Repetitive administration of autologous CD34+ cells significantly improved eGFR slope for three years in patients with progressive chronic kidney disease.

 

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https://storage.unitedwebnetwork.com/files/1099/4fe07a47ea832e26c0f294db8ded2244.pdf
Repetitive administration of autologous CD34+ cells significantly improved eGFR slope for three years in patients with progressive chronic kidney disease.

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Takayasu
Ohtake
Takayasu Ohtake ohtake@shonankamakura.or.jp Shonan Kamakura General Hospital Kidney Disease and Transplant Center Kamakura Japan *
Yasuhiro Mochida yasuhiromochida@icloud.com Shonan Kamakura General Hospital Kidney Disease and Transplant Center Kamakura Japan -
Kunihiro Ishioka kunihiro.ishioka@tokushukai.jp Shonan Kamakura General Hospital Kidney Disease and Transplant Center kamakura Japan -
Sumi Hidaka s_hidaka@shonankamakura.or.jp Shonan Kamakura General Hospital Kidney Disease and Transplant Center Kamakura Japan -
Shuzo Kobayashi shuzo@shonankamakura.or.jp Shonan Kamakura General Hospital Kidney Disease and Transplant Center Kamakura Japan -
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To date, no specific treatment has been established to reverse progressive chronic kidney disease (CKD). To evaluate the safety and efficacy of autologous CD34+ cell transplantation in CKD patients who exhibited a progressive decline in renal function, we performed a pilot clinical trial of regenerative therapy using autologous CD34+ cells in patients with progressive CKD. 

A clinical trial of autologous CD34+ cell therapy for progressive CKD with inclusion criteria of estimated glomerular filtration rate (eGFR) 15–45 mL/minute/1.73 m2 (CKD stage G3a–G4) was performed. After five days of treatment with the granulocyte colony-stimulating factor, mononuclear cells were harvested and CD34+ cells were magnetically collected. CD34+ cells (1×106/kg) were directly injected into the bilateral renal arteries twice (at zero and three months), and their safety and efficacy were evaluated for 6 months.

Four patients were enrolled and completed the study. The eGFR levels at study entry was 15-28 mL/minute/1.73 m2. Three of four patients showed improvement in eGFR slope (eGFR slope > 0 mL/minute/1.73 m2), with the monthly slope of eGFR (delta eGFR) changing from -1.36 ± 1.1 (pretreatment) to +0.22 ± 0.71 (at 6 months) mL/minute/1.73 m2/month (P = 0.135) after cell therapy. Additionally, intrarenal resistive index (P = 0.004) and shear wave velocity (P = 0.04) were significantly improved after cell therapy. No severe adverse events were reported. 

Our findings suggest that repetitive peripheral blood-derived autologous CD34+ cell transplantation into the renal arteries is safe, feasible, and may be effective for patients with progressive CKD. Renal function improvement was accompanied by intra-renal microcirculatory improvement. A largescale clinical trial is warranted to validate the efficacy of cell therapy. We are now performing next step clinical trial of this cell therapy by expanding the subjects with eGFR less than 60 mL/min/1.73m2, but not on hemodialysis (CKD stage G3a-G5). 

Kewords