NOVEL THERAPEUTIC APPROACH FOR SEVERE IgA NEPHROPATHY BY MP PULSE AND SVF/MSC

 

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https://storage.unitedwebnetwork.com/files/1099/cc5c61e6616c0992e86f80b4b8abdb62.pdf
NOVEL THERAPEUTIC APPROACH FOR SEVERE IgA NEPHROPATHY BY MP PULSE AND SVF/MSC

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Byoung-Soo
Cho
Byoung-Soo Cho koreakidney@daum.net Dr.Cho Nephrology Seoul Korea (Republic of) *
Sung-Min Jung jungsmdr@naver.com Dr.Cho Nephrology Seoul Korea (Republic of) -
Won-Hee Cho minimel12@daum.net Veterans Health Service Medical Center Nephrology Seoul Korea (Republic of) -
Hyun-Soon Lee hyunsoon@plaza.snu.ac.kr Korea Pathology Lab Pathology Seoul Korea (Republic of) -
Dae-Yong Kim ceo@n-biotek.com N-BIOTEK president Bucheon Korea (Republic of) -
Jun-Young Choi Uni0121@gmail.com JY plastic clinic plastic surgery Seoul Korea (Republic of) -
 
 
 
 
 
 
 
 
 

Up to date there is no specific treatment method for severe IgAN,but trying ARB,omega-3,MRA,complement inhibitos,budesonide,endothelin inhibitors,complement inhibitors,SGLT2 inhibitors etc but eventually fall into ESRD. Cell based therapy especially SVF(stromal vascular fraction)/MSC(mesenchymal stem cell) is an emerging field in intractable immune mediated disorders,however reports in nephrology fieldis are very rare.We firstly reported 2 years promising results in severe IgAN by MP pulse and SVF therapy(2015,ASN). We further analyzed longterm follow up results

We selected severe IgAN as two groups,first group : clinically severe showing  massive proteinuria more than 1,000mg/day. (GroupA), and second group : pathologically severe (stage IV/V by Lee's classification)(GroupB). We tried methylprednisolone (MP) pulse therapy followed by autologous SVF/MSC. Onew cycle of MP pulse is 20-30mg/kg/day for 3 consecutive days, we tried 3-17 cycles depends on the pathologic findings. Autologous SVF/MSC was obtained from abdominal fat.Mean cell count was 3x10(7)/injection(IV)

Three pts. were group A.Mean age 32 yrs.Mean initial eGFR before therapy was 85ml/min and 88 ml/min after therapy. Mean follow up period was 11.3 years. Eleven pts. were group B.Mean age 57 years.Mean initial eGFR before therapy were 26ml/min and 32ml/min after therapy. Mean follow up periods were 7.7 years.No pts.took dialysis even CKD stage 5 duiring 9 years follow up in one patient. Control patient who refused  MP and SVF therapy but ARB,started hemodialysis in 2.5 yrs. No significant side-effects were noted. Follow up renal biopsy showed disppearance of EDD,reduced mesangial proliferation,improved epithelial foot process fusion and disappearance of IgA deposition by IF microscopy in group A & B.

MP pulse therapy and autologous SVF/MSC have showed promising results without signicant side-effects  in severe IgAN. Although further longterm and large number studies are mandatory.

Kewords