Stem Cell Therapy Ushers in A New Breakthrough in The Treatment Of Kidney Disease

According to statistics, the incidence of kidney disease in China is 10% to 13%, of which the prevalence of chronic kidney disease is as high as 10.8%, and most kidney injuries tend to progress to chronic or even acute renal failure, that is, uremia. That is, 1 in 10 people suffer from kidney disease. It causes 5 million to 10 million deaths every year, which has aroused the attention and attention of the medical community.

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Stem cells are also receiving more and more attention in the field of kidney disease. At present, the use of stem cells for diabetic nephropathy and lupus nephritis has entered the clinical stage of stem cell filing in my country, and multi-center clinical research methods have been carried out to improve the authenticity and effectiveness of clinical trials. Stem cells have gradually shown good research results in the basic research of chronic kidney disease (CKD), acute kidney injury (AKI), diabetic nephropathy (DN), lupus nephritis (LN), IgA nephropathy, obstructive nephropathy, and other kidney diseases. foundation for clinical application.

Let me chat with you today: Which kidney diseases have been researched and applied to treat stem cells?

01 Acute kidney injury

Acute kidney injury is one of the most common clinical critical illnesses with a high mortality rate. The common etiology of AKI is acute tubular necrosis caused by renal ischemia and nephrotoxicity. Recently, Qi et al. used a BMSC medium to incubate renal proximal tubular cells NRK-52E in vitro, which could improve cell viability and inhibit cell apoptosis.

For the same research purpose, AMSCs were transplanted into rats with ischemia-reperfusion injury through the renal artery or tail vein, and it was found that the levels of serum creatinine and blood urea nitrogen were reduced, and the renal tubular score was improved, which proved that AMSCs could reduce apoptosis and promote renal tubular cell regeneration. proliferation.

02 Chronic Kidney Disease

In China, chronic kidney disease is one of the most common chronic diseases, with as many as 119.5 million patients, higher than those with diabetes (113.9 million), and second only to those with hypertension (254 million). Renal interstitial fibrosis is a common pathway for renal failure in various renal diseases (end-stage renal disease, ESRD). For ESRD, kidney transplantation and maintenance dialysis are the traditional basic treatments.

The lack of kidney sources, the side effects of immunosuppressants, the high cost of suppressive drugs, surgical complications, and the poor effect of dialysis-related transplantation due to the long waiting time for transplantation all limit the development of kidney transplantation. Dialysis cannot fundamentally improve the pathological damage of renal parenchyma damage, nor can it prevent the occurrence of various complications.

Studies have shown that in the 5/6 nephrectomy renal failure model of SD rats, there were obvious changes in glomerular sclerosis and renal interstitial fibrosis at 30 days after nephrectomy, while the subrenal capsule injection of the MSC group had renal changes at 30 days. Glomerular sclerosis was significantly reduced, while renal interstitial fibrosis was also reduced.

03 Obstructive nephropathy

Obstructive nephropathy is one of the main causes of renal failure in adults and children. If severe acute ureteral obstruction and chronic incomplete obstruction cannot be relieved in time, the renal function will be seriously damaged, and eventually, ESRD (end-stage renal disease) will be developed, requiring renal replacement therapy. Studies have shown that in a mouse model of unilateral ureteral obstruction, after arterial injection of hMSCs, they are still active in the kidney for 4 weeks, which can effectively prevent tubulointerstitial fibrosis caused by obstruction.

04 IgA nephropathy

IgA nephropathy (IgA nephropathy, IgAN) is an important cause of chronic renal failure, the current treatment of this disease is still non-specific treatment based on glucocorticoids, and cyclophosphamide, and some patients will eventually develop ESRD.

Kunter et al. found that BMSCs labeled with green fluorescent protein GFP were transplanted into mice with IgAN, BMSCs expressing GFP markers could be seen in the mesangial area, and the accumulation of IgA in this area was significantly reduced, and the kidney function was significantly improved. Multiple experiments have proved that MSC has a significant protective effect on the kidneys in the treatment of IgAN model mice. After the application of MSC, the degree of glomerular and interstitial fibrosis, hematuria, and proteinuria are reduced, and the symptoms of IgAN are significantly improved.

05 End-stage renal failure

End-stage renal failure is one of the important causes of death in patients with chronic kidney disease. In the past 20 years, chronic renal failure has ranked 5th to 9th among the major causes of death in humans. Lesions etc.

At present, the available treatment methods mainly include hemodialysis, peritoneal dialysis, and kidney transplantation. The former two are called incomplete replacement therapy. Erythropoietin needs to be supplemented at the same time as dialysis, and there are many complications and the quality of life is not high; Kidney transplantation is a complete replacement. However, donor shortage, immunosuppression, surgical complications, and long-term waiting for kidney transplantation, poor transplantation results, including high costs, force people to look for more effective and advanced treatment techniques.

Intravenous infusion of umbilical cord mesenchymal stem cells is a new therapy for chronic renal failure, which can improve, delay or even reverse the progression of chronic kidney failure.

Mechanism of Action of Stem Cells

(1) Stem cells have the characteristics of regeneration and multipotent differentiation, and can differentiate into functional cells of the kidney such as glomerular endothelial cells, mesangial cells, and renal tubular cells, helping to repair damaged kidney tissue and reshape the kidney structure;

(2) The paracrine function of stem cells supports stem cells to secrete growth factors, cytokines, regulatory peptides, cell signaling molecules, and other biologically active factors, which can play an active role in angiogenesis and kidney protection, and regulate the kidney microenvironment;

(3) The homing properties of stem cells can target damaged kidney tissue, play an anti-inflammatory mechanism, reduce the inflammatory response in kidney tissue, complete the repair under pathological conditions, and protect kidney function.

Research progress of stem cell therapy for chronic kidney disease

Domestic clinical research progress: At present, some clinical trials have been conducted to evaluate the safety and effectiveness of cell transplantation in the treatment of kidney diseases. Due to the low immune response and high regenerative capacity of MSCs, most experiments use MSCs as cell resources.

At present, more and more studies are devoted to the use of cell therapy to restore renal function in patients with AKI and CKD. According to recent clinical reports, some investigators will start phase II clinical trials using autologous MSCs and other types of cells in the treatment of acute renal failure.

In Wanfang Data, the relevant literature was searched through the keyword "stem cell treatment of renal failure". The final results showed that there were as many as 129 basic research and clinical research on stem cell treatment of renal failure. From 2016 to 2019, China's central financial fund allocated funds to support stem cell clinical research involving severe acute kidney injury and other diseases, and the National Health and Medical Commission approved "Umbilical Cord Mesenchymal Stem Cell Therapy for Lupus Nephritis: Randomized Blind Parallel Control Multi-center Research" filing project.

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