Microparticles at the crossroads of the gut-kidney axis: Mechanistic drivers and therapeutic horizons in hemodialysis

Table 1 Therapeutic approaches targeting microparticles and the gut-kidney axis in chronic kidney disease

Therapeutic class	Mechanism of action	Representative agents or interventions	Clinical status
Probiotics & synbiotics	Rebalance gut microbiota, reduce uremic toxins	Lactobacillus, Bifidobacterium	Clinical use; evidence from randomized controlled trials
Adsorbents	Bind and reduce gut-derived toxin precursors	AST-120	Clinical use; mixed evidence, beneficial subsets
Statins	Inhibit cellular release of MPs	Atorvastatin, rosuvastatin	Clinical use; proven reduction in MPs
MP signaling blockers	Block MP cellular interactions and inflammatory signaling	Annexin V, integrin αvβ3 antagonists	Preclinical; promising early data
Extracorporeal MP removal	Remove MPs from circulation through filtration or adsorption	High-flux dialysis, adsorption columns	Experimental; preliminary data
Personalized microbiome therapy	Individualized microbiome correction, engineered probiotics	Fecal microbiota transplantation, engineered probiotics	Experimental; ongoing clinical research
EV-based therapies	Therapeutic EVs delivering anti-inflammatory or regenerative factors	Mesenchymal stem cell EVs, engineered EVs	Preclinical; highly promising results
MP-targeted immunomodulation	Immunological modulation to reduce MP-induced inflammation	Regulatory MPs, monoclonal antibodies	Experimental; concept development

EVs: Extracellular vesicles; MPs: Microparticles.