by Arrigo Schieppati
The goal of creating a kidney in the laboratory is very ambitious and currently faces great obstacles, but the hope that concrete results will be achieved with the development of cell therapies to be used on a large scale
I have Berger’s glomerulonephritis discovered six years ago and I would have to remove my right kidney due to hydronephrosis; the other kidney is progressively losing its function. I inquired about the present and future treatment prospects for this terrible disease. Could you tell me at what stage research on stem cells is? These cells should on the one hand regenerate the kidney, on the other allow the transplant recipients to live without the need to resort to anti-rejection therapy.
Answered by Arrigo Schieppati, Clinical Research Center for Rare Diseases, Mario Negri Institute, Bergamo (VAI AL FORUM)
In many laboratories, in many parts of the world, researchers (including those of our Mario Negri laboratories) are studying the possibility of repairing or even reconstructing the kidney damaged by a disease with the administration of stem cells, in the hypothesis that these can assume the characteristics of the kidney cells. The recent discovery that cells of this nature already exist in the kidney reinforces the hope that we could find a way to induce kidney tissue to regenerate or repair itself, if only we could understand what types of cells they are and how they are can induce these repair and regeneration processes. These are extremely interesting researches, but also very complex ones, for various reasons. Researchers are already using in the laboratory – that is, in experimental animals – a certain type of stem cell (defined as induced pluripotent) to try to reproduce three-dimensional structures, which are similar to the nephron, the functional unit of the kidney, i.e. the most small structure capable of performing all the functions of the organ (in each kidney there are about a million).
Kidney created in the laboratory
The goal of this line of research is therefore to create new nephrons to replace those damaged by kidney disease. However, the difficulty of these studies lies first of all in the fact that the architecture – that is, the conformation – of the nephrons is very complex; furthermore they are not made up of a single type of cell, but of a set of cells that differ in anatomy and function, cells that must work in concert with each other. So the goal of creating a new kidney in the laboratory starting from stem cells is very ambitious, but at the moment it is facing major obstacles, which research is still facing. The possibility of repairing only the damaged parts of the kidney with stem cells is also fascinating, but equally difficult to implement: kidney diseases are many and different in terms of the structures and cells affected and therefore to develop treatments aimed at replacing specific damaged cells within a patient’s kidney is a major challenge. There are many basic research projects in this field and clinical studies are underway (ie in patients) to verify the possibility of treating kidney disease with stem cells; the hope that concrete results will be achieved with the development of cell therapies to be used on a large scale.
Stem them in transplants
As regards instead the use of stem cells in association with kidney transplantation to induce in the recipient that state of acceptance of the organ (to put it in appropriate terms: induce tolerance) which no longer requires the use of immunosuppressant drugs, there are ongoing studies that are in various stages of development; the very first results seem to indicate that the procedure of administration of stem cells in association with the transplant is safe for the recipient. Preliminary data indicate that this approach is effective in inducing varying degrees of tolerance, although further clinical trials are needed to demonstrate this convincingly. At the moment, therefore, the use of stem cells in transplantation is not a routine procedure.
June 24, 2023 (change June 24, 2023 | 06:35)
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