肾脏疾病的再生治疗:解决相关医疗和经济问题的最接近和最快的策略。

Regenerative treatments for kidney diseases: The closest and fastest strategies to solving related medical and economic problems.

机构信息

Center for iPS Cell Research and Application (CiRA), Kyoto University, Kyoto, Japan.

出版信息

Artif Organs. 2021 May;45(5):447-453. doi: 10.1111/aor.13943. Epub 2021 Mar 25.

Abstract

Recent advances in developmental biology and stem cell biology have led to the increased availability of extrarenal stem cells, including mesenchymal/stromal stem cells (MSCs), renal stem or progenitor cells isolated from embryonic and adult kidneys, and kidney lineage cells or tissues generated from human pluripotent stem cells (hPSCs), such as human embryonic stem cells and human-induced pluripotent stem cells. Regenerative medicine strategies for kidney diseases are largely categorized into the transplantation of reconstructed kidney organs and cell therapies. Reconstruction is being attempted by hPSC-derived kidney lineage cells with various strategies, such as self-organization, interspecies blastocyst complementation, utilization of a xenogeneic organ niche, decellularization and repopulation, and 3D bioprinting. However, cell therapies using extrarenal stem cells, such as MSCs, and renal stem or progenitor cells derived from embryonic and adult kidneys or differentiated from hPSCs have been investigated in animal models of both acute kidney injury and chronic kidney disease. Indeed, multiple clinical trials using MSCs, bone marrow stem cells, and kidney-derived cells have already been carried out. This review summarizes the current status and future perspective of kidney regenerative medicine strategies and discusses the closest and fastest strategies to solving the medical and economic problems associated with kidney diseases.

摘要

近年来,发育生物学和干细胞生物学的进展使得更多的肾外干细胞得以应用,包括间充质/基质干细胞(MSCs)、从胚胎和成人肾脏中分离出来的肾干/祖细胞,以及从人类多能干细胞(hPSCs)如人类胚胎干细胞和人类诱导多能干细胞产生的肾系细胞或组织。肾脏疾病的再生医学策略主要分为重建肾脏器官的移植和细胞治疗。通过各种策略,如自我组织、种间胚泡互补、利用异种器官龛、去细胞化和再灌注以及 3D 生物打印,尝试用 hPSC 衍生的肾系细胞进行重建。然而,使用肾外干细胞(如 MSCs)和源自胚胎和成人肾脏的肾干/祖细胞或从 hPSCs 分化而来的细胞治疗已在急性肾损伤和慢性肾脏病的动物模型中进行了研究。事实上,已经进行了多项使用 MSCs、骨髓干细胞和肾源性细胞的临床试验。本综述总结了肾脏再生医学策略的现状和未来展望,并讨论了解决与肾脏疾病相关的医学和经济问题的最接近和最快的策略。

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