cell, Dose-response relationships, Meta-analysis
Received: 25 Jun 2025; Accepted: 19 Aug 2025.
Copyright: © 2025 Wang, Tai, Cheng, Yang, Chang, Yan, Tao and Zhou. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Junyue Tao, Department of Urology, First Affiliated Hospital of Anhui Medical University, Hefei, China
Jun Zhou, Department of Urology, First Affiliated Hospital of Anhui Medical University, Hefei, China
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