Mesenchymal stem cell therapy in acute kidney injury (AKI): review and perspectives

Abstract

INTRODUCTION: Acute kidney injury (AKI) is highly prevalent today. It has a multifactorial aetiology and affects people of all ages, genders and ethnicities. Its treatment is essentially supportive of renal function substitution, so new treatment alternatives such as mesenchymal stem cell therapy (MSCs) should be investigated. METHODS: This review encompasses our understanding of the main mechanisms of action of MSCs in preclinical models of AKI by renal pedicle clamping ischemia-reperfusion, chemotherapy (cisplatin) and kidney transplantation in small and large animals, as well as outcomes in patients with AKI due to ischemia and kidney transplantation.RESULTS: Cellular therapy with MSCs has benefits in preclinical studies of AKI through various mechanisms, such as anti-inflammatory, antiapoptotic, oxidative anti-stress, antifibrotic, immunomodulatory and proangiogenic. In humans, MSC therapy is safe and effective. However, the challenges of MSC cell therapy include investigating protocols about the optimal dose of these cells, the route and frequency of appropriate administration, and the design of further biodistribution studies over a long follow-up period. In addition, a better understanding of molecular signalling and cellular interactions in the microenvironment of each organ and tissue is needed in order to define the best time to administer MSCs. Another challenge would be to mitigate the heterogeneity of the profile of cultured MSCs through preconditioning approaches.CONCLUSIONS: Cellular therapy with MSCs is very promising and should be part of the treatment of AKI patients in combination with other approaches already available, helping to accelerate recovery and/or slow the progression to chronic kidney disease. Randomized, multicentre controlled studies are needed to develop robust protocols that validate population-based cell therapy with MSCs. MESENCHYMAL STEM CELL THERAPY IN ACUTE KIDNEY INJURY (AKI): REVIEW AND PERSPECTIVES REV ASSOC MED BRAS 2020; 66(SUPPL 1):S:45-S54 46 PALAVRAS-CHAVE: Lesão renal aguda. Terapia celular. Desfechos. Ensaios clínicos.

Stem cells and COVID-19: are the human amniotic cells a new hope for therapies against the SARS-CoV-2 virus?

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Mesenchymal Stem Cell Therapy for Diabetic Kidney Disease: A Review of the Studies Using Syngeneic, Autologous, Allogeneic, and Xenogeneic Cells

“…MSC-based therapy is a promising strategy for accelerating kidney recovery, repairing and regenerating tissue damage after acute injury following ischemia-reperfusion, kidney transplant, and drug-mediated toxicity, as reviewed elsewhere [ 55 ]. In a meta-analysis including MSC from rat and mice (~200 animals treated) and different types of acute and chronic kidney injury (but not DKD), routes of delivery (intravenous, intrarenal, intraperitoneal, and intra-arterial), and MSC number (range, 7.5 × 10 4 ‐3.0 × 10 6 ), the beneficial outcomes for kidney recovery favored MSC treatment [ 56 ].…”

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“…O primeiro paciente, apresentava uma concentração sérica de creatinina classificada no estágio 4 (5,76 mg/dL) e era submetido a procedimentos de fluídoterapia subcutânea por pelo menos três vezes por semana, além de se alimentar via sonda esofágica a mais de 30 dias. Foi Esses resultados vão de encontro ao encontrado em um estudo recente, o qual concluiu que a terapia com CTM é muito promissora e pode retardar a progressão da DRC (SILVA et al, 2020).…”