Mesenchymal stem cell-derived extracellular vesicles: emerging cell-free therapeutics for kidney diseases

The increasing global impact of kidney diseases highlights a pressing and unmet need for new treatment strategies. In this context, mesenchymal stem cell-derived extracellular vesicles (MSC-EVs) have emerged as a promising cell-free therapeutic approach, attracting growing interest due to their dual regenerative functions. MSC-EVs not only possess intrinsic therapeutic effects mediated by their cargo of mRNAs, proteins, and miRNAs that regulate inflammation, promote cell repair, reduce fibrosis, but also serve as highly biocompatible vehicles for drug delivery. This versatility places them at the forefront of a potential shift in how kidney diseases may be treated. In this review, we systematically summarize current knowledge on the mechanisms and therapeutic potential of MSC-EVs in various kidney diseases. Although challenges related to standardization and clinical translation persist, ongoing progress supports the view that MSC-EVs are poised to become key next-generation therapies for kidney diseases.