8 - Strategies for cell replacement for kidney failure

Abstract

At present, dialysis and renal allotransplantation are standard medical treatments. Although life-preserving, the former therapy replaces only a small fraction of normal kidney function and has considerable morbidity. The number of human organs available limits the latter therapy. Although it is certain that dialysis and renal transplantation will continue to be employed for the foreseeable future, it is likely that these modalities will eventually be supplanted by one or more alternatives currently under development that employ cell transplantation or the growing of a new kidney altogether (renal organogenesis). The use of exogenous renal cells or groups of renal cells for transplantation and organogenesis confers an array of therapeutic advantages relative to the transplantation of whole kidneys. Thus, renal cells can be infused or implanted at optimal therapeutic locations, including natural (renal) sites, immunoprivileged sites, or ectopic (nonrenal) sites; renal cells can be manipulated prior to transplantation to enhance their function or reduce their immunogenicity; renal cells can be banked and cryopreserved; and renal cells can be combined with different cell types in the same graft or with noncellular biomaterials. Sources for cell replacement can be autologous, allogeneic, or xenogeneic. Today, the work described is at the cutting edge of biomedicine, and many therapeutic concepts it embraces are novel and controversial. No doubt, during the coming decades the tenets of renal cellular therapy and organogenesis delineated herein will assume a place as a part of mainstream clinical practice.