Advanced Therapies for Diabetic Kidney Disease: A Critical Review of Gene-, RNA-, and Cell-Based Strategies to Address Residual Risk.
- 1Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia.
- 2Division of Medical and Biological Sciences, Tatarstan Academy of Sciences, 420111 Kazan, Russia.
Abstract
Background
Diabetic kidney disease (DKD) can progress despite contemporary kidney-protective treatment, motivating the development of additional mechanism-based interventions. This critical narrative review evaluates whether gene-, RNA-, and cell-based strategies are ready to address this residual risk and identifies the evidence required for clinical translation.Methods
A targeted literature verification and update was undertaken for the revision, with emphasis on primary intervention studies, contradictory findings, and the distinction between target validation and product efficacy. Mechanistic and model system background is considered in relation to therapeutic selection.Results
Adeno-associated viral vectors offer potentially durable expression but face species-dependent renal tropism, immunity, and limited control after administration. RNA therapeutics permit time-limited modulation, although productive renal delivery and compartment-specific effects remain unresolved. Mesenchymal stromal cells and extracellular vesicles provide broader paracrine activity, with challenges in potency definition, biodistribution, and manufacturing. Autologous renal cell products have entered clinical testing but require individualized production and invasive delivery. Most gene and RNA evidence is preclinical; cell therapy trials provide feasibility or exploratory efficacy signals rather than definitive kidney protection.Conclusions
Thus, at present, progress toward routine DKD use requires reproducible renal target engagement, validated manufacturing, and confirmation of clinical benefit in randomized trials.
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BibTeX
@article{kitaeva2026advanced,
title = {{Advanced Therapies for Diabetic Kidney Disease: A Critical Review of Gene-, RNA-, and Cell-Based Strategies to Address Residual Risk.}},
author = {Kristina V Kitaeva and Valeriya V Solovyeva and Albert A Rizvanov},
journal = {Diseases (Basel, Switzerland)},
year = {2026},
month = oct,
doi = {10.3390/diseases14100383},
url = {https://europepmc.org/article/MED/42930010},
note = {CC BY},
}
RIS
TY - JOUR
TI - Advanced Therapies for Diabetic Kidney Disease: A Critical Review of Gene-, RNA-, and Cell-Based Strategies to Address Residual Risk.
AU - Kristina V Kitaeva
AU - Valeriya V Solovyeva
AU - Albert A Rizvanov
PY - 2026
DA - 2026/10/19
JO - Diseases (Basel, Switzerland)
DO - 10.3390/diseases14100383
UR - https://europepmc.org/article/MED/42930010
AB - Background Diabetic kidney disease (DKD) can progress despite contemporary kidney-protective treatment, motivating the development of additional mechanism-based interventions. This critical narrative review evaluates whether gene-, RNA-, and cell-based strategies are ready to address this residual risk and identifies the evidence required for clinical translation.Methods A targeted literature verification and update was undertaken for the revision, with emphasis on primary intervention studies, contradictory findings, and the distinction between target validation and product efficacy. Mechanistic and model system background is considered in relation to therapeutic selection.Results Adeno-associated viral vectors offer potentially durable expression but face species-dependent renal tropism, immunity, and limited control after administration. RNA therapeutics permit time-limited modulation, although productive renal delivery and compartment-specific effects remain unresolved. Mesenchymal stromal cells and extracellular vesicles provide broader paracrine activity, with challenges in potency definition, biodistribution, and manufacturing. Autologous renal cell products have entered clinical testing but require individualized production and invasive delivery. Most gene and RNA evidence is preclinical; cell therapy trials provide feasibility or exploratory efficacy signals rather than definitive kidney protection.Conclusions Thus, at present, progress toward routine DKD use requires reproducible renal target engagement, validated manufacturing, and confirmation of clinical benefit in randomized trials.
SN - 2079-9721
ER -