Kidney disease treatment
How Stem Cells Can Help Treat Kidney Disease ? Stem cell based therapies could offer an alternative to transplants when it comes to kidney disease. The demand for kidney transplants is increasing. The rise is high blood pressure and type II diabetes are contributing to higher rates of kidney disease.
About The Kidney
The kidneys are located towards the back of the body. They are roughly about 10cm above the hipbones and just below the ribcage. The kidneys are the body’s filtering units and they are responsible for maintaining a safe balance of fluid, minerals, salts and other substances in the blood. The kidneys produce urine to remove waste and harmful substances from the body. They also produce several hormones. These include erythropoietin (EPO), which acts on the bone marrow to increase the production of red blood cells, calcitriol (active Vitamin D3), which promotes the absorption and use of calcium and phosphate for healthy bones and teeth, and the enzyme renin, which is involved in monitoring and controlling blood pressure.
The key working component of the kidney is the nephron. The nephron is essentially the functional unit of the kidney. The best evidence so far for stem cells in the adult kidney suggests that they might be found in the urinary pole. Some studies have also suggested that stem cells may be found in other parts of the nephron.
The nephron is made up of the glomerulus, which is a dense network of capillaries that filters the blood, the Bowman capsule, which surrounds the glomerulus and captures the fluid that has been filtered out of the bloodstream and empties it into the tubules, the tubules which are tiny tubes lined with a single layer of specialized cells who job is mainly to reabsorb water and electrolytes (sodium, potassium, chloride and bicarbonate) into the blood before the remaining waste fluid leaves the body as urine.
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Most kidney diseases involve damage to the nephrons. These diseases can be acute or chronic. In acute kidney diseases there is a sudden drop in kidney function. This is usually caused by loss of large amounts of blood or an accident and is often short lived, though it can occasionally lead to lasting kidney damage. Chronic kidney disease (CKD) is defined as loss of a third or more of kidney function for at least three months. In chronic kidney disease function worsens over a number of years and the problem often goes undetected for a number of years because the effects are relatively mild. Some of the symptoms associated with CKD include headache, fatigue, high blood pressure, itching, fluid retention and shortness of breath.
Kidney disease can lead to kidney failure and this is where you have less than 10% kidney function. Once this happens, patients are required to have dialysis or a kidney transplant in order to stay alive. The risk of developing chronic kidney failure is increased by old age, diabetes, high blood pressure, obesity and smoking. There are at least 40 million people around the world that currently have a degree of chronic kidney disease and this puts them at risk of developing kidney failure. This figure increases yearly and there are not enough donors to provide transplants. This is why the development of new therapeutic options for treating chronic kidney disease is so important.
Kidney Stem Cells
Scientists are still debating over whether kidney stem cells exist in the human body and if they do, where they can be found and how they can identify them. Cells found in a number of places within the nephrons have been proposed as candidates for kidney stem cells. The most convincing evidence so far for the existence of kidney stem cells is the discovery of a group of cells at the urinary pole of the Bowman’s capsule of the nephron. These cells have some of the key features of stem cells and researchers have shown that they are responsible for the production of podocytes. Podocytes are specialized cells that are involved in the filtration work of the nephron and these cells need to be replaced continuously throughout our lifetime. Studies have also suggested that these proposed stem cells might also be able to generate a second type of specialized cell found in the nephron lining. These are called proximal tubular epithelial cells.
Other suggested locations for kidney stem cells include certain places in the tubules. As well as kidney stem cells, cells with some of the characteristics of mesenchymal stem cells have also been isolated from the kidney.
A number of different types of cells from the bone marrow have already been tested in animals and in clinical studies for the potential use in kidney disease. Mesenchymal stem cells (MSCs) are among the cells under investigation and these have shown the most promising results to date. Studies have suggested that MSCs may be able to enhance the intrinsic ability of the kidney to repair itself.
MSCs that are found in the bone marrow can differentiate to produce specialized bone, fat and cartilage cells. Researchers that are looking into the therapeutic effects of mesenchymal stem cells within the kidney have suggested that these cells may release proteins that can help kidney cells to grow, inhibit cell death and that they could also encourage the kidney’s own stem cells to repair kidney damage. Further research is needed to establish whether or not these ideas are correct and if so, how this information could be translated into a treatment for patients.
Cells that have some of the features of mesenchymal stem cells appear to exist in many other organs as well as the bone marrow. Cells with MSC-like features have recently been isolated from the kidneys. These so called Kidney mesenchymal stem cells are distinctly different from their bone marrow and heart counterparts. More research is needed to identify their precise role in normal kidney maintenance and to investigate their potential to enhance the kidney’s ability to regenerate and repair itself after damage.
Induced Pluripotent Stem Cells and Kidney Disease
Another type of stem cells that researchers are using in their kidney investigations is the induced pluripotent stem cell (iPSC). These stem cells are made by reprogramming adult, specialized cells of the body to act like embryonic stem cells. These cells have the ability to develop into any cell or tissue in the body. Scientists have been able to use iPSCs to produce kidney cells in a very early stage of development. These very early kidney cells resemble cells found in the embryo that will turn into the cells that eventually make up the kidney in foetal development. These cells could have the potential to make the glomerulus and tubules, which are the building blocks of the nephron. A lot of further research needs to be carried out before these types of cells can be used in patients to treat chronic kidney disease.
An alternative approach to organ replacement is also under investigation and this is something that may help kidney disease patients in the future. The use of organ scaffolds to produce whole, transplantable organs. Organ scaffolds are organs from which all the cells have been removed and what remains is the extracellular matrix. This is the part of the organ that supports its shape. The matrix can then be seeded with a patient’s own cells, which can be carefully nurtured to grow and multiple to re-cover the scaffold. By using the patient’s own cells, the complication of immune system rejection is drastically reduced. The challenge with this approach is identifying and obtaining the right types of cells to see the scaffold, especially in organs with complex structurs made up of many different cells. Induced pluripotent stem cells or the recently identified kidney mesenchymal stem cells could be useful candidate cells for seeding kidney organ scaffolds and experiments in rats have show that this approach is feasible.
Can Stem Cells Be Used To Treat Kidney Disease Today ?
As of yet, there are no stem cell treatments for kidney disease. The kidney is a very complex organ that consists of a large number of different types of cells. To make a new kidney in the laboratory, all these different cells would need to be produced in a different way and mixed together in the hope that they would eventually recreate a functional kidney. Kidney disease also comes in many different types with different cells being affected. Because of these treatments that aim to replace damaged cells within a patient’s kidney would need to supply different types of cells for different patients. Research on organ or cell replacement therapies is ongoing and this is the future goal.
Stem cells can benefit patients in other ways while this goal is being worked on. For example, stem cells can be used to help progress scientists’ understanding of the disease through studies on the development and behavior of kidney cells grown in large numbers in the laboratory. Stem cell research can also help scientists to use the body’s own repair mechanisms to find treatments for kidney disease. In acute kidney disease, the body can often repair kidney damage itself, but it is unable to do this well enough to tackle the progressive damage that occurs in chronic kidney failure. The recent identification of mesenchymal stem cell-like cells in the kidney may open up new possibilities for enhancing the body’s own capacity for regeneration and repair of damaged kidneys. Researchers are currently studying these possibilities and how these cells work. Researchers are also continuing to explore new ideas using emerging technologies in stem cell research such as reprogramming cells to change their behavior.
I have never had a more meaningful visit with a medical professional such as I had with you this morning. You knew exactly my condition, why I was how I was... You made me feel like there was hope.
Your kindness and thoughtfulness was most appreciated and I must say, you really made me laugh.
We are in Kissimmee just now and am managing to play golf without any pain. We were over in Kissimmee in October 2014 and played golf for the first time since I had the stem cell replacement and couldn't believe that I had no pain at all. This is great.
The stem cell procedure was done here in the office and they used my own fat, my own bone marrow, and my own blood. It was very safe and I didn’t have any worries. More people should look into (stem cell treatments), and there’s really nothing to be worried about.