EXOSOME-FUNCTIONALIZED SCAFFOLDS FOR MULTIMORBID CKD PATIENTS: A DUAL APPROACH TO RENAL AND BONE REGENERATION

Chronic Kidney Disease (CKD) has a global prevalence of an estimated 10% of the population, frequently causing the complication of CKD-Mineral and Bone Disorder (CKD-MBD), the debilitating complex multi-morbidity characterized by skeletal fragility and vascular calcifications with significant impacts on quality of life and long-term outcomes in advanced CKD stage.

New advances in regenerative medicine have identified exosome-infused scaffolds as modern independent cell-free therapeutic targets or talismans for tissue repair. Exosomes are nanoscale extracellular vesicles containing enriched levels of bioactive molecules that facilitate abundant intercellular communication, which regulate inflammation, apoptosis, and regeneration. Exosomes may be embedded in biomaterial scaffolds to further enhance mesenchymal stem cell (MSC) proliferation, osteogenic differentiation, and angiogenic processes to speed up the healing process at bone repair. Exosome scaffolds will also promote protection and repair of renal tissue when considered their anti-inflammatory and anti-apoptotic properties.

This review is aimed at defining the dual regenerative approach of exosome-based scaffolds as restorative targets for CKD patients affected by some facet of renal impairment and bone disorders, the molecular mechanisms underpinning the scaffold movement, scaffold material design approaches, and their imminent integration into the therapeutic practices of nephrology/endocrinology. A firm emphasis on a collaborative team of nephrologists, orthopaedic specialty consultants, and tissue engineers is needed to find integrative, relative, and translational solutions to advanced interventions for injuries.

Besides exploring the therapeutic possibilities, in this article, we also discuss clinical (notably regulatory) challenges, ethical issues, and the role of academia-industry partnerships in producing next-generation exosome-based therapies. The approach exemplifies a paradigm shift in CKD care that offers a vision for complete care planning interventions that can manage patients with CKD and multimorbidity, including their systemic health and skeletal integrity.