Cell-based strategies for the treatment of kidney dysfunction: a review

Abstract

Conventional treatment of acute and chronic renal diseases has focused on solute removal. Novel strategies aim to treat the multifactorial disease states of acute kidney injury and chronic kidney disease by mitigating inflammation. Cell-based technologies for the treatment of kidney dysfunction fall under two broad categories: cell therapy and cell processing. Cell therapy utilizes cells that are isolated, cultured outside of the body, and reintroduced as therapy, leveraging beneficial metabolic and synthetic functions. For example, renal tubule cells have been used to provide gluconeogenesis, ammoniagenesis, metabolism of glutathione, catabolism of important peptide hormones, growth factors, and cytokines critical to multiorgan homeostasis and immunomodulation to treat renal dysfunction. Cell processing focuses on altering the characteristics of cell populations inside the body to provide therapy. The selective cytopheretic device is an example of this novel therapeutic strategy that aims to modulate the innate immune response during organ dysfunction, additional organ injury, by binding and deactivating leukocytes. In this review, both cell therapy and cell processing approaches will be discussed in the context of acute kidney injury and chronic renal disease.

Figure 1

SCD-CRRT circuit diagram depicting regional citrate anticoagulation. Citrate is administered pre-SCD, and iCa is replaced post-SCD, prior to blood return to the patient.

Figure 2

Change in mean urine output vs. time in a pilot study of SCD treated patients (black bars) compared to PICARD data set case-matched historical controls (white bars).

Figure 3

SCD pilot trial vs. historical outcomes data in AKI in the ICU