Integrative Approaches to Treating Cellular Senescence in Kidney Disease.

Cellular senescence in the kidney plays a crucial role in the progression of acute kidney injury and chronic kidney disease. Therapeutic approaches targeting senescent cells, such as small molecule senolytic and senomorphic drugs, display efficacy in preclinical models. However, such drugs pose a risk of adverse effects and only partially mitigate disease progression, highlighting the need for new therapeutic approaches that more comprehensively and safely address disease pathways in aging kidney disease. This review discusses the potential of extracellular vesicles and longevity proteins, such as α-klotho and silencing information regulator 2-related enzyme 1 (SIRT1), in regulating cellular senescence and alleviating kidney fibrosis. Particularly, combination therapy that simultaneously targets inflammation, tissue damage, and senescence is promising for kidney disease, given the potential to synergistically overcome the limitations of current unimodular treatment modalities and pave the way for more effective management of kidney disease. This review highlights the mechanisms of cellular senescence in kidney disease, particularly in diabetic kidney disease, the latest knowledge on senotherapy, and the potential and challenges of new therapeutic strategies, including combining extracellular vesicles and longevity proteins.