Department of Internal Medicine, 3101 Taubman Center, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI, 48109-0368, U.S.A..
Cytotechnology. 1998 Nov;28(1-3):1-8. doi: 10.1023/A:1008054723518.
Current therapy for acute renal failure continues to have an exceedingly high mortality rate, exceeding 50% even with dialytic or hemofiltrative support. Current renal replacement therapy in ARF only substitutes for filtration function of the kidney but not its cellular metabolic functions. Replacing these metabolic functions may optimize current therapy for this devastating disease process. In this regard, a renal tubule assist device (RAD) has been developed to be placed in an extracorporeal continuous hemoperfusion circuit in series with a hemofilter. The RAD consists of porcine renal proximal tubule cells grown as confluent monolayers in a multifiber bioreactor with a membrane surface area from 0.4 to 1.6 m2. The cells along the inner surface of the hollow fibers are immunoprotected from the patient's blood by the hollow fiber membrane. In vitro experiments demonstrate that this device possesses differentiated renal transport, metabolic and endocrinologic properties. These properties, in fact, are responsive to normal physiological regulatory parameters. In preliminary experiments in uremic dogs, this device has also been shown to tolerate a uremic environment while providing reabsorptive, metabolic, and endocrinologic activity. Pilot human trials of the RAD are anticipated within the next year to improve current renal replacement therapy in this devastating disease process.
目前治疗急性肾衰竭的方法仍然具有极高的死亡率，即使有透析或血液滤过支持，死亡率仍超过 50%。目前 ARF 的肾脏替代治疗仅替代肾脏的滤过功能，而不能替代其细胞代谢功能。替代这些代谢功能可能会优化这种破坏性疾病过程的当前治疗方法。在这方面，已经开发出一种肾小管辅助装置 (RAD)，可放置在体外连续血液灌流回路中，与血液滤器串联。RAD 由猪肾近端小管细胞组成，在多纤维生物反应器中培养为连续单层，膜表面积为 0.4 至 1.6 m2。这些细胞沿着中空纤维的内表面被中空纤维膜从患者的血液中免疫保护。体外实验表明，该装置具有分化的肾脏转运、代谢和内分泌功能。事实上，这些特性对正常生理调节参数有反应。在尿毒症犬的初步实验中，该装置还被证明可以在提供吸收、代谢和内分泌活性的同时耐受尿毒症环境。预计在未来一年内将进行 RAD 的人体初步试验，以改善这种破坏性疾病过程中的当前肾脏替代治疗。
