Analysis of urinary exosomes applications for rare kidney disorders

ABSTRACT

Introduction: Exosomes are nanovesicles that play important functions in a variety of physiological and pathological conditions. They are powerful cell-to-cell communication tool thanks to the protein, mRNA, miRNA, and lipid cargoes they carry. They are also emerging as valuable diagnostic and prognostic biomarker sources. Urinary exosomes carry information from all the cells of the urinary tract, downstream of the podocyte. Rare kidney diseases are a subset of an inherited diseases whose genetic diagnosis can be unclear, and presentation can vary due to genetic, epigenetic, and environmental factors.

Areas covered: In this review, we focus on a group of rare and often neglected kidney diseases, for which we have sufficient available literature data on urinary exosomes. The analysis of their content can help to comprehend pathological mechanisms and to identify biomarkers for diagnosis, prognosis, and therapeutic targets.

Expert opinion: The foreseeable large-scale application of system biology approach to the profiling of exosomal proteins as a source of renal disease biomarkers will be also useful to stratify patients with rare kidney diseases whose penetrance, phenotypic presentation, and age of onset vary sensibly. This can ameliorate the clinical management.

KEYWORDS:

• Exosomes
• biomarker
• rare kidney diseases
• proteomics

Article highlights

• Rare kidney diseases represent a large number (more than 150) of life-threatening or chronically debilitating disorders and some of them can evolve towards end-stage renal disease.

• At the moment, the diagnostic accuracy for a large number of rare kidney disorders is low, based on personal experience and requiring invasive procedures (including radiation and/or nephrotoxic contrast media agents from medical imaging and histological evaluations).

• Proteomic analysis of urinary-derived exosomes may help clinicians/researchers to reveal previous-unrecognized features involved in the biological machinery deregulated in several rare kidney disorders and to identify potential new diagnostic/therapeutic biomarkers.

• The introduction of reliable/quick and noninvasive urinary assays of exosome biomarkers (liquid biopsy) might facilitate in the future an adequate personalization of the treatment with a great positive impact on the national health-care system.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This paper was not funded.