Mesenchymal Stem Cell-Based Therapy for Kidney Disease: A Review of Clinical Evidence

Abstract

Mesenchymal stem cells form a population of self-renewing, multipotent cells that can be isolated from several tissues. Multiple preclinical studies have demonstrated that the administration of exogenous MSC could prevent renal injury and could promote renal recovery through a series of complex mechanisms, in particular via immunomodulation of the immune system and release of paracrine factors and microvesicles. Due to their therapeutic potentials, MSC are being evaluated as a possible player in treatment of human kidney disease, and an increasing number of clinical trials to assess the safety, feasibility, and efficacy of MSC-based therapy in various kidney diseases have been proposed. In the present review, we will summarize the current knowledge on MSC infusion to treat acute kidney injury, chronic kidney disease, diabetic nephropathy, focal segmental glomerulosclerosis, systemic lupus erythematosus, and kidney transplantation. The data obtained from these clinical trials will provide further insight into safety, feasibility, and efficacy of MSC-based therapy in renal pathologies and allow the design of consensus protocol for clinical purpose.

Figure 1

Sources of MSC used in experimental models of renal injury. Preclinical studies have shown that MSC used to treat renal diseases can be isolated from the following tissues: (A) tooth pulp, (B) kidney, (C) adipose tissue, (D) umbilical cord, (E) amniotic fluid, and (F) bone marrow.

Figure 2

Properties of MSC in kidney diseases. MSC, soluble factors, or microvesicles can be delivered to the kidney via the intraperitoneal, intra-arterial, intravenous, intraparenchymal, or intraosseous route. They exert a series of renoprotective and regenerative actions on the injured tissues through various paracrine mechanisms: antifibrotic and antiapoptotic, proangiogenic, proliferative and differentiative, antioxidative stress, and immunosuppression and immunomodulation of the immune system. ROS: reactive oxygen species. Arrow: enhancement; T-bar: reduction.