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2016 ; 1
(3
): 105-113
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Implantation of Autologous Selected Renal Cells in Diabetic Chronic Kidney
Disease Stages 3 and 4-Clinical Experience of a "First in Human" Study
#MMPMID29142919
Stenvinkel P
; Wadström J
; Bertram T
; Detwiler R
; Gerber D
; Brismar TB
; Blomberg P
; Lundgren T
Kidney Int Rep
2016[Sep]; 1
(3
): 105-113
PMID29142919
show ga
INTRODUCTION: Animal models of chronic kidney disease demonstrate that a
redundant population of therapeutically bioactive selected renal cells (SRCs) can
be delivered to the kidney through intraparenchymal injection and arrest disease
progression. Direct injection of SRCs has been shown to attenuate nuclear
factor-?B, which is known to drive tissue inflammation, as well as the
transforming growth factor-?-mediated plasminogen activator inhibitor-1 response
that drives tissue fibrosis. METHODS: We present experience from the
first-in-human clinical study with SRCs. Seven male type 2 diabetic patients (63
± 2 years of age) with chronic kidney disease stage 3 to 4 (estimated glomerular
filtration rate 25 ± 2 ml/min) were recruited. After blood and urine sampling,
iohexol clearance, magnetic resonance imaging, and renal scintigraphy, patients
underwent ultrasound-guided renal biopsy. Two cores of renal tissue were shipped
to the manufacturing plant for cell isolation, culture, and product preparation.
Formulated SRCs were transported back to study sites (range 59-87 days after
biopsy) for intracortical injection using a retroperitoneoscopic technique.
RESULTS: Laparoscopically assisted implantation of SRCs was uneventful in all
patients. However, postoperative complications were common and suggest that other
techniques of SRC delivery should be used. Kidney volume, split function, and
glomerular filtration rate did not change during 12 months of follow-up. An
extended 24-month follow-up in 5 of the patients showed a decline in estimated
glomerular filtration rate (cystatin C). DISCUSSION: Postoperative complications
following retroperitoneoscopic implantation of SRC in the kidney cortex seem to
be related to the surgical procedure rather than to injection of the cell
product. No changes in renal function were observed during the original 12-month
protocol. Beyond the first 12 months after cell implantation, individual renal
function began to deteriorate during further follow-up.